Journal articles on the topic 'Information technology Cost effectiveness Evaluation'
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Huang, Duen-Huang, Hao-En Chueh, Huai-Te Huang, Hong-Fa Ho, and Chang-Yi Kao. "Method of Information Technology Enhanced Japanese Vocabulary Learning and Evaluation." International Journal of Emerging Technologies in Learning (iJET) 16, no. 12 (June 18, 2021): 233. http://dx.doi.org/10.3991/ijet.v16i12.22207.
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Japanese vocabulary proficiency is directly related to Japanese language proficiency, and the learning and evaluation of Japanese vocabulary is vital in Japanese learning. To evaluate the learners’ Japanese vocabulary proficiency, in this study, we propose an effective method for evaluating Japanese vocabulary and implement it into a system. To prove the evaluation ability of the proposed method and implemented system, we conducted an experiment involving 80 students from the Japanese Group of the department of applied foreign languages of a senior high school to investigate the effectiveness of the method and system. The results of this study confirmed that (1) the reliability and validity of the proposed Japanese vocabulary evaluation method and system are favorable; and (2) the correlation coefficient between the experimental results and the students’ academic performance is higher than 0.80. Theoretically, the multidimensional Japanese vocabulary quotient model proposed herein can be the basis for Japanese vocabulary detection. Practically, the low-cost and rapid Japanese vocabulary evaluation system developed is applicable to educational evaluation, whereas the technical evaluation method and system for Japanese vocabulary can improve the efficiency and effectiveness in evaluating the Japanese vocabulary of learners.
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Shearer, James, and Sarah Byford. "The basics of economic evaluation in mental healthcare." BJPsych Advances 21, no. 5 (September 2015): 345–53. http://dx.doi.org/10.1192/apt.bp.114.013003.
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SummaryEconomic evaluation involves the comparative analysis of the costs and consequences of alternative (different) treatment options. Economic evaluations provide decision makers with information about the relative value for money, or cost-effectiveness, of various treatment programmes. The relative cost-effectiveness of new interventions is a key consideration in health technology assessments by the UK's National Institute for Health and Care Excellence, and economic evaluations alongside randomised controlled trials are routinely requested by funders such as the National Institute for Health Research. This article outlines some of the key concepts and issues in the economic evaluation of mental healthcare.
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Hazel, Cynthia Afedi, Sheana Bull, Elizabeth Greenwell, Maya Bunik, Jini Puma, and Marcelo Perraillon. "Systematic review of cost-effectiveness analysis of behavior change communication apps: Assessment of key methods." DIGITAL HEALTH 7 (January 2021): 205520762110005. http://dx.doi.org/10.1177/20552076211000559.
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Objective Evidence backing the effectiveness of mobile health technology is growing, and behavior change communication applications (apps) are fast becoming a useful platform for behavioral health programs. However, data to support the cost-effectiveness of these interventions are limited. Suggestions for overcoming the low output of economic data include addressing the methodological challenges for conducting cost-effectiveness analysis of behavior change app programs. This study is a systematic review of cost-effectiveness analyses of behavior change communication apps and a documentation of the reported challenges for investigating their cost-effectiveness. Materials and methods Four academic databases: Medline (Ovid), CINAHL, EMBASE and Google Scholar, were searched. Eligibility criteria included original articles that use a cost-effectiveness evaluation method, published between 2008 and 2018, and in the English language. Results Out of the 60 potentially eligible studies, 6 used cost-effectiveness analysis method and met the inclusion criteria. Conclusion The evidence to support the cost-effectiveness of behavior change communication apps is insufficient, with all studies reporting significant study challenges for estimating program costs and outcomes. The main challenges included limited or lack of cost data, inappropriate cost measures, difficulty with identifying and quantifying app effectiveness, representing app effects as Quality-adjusted Life Years, and aggregating cost and effects into a single quantitative measure like Incremental Cost Effectiveness Ratio. These challenges highlight the need for comprehensive economic evaluation methods that balance app data quality issues with practical concerns. This would likely improve the usefulness of cost-effectiveness data for decisions on adoption, implementation, scalability, sustainability, and the benefits of broader healthcare investments.
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Wang, George, and Richard Macaulay. "VP07 Cost-Effectiveness Of HTA Fees." International Journal of Technology Assessment in Health Care 35, S1 (2019): 77. http://dx.doi.org/10.1017/s0266462319002873.
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IntroductionHealth technology assessment (HTA) bodies evaluate the clinical and/or economic impact of new therapies to inform public reimbursement decision-making. This research evaluates the value for money of current or proposed fees for HTA in countries with mandatory cost-effectiveness HTA bodies relative to their respective public drug expenditure.MethodsHTA appraisal fees were identified from publicly-available websites: National Institute for Health and Care Excellence (NICE), Canadian Agency for Drugs and Technologies in Health (CADTH), Institut National d'Excellence en Santé et Services Sociaux (INESSS), and Pharmaceutical Benefits Advisory Committee (PBAC). Annual national public drug expenditure (ANPDE) were sourced from the National Health Service England, Canadian Institute for Health Information, and the Pharmaceutical Benefit Scheme.ResultsNICE is proposing to charge GBP 126,000 (EUR 142,582) for a single technology or highly specialized technology appraisal, CADTH charges CAD 72,480 (EUR 48,576) for a Schedule A submission, INESSS charges CAD 38,921 (EUR 26,089) for the first evaluation of a new drug or new indication, and PBAC charges AUD 136,716 (EUR 87,576) for a Major Lodgment. The ANPDE in England: GBP 16 billion (EUR 18.1 billion), Canada: CAD 14.5 billion (EUR 9.7 billion), Quebec: CAD 4 billion (EUR 2.7 billion) and Australia: AUD 8.7 billion (EUR 5.6 billion). The appraisal cost to drug expenditure ratio for these countries/regions were: 126,984, 200,055, 102,772, and 63,636, respectively.ConclusionsHTA submissions in the United Kingdom, Canada and Australia require financial contributions from manufacturers. These contributions bear little relation to the market size and cumulatively exceed EUR 300,000 (assuming no resubmissions). By adopting charging/cost recovery models, HTA bodies are aiming to reinvest the proceeds to increase the efficiency and capacity of appraisals, expediting patient access. However, these fees may be burdensome, especially for SMEs with promising therapies for orphan/rare diseases, and they may thus have the potential to deter/delay their submissions.
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Gelijns, Annetine C., and Henk Rigter. "Health Care Technology Assessment in the Netherlands." International Journal of Technology Assessment in Health Care 6, no. 1 (January 1990): 157–63. http://dx.doi.org/10.1017/s0266462300009016.
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Our present-day health sectors are increasingly characterized by both rapid technological change and growing visibility of its considerable consequences in terms of the quality and costs of health care. Improved health care decision-making in such an environment requires adequate and timely information on the benefits, risks, and costs of health care technology. Whereas traditionally, technology assessment focused predominantly on evaluating efficacy and (short-term) safety in a more or less “controlled” environment, an interesting shift in emphasis is now occurring. There is a growing recognition that improved information is also needed on the health and economic outcomes of technology as used in everyday clinical practice, i.e., on its effectiveness, cost-effectiveness, and long-term safety in normal “uncontrolled” daily medical life. Moreover, because the treatment of particular clinical conditions (such as stable angina, gallstones, or prostatism) increasingly involves choices among alternative diagnostic and therapeutic options, these assessments should ideally provide effectiveness and cost-effectiveness information for all the various technological alternatives involved.
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Tinelli, Michela, Andrea Manfrin, Martin Knapp, Americo Cicchetti, and Andrea Mandelli. "VP164 Applying Health Technology Assessment To Pharmacy: The Italian-Medicine-Use-Review-Health Technology Assessment." International Journal of Technology Assessment in Health Care 33, S1 (2017): 223–24. http://dx.doi.org/10.1017/s0266462317004007.
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INTRODUCTION:There is a lack of Health-Technology-Assessment (HTA) tools in pharmacy practice and the collection of real-world-evidence (RWE) in community pharmacy to populate longer-term-disease-progression-modelling (1). This project is looking at the development and application of a novel Patient-Reported-Outcome- Measure (PROM) in community pharmacy that can enable: the evaluation of the quality of care delivered from the patient perspective in terms of economic impact, patient health outcomes and ‘utilities’; the collection of RWE and evaluate long-term effect of care; to provide different stakeholders with unique evidence-based information that help formulate health policies in community pharmacy that are safe, effective, patient-focused and cost-effective, balancing access to innovation and cost containment.METHODS:Evidence from the Italian-Medicine-Use-Review (I-MUR) trial (2) showed that the I-MUR intervention provided by community pharmacists to asthma patients is effective, cost-saving and cost-effective (3). The trial allowed to model a framework (I-MUR-HTA) that would enable to routinely deliver the intervention, but also collect and analyse PROM data on its clinical-effectiveness, quality-of-life and cost-effectiveness. I-MUR-HTA was discussed within three expert-panel discussions including policy-makers, commissioners, academics, healthcare-professionals and patient-representatives in Italy, United Kingdom and Europe. Current plan include testing the use of the tool in the real world environment.RESULTS:Evidence collected from the panel discussions confirmed that I-MUR-HTA evidence-based information is relevant to meet current National-Health-Care-System plans and this is what is needed to support the evaluation of innovative effective and cost-effective health policies and promote their implementation across nations. Current Italian law on pharmacy services provides the appropriate institutional framework to regulate the introduction of I-MUR-HTA across the territory. Its implementation is underway and a real-world pilot is planned to take place in Italy.CONCLUSIONS:I-MUR-HTA appears to be an innovative tool to promote active patient involvement into policy-decision-making and pharmacy-service.
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Lamrock, Felicity, Joanne O'Connor, Joy Leahy, Claire Gorry, Lesley Tilson, and Michael Barry. "OP97 Cost-effectiveness Model Appraisal Guidelines For Health Technology Assessments In Ireland." International Journal of Technology Assessment in Health Care 35, S1 (2019): 24–25. http://dx.doi.org/10.1017/s0266462319001478.
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IntroductionThe National Centre for Pharmacoeconomics (NCPE) assesses the cost-effectiveness of new drugs for which reimbursement by the healthcare payer, the Health Service Executive (HSE), is sought in Ireland. This research aims to create a systematic approach for the NCPE review group (RG) to assess each of the cost-effectiveness models submitted by the applicant by creating cost-effectiveness model appraisal guidelines.MethodsThe RG consists of clinical, statistical and health economic expertise. In order to systematically appraise the HTA submission, which includes a cost-effectiveness model, clear guidelines on how each of the members of the RG can work together are required. The current members of the RG in the NCPE were given a draft of the guidelines created by the primary author, and additional feedback and testing was performed using the expert experience of the team. A version of the guidelines was tested for its usefulness.ResultsThree checklists were created. The purpose of the first checklist is to evaluate if the cost-effectiveness model works correctly. The second checklist ensures that each of the assumptions included in the HTA dossier are the same as those included in the cost-effectiveness model. The final checklist validates the assumptions used in the cost-effectiveness model to ensure they are reasonable and appropriate for decision making. The final version of the checklists were validated by choosing cost-effectiveness models with known errors and/or discrepancies and testing that the issues were captured by the checklists.ConclusionsThese guidelines are not an exhaustive list of checks that should be performed, but are presented as the minimum requirements for consideration to be included with each RG assessment of the corresponding HTA submission. The guidelines will be constantly updated as the process evolves over time. The cost-effectiveness models should follow the National Health Information and Quality Authority (HIQA) Guidelines for the Economic Evaluation of Health Technologies in Ireland.
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Shields, Gemma E., Adrian Wells, Patrick Doherty, Anthony Heagerty, Deborah Buck, and Linda M. Davies. "Cost-effectiveness of cardiac rehabilitation: a systematic review." Heart 104, no. 17 (April 13, 2018): 1403–10. http://dx.doi.org/10.1136/heartjnl-2017-312809.
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Patients may be offered cardiac rehabilitation (CR), a supervised programme often including exercises, education and psychological care, following a cardiac event, with the aim of reducing morbidity and mortality. Cost-constrained healthcare systems require information about the best use of budget and resources to maximise patient benefit. We aimed to systematically review and critically appraise economic studies of CR and its components. In January 2016, validated electronic searches of the National Health Service Economic Evaluation Database (NHS EED), Health Technology Assessment, PsycINFO, MEDLINE and Embase databases were run to identify full economic evaluations published since 2001. Two levels of screening were used and explicit inclusion criteria were applied. Prespecified data extraction and critical appraisal were performed using the NHS EED handbook and Drummond checklist. The majority of studies concluded that CR was cost-effective versus no CR (incremental cost-effectiveness ratios (ICERs) ranged from $1065 to $71 755 per quality-adjusted life-year (QALY)). Evidence for specific interventions within CR was varied; psychological intervention ranged from dominant (cost saving and more effective) to $226 128 per QALY, telehealth ranged from dominant to $588 734 per QALY and while exercise was cost-effective across all relevant studies, results were subject to uncertainty. Key drivers of cost-effectiveness were risk of subsequent events and hospitalisation, hospitalisation and intervention costs, and utilities. This systematic review of studies evaluates the cost-effectiveness of CR in the modern era, providing a fresh evidence base for policy-makers. Evidence suggests that CR is cost-effective, especially with exercise as a component. However, research is needed to determine the most cost-effective design of CR.
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Riley, Philip, Anne-Marie Glenny, Helen V. Worthington, Elisabet Jacobsen, Clare Robertson, Justin Durham, Stephen Davies, Helen Petersen, and Dwayne Boyers. "Oral splints for patients with temporomandibular disorders or bruxism: a systematic review and economic evaluation." Health Technology Assessment 24, no. 7 (February 2020): 1–224. http://dx.doi.org/10.3310/hta24070.
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Background Splints are a non-invasive, reversible management option for temporomandibular disorders or bruxism. The clinical effectiveness and cost-effectiveness of splints remain uncertain. Objectives The objectives were to evaluate the clinical effectiveness and cost-effectiveness of splints for patients with temporomandibular disorders or bruxism. This evidence synthesis compared (1) all types of splint versus no/minimal treatment/control splints and (2) prefabricated versus custom-made splints, for the primary outcomes, which were pain (temporomandibular disorders) and tooth wear (bruxism). Review methods Four databases, including MEDLINE and EMBASE, were searched from inception until 1 October 2018 for randomised clinical trials. The searches were conducted on 1 October 2018. Cochrane review methods (including risk of bias) were used for the systematic review. Standardised mean differences were pooled for the primary outcome of pain, using random-effects models in temporomandibular disorder patients. A Markov cohort, state-transition model, populated using current pain and Characteristic Pain Intensity data, was used to estimate the incremental cost-effectiveness ratio for splints compared with no splint, from an NHS perspective over a lifetime horizon. A value-of-information analysis identified future research priorities. Results Fifty-two trials were included in the systematic review. The evidence identified was of very low quality with unclear reporting by temporomandibular disorder subtype. When all subtypes were pooled into one global temporomandibular disorder group, there was no evidence that splints reduced pain [standardised mean difference (at up to 3 months) –0.18, 95% confidence interval –0.42 to 0.06; substantial heterogeneity] when compared with no splints or a minimal intervention. There was no evidence that other outcomes, including temporomandibular joint noises, decreased mouth-opening, and quality of life, improved when using splints. Adverse events were generally not reported, but seemed infrequent when reported. The most plausible base-case incremental cost-effectiveness ratio was uncertain and driven by the lack of clinical effectiveness evidence. The cost-effectiveness acceptability curve showed splints becoming more cost-effective at a willingness-to-pay threshold of ≈£6000, but the probability never exceeded 60% at higher levels of willingness to pay. Results were sensitive to longer-term extrapolation assumptions. A value-of-information analysis indicated that further research is required. There were no studies measuring tooth wear in patients with bruxism. One small study looked at pain and found a reduction in the splint group [mean difference (0–10 scale) –2.01, 95% CI –1.40 to –2.62; very low-quality evidence]. As there was no evidence of a difference between splints and no splints, the second objective became irrelevant. Limitations There was a large variation in the diagnostic criteria, splint types and outcome measures used and reported. Sensitivity analyses based on these limitations did not indicate a reduction in pain. Conclusions The very low-quality evidence identified did not demonstrate that splints reduced pain in temporomandibular disorders as a group of conditions. There is insufficient evidence to determine whether or not splints reduce tooth wear in patients with bruxism. There remains substantial uncertainty surrounding the most plausible incremental cost-effectiveness ratio. Future work There is a need for well-conducted trials to determine the clinical effectiveness and cost-effectiveness of splints in patients with carefully diagnosed and subtyped temporomandibular disorders, and patients with bruxism, using agreed measures of pain and tooth wear. Study registration This study is registered as PROSPERO CRD42017068512. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 7. See the NIHR Journals Library website for further project information.
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Nikulchev, Evgeny, Dmitry Ilin, and Alexander Gusev. "Technology Stack Selection Model for Software Design of Digital Platforms." Mathematics 9, no. 4 (February 4, 2021): 308. http://dx.doi.org/10.3390/math9040308.
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The article is dedicated to the development of a mathematical model and methodology for evaluating the effectiveness of integrating information technology solutions into digital platforms using virtual simulation infrastructures. The task of selecting a stack of technologies is formulated as the task of selecting elements from sets of possible solutions. This allows us to develop a mathematically unified approach to evaluating the effectiveness of different solutions, such as choosing programming languages, choosing Database Management System (DBMS), choosing operating systems and data technologies, and choosing the frameworks used. Introduced technology compatibility operation and decomposition of the evaluation of the efficiency of the technology stack at the stages of the life cycle of the digital platform development allowed us to reduce the computational complexity of the formation of the technology stack. A methodology based on performance assessments for experimental research in a virtual software-configurable simulation environment has been proposed. The developed solution allows the evaluation of the performance of the digital platform before its final implementation, while reducing the cost of conducting an experiment to assess the characteristics of the digital platform. It is proposed to compare the characteristics of digital platform efficiency based on the use of fuzzy logic, providing the software developer with an intuitive tool to support decision-making on the inclusion of the solution in the technology stack.
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Moshi, Magdalena Ruth, Rebecca Tooher, and Tracy Merlin. "SUITABILITY OF CURRENT EVALUATION FRAMEWORKS FOR USE IN THE HEALTH TECHNOLOGY ASSESSMENT OF MOBILE MEDICAL APPLICATIONS: A SYSTEMATIC REVIEW." International Journal of Technology Assessment in Health Care 34, no. 5 (2018): 464–75. http://dx.doi.org/10.1017/s026646231800051x.
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Objectives:To identify and appraise existing evaluation frameworks for mobile medical applications (MMA) and determine their suitability for use in health technology assessment (HTA) of these technologies.Methods:Systematic searches were conducted of seven bibliographic databases to identify literature published between 2008 and 2016 on MMA evaluation frameworks. Frameworks were eligible if they were used to evaluate at least one of the HTA domains of effectiveness, safety, and/or cost and cost-effectiveness of an MMA. After inclusion, the frameworks were reviewed to determine the number and extent to which other elements of an HTA were addressed by the framework.Results:A total of forty-five frameworks were identified that assessed MMAs. All frameworks assessed whether the app was effective. Of the thirty-four frameworks that examined safety, only seven overtly evaluated potential harms from the MMA (e.g., the impact of inaccurate information). Only one framework explicitly considered a comparator. Technology specific domains were sporadically addressed.Conclusion:None of the evaluation frameworks could be used, unaltered, to guide the HTA of MMAs. To use these frameworks in HTA they would need to identify relevant comparators, improve assessments of harms and consider the ongoing effect of software updates on the safety and effectiveness of MMAs. Attention should also be paid to ethical issues, such as data privacy, and technology specific characteristics. Implications: Existing MMA evaluation frameworks are not suitable for use in HTA. Further research is needed before an MMA evaluation framework can be developed that will adequately inform policy makers.
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Ali, Omar, Anup Shrestha, Ashraf Jaradat, and Ahmad Al-Ahmad. "An Evaluation of Key Adoption Factors towards Using the Fog Technology." Big Data and Cognitive Computing 6, no. 3 (July 26, 2022): 81. http://dx.doi.org/10.3390/bdcc6030081.
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Fog technology is one of the recent improvements in cloud technology that is designed to reduce some of its drawbacks. Fog technology architecture is often widely distributed to minimize the time required for data processing and enable Internet of Things (IoT) innovations. The purpose of this paper is to evaluate the main factors that might influence the adoption of fog technology. This paper offers a combined framework that addresses fog technology adoption based on the technology adoption perspective, which has been comprehensively researched in the information systems discipline. The proposed integrated framework combines the technology acceptance model (TAM) and diffusion of innovation (DOI) theory to develop a holistic perspective on the adoption of fog technology. The factors that might affect the adoption of fog technology are analyzed from the results of an online survey in 43 different organizations across a wide range of industries. These factors are observed based on data collected from 216 participants, including professional IT staff and senior business executives. This analysis was conducted by using structural equation modeling (SEM). The research results identified nine factors with a statistically significant impact on the adoption of fog technology, and these factors included relative advantage, compatibility, awareness, cost-effectiveness, security, infrastructure, ease of use, usefulness, and location. The findings from this research offer insight to organizations looking to implement fog technology to enable IoT and tap into the digital transformation opportunities presented by this new digital economy.
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Regier, Dean A., Deirdre Weymann, Brandon Chan, Cheryl Ho, Howard John Lim, Stephen Yip, Rebekah Rittberg, et al. "Life-cycle health technology assessment for precision oncology." Journal of Clinical Oncology 40, no. 16_suppl (June 1, 2022): e18704-e18704. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.e18704.
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e18704 Background: Rapid advances in precision oncology challenge timely and sustainable reimbursement decisions. Life-cycle health technology assessment (LC-HTA) can enable conditional patient access to promising precision oncology innovations alongside evidence development. Our objective was to create a life-cycle evaluative framework, called PRecision oncology Evidence Development in Cancer Treatment (PREDiCT). Methods: Through an iterative, health system and stakeholder-informed approach, we designed our LC-HTA framework. Elements supporting data and evidence generation were subsequently implemented within British Columbia, Canada’s provincial cancer control system. Our development, refinement, and pilot implementation process included a structured literature review, multi-disciplinary international expert consultation, a formal gap assessment, and a series of pan-Canadian inter-disciplinary stakeholder workshops to refine framework elements. Results: We engaged n = 15 pan-Canadian and international stakeholders to co-develop the LC-HTA framework. Defining framework components include: (a) managed access that defines the time horizon and pricing conditions of real-world healthcare system trialing; (b) collection of core data elements required to enable economic evaluation of precision oncology using real world data; (c) externally leveraged real world data and evidence generation to determine comparative effectiveness, cost-effectiveness, and the value of conducting additional research; and (d) data interpretation updating decisions, including investment, continued evaluation, or disinvestment from managed access. Key to the success of early framework implementation is the expansion of infrastructure to enable routine collection and linkage of genomic sequencing and cancer treatment data, patient quality of life and clinical outcomes, as well as health resource use spanning the diagnostic, treatment, and follow up trajectory. Conclusions: Sustainable integration of precision oncology requires the design and implementation of learning healthcare systems (LHS) that integrate genomic data with other health information. LC-HTA moves beyond static estimates of clinical and cost-effectiveness to continuously generate evidence that reduces evidentiary uncertainty and supports life-cycle decisions. We are embarking on a PREDiCT pilot to implement the framework in real-time to demonstrate the ability of real-world data to support life cycle evaluation.
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Turner, A., J. Fyfe, P. Rickwood, and S. Mohr. "Evaluation of implemented Australian efficiency programs: results, techniques and insights." Water Supply 14, no. 6 (July 10, 2014): 1112–23. http://dx.doi.org/10.2166/ws.2014.065.
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Australia has invested heavily in water efficiency in recent years, mainly due to severe drought, and has implemented some of the largest efficiency programs in the world. Despite this there is little public information on actual savings achieved or the cost effectiveness of programs implemented. This paper draws together the limited publicly available evaluations from Australia, focusing on the residential sector. It describes some of the large-scale residential programs implemented such as home retrofits, showerhead exchanges, washing machine rebates, toilet retrofits and rainwater tank rebates. It identifies key savings evaluation techniques used including participant-control and regression analysis, and summarizes water savings results from evaluation studies conducted. It also discusses key learnings from both the evaluation techniques employed and the programs implemented. The paper will be of significant interest to water service providers looking for evidence of actual savings achieved and/or wanting to understand how to evaluate their own programs.
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Yusuf, Nadia, and Nisreen Al-Banawi. "The Impact Of Changing Technology: The Case Of E-Learning." Contemporary Issues in Education Research (CIER) 6, no. 2 (March 27, 2013): 173. http://dx.doi.org/10.19030/cier.v6i2.7726.
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For centuries, education has relied on classroom methods, but technology-enhanced learning can potentially bring about a revolution in learning, making high-quality, cost-effective education available to a greater number of people. The basic advantages of e-learning include anytime-anywhere access to learning, cost reductions, ability to reach larger markets, more effective learning with personalized instructions, and flexibility. For the full potential of e-learning to be realized, however, the content, services, and systems from different suppliers all need to work together. This paper provides an overview of the benefits and limitations of e-learning as well as its cost-effectiveness. The continual advances in information technology as well as software-based training and education are rapidly offering a cost-effective and flexible alternative to traditional face-to-face learning. With the introduction of e-learning, students are empowered to embark on active, independent learning. They can access course information and perform research with the help of this virtual space provided using the Internet. Consistency, fast deployment, and simple evaluation are all attractive features of e-learning, but the most compelling reason to consider the introduction of e-learning may be the significant reduction in costs associated with education. Once developed, the online guidance component can be used many times with minimal costs. Students can also go through the training process repeatedly to ensure maximum effective learning.
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Scott, Arthur G. "Analysis of the U.S. Geological Survey Streamgaging Network." Water Science and Technology 19, no. 9 (September 1, 1987): 31–42. http://dx.doi.org/10.2166/wst.1987.0064.
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This paper summarizes the results from the first 3 years of a 5-year cost-effectiveness study of the U.S. Geological Survey streamgaging network. The objective of the study is to define and document the most cost-effective means of furnishing streamflow information. In the first step of this study, data uses were identified for 3,493 continuous-record stations currently being operated in 32 States. In the second step, evaluation of alternative methods of providing streamflow information, flow-routing models, and regression models were developed for estimating daily flows at 251 stations of the 3,493 stations analyzed. In the third step of the analysis, relationships were developed between the accuracy of the streamflow records and the operating budget. The weighted standard error for all stations, with current operating procedures, was 19.9 percent. By altering field activities, as determined by the analyses, this could be reduced to 17.8 percent. The existing streamgaging networks in four Districts were further analyzed to determine the impacts that satellite telemetry would have on the cost effectiveness. Satellite telemetry was not found to be cost effective on the basis of hydrologic data collection alone, given present cost of equipment and operation.
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Pererva, Petro, and Stanislav Nazarenko. "Economic evaluation of outsourcing: information and logistics services." Marketing and Digital Technologies 5, no. 4 (December 19, 2021): 6–15. http://dx.doi.org/10.15276/mdt.5.4.2021.1.
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The aim of the article. The main purpose of the study is to develop scientific, methodological and practical provisions for the formation of organizational and economic dominants, which become one of the main factors in ensuring the rational logistics and information support of production activities of enterprises and organizations. Analyses results. Theoretical and methodological issues of outsourcing as an economic category are considered. A system of indicators has been developed, the use of which largely determines the value of the economic effect when using information and logistics technologies in the production and commercial activities of industrial enterprises. These include indicators of direct action (the effect of using outsourcing, which is directly related to a particular function or business process) and indicators of indirect action (the effect of using outsourcing is not directly related to this function). To calculate the factors of economic effect, which determines the feasibility and effectiveness of the use of outsourcing of logistics services and information technology, a method of synthesis of economic efficiency factors is proposed. This approach significantly expands the possibilities of economic evaluation of the rational use of outsourcing services in production and commercial activities and allows you to more accurately and objectively assess its benefits in the use of outsourcing services and information technology. The methodological approach to evaluating the effectiveness of outsourcing management information systems in real business enterprises is quite universal, as it takes into account the conceptual principles of outsourcing, on the one hand, and allows to adapt the structure of efficiency evaluation depending on the complexity and cost of work. technologies used in business. enterprise, goals and scope of outsourcing. Conclusions and directions for further research. The use of the proposed guidelines in the practice of production and commercial activities of industrial enterprises allows ensuring an important link between the processes of development, distribution and use of information and logistics technologies and their required quality. Studies conducted at enterprises in the Kharkiv industrial region showed that only three of the eight surveyed enterprises have economic grounds for the use of outsourcing. Other enterprises are more expedient from the economic point of view to carry out information (logistical) support of the activity by own forces. Based on this, we consider as a direction of further development and research to develop guidelines for detailing these indicators in order to identify their components, to which the outsourcing company needs to pay special attention.
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Abel, Lucy, Bethany Shinkins, Alison Smith, Andrew J. Sutton, Gurdeep S. Sagoo, Ijeoma Uchegbu, A. Joy Allen, et al. "Early Economic Evaluation of Diagnostic Technologies: Experiences of the NIHR Diagnostic Evidence Co-operatives." Medical Decision Making 39, no. 7 (September 26, 2019): 857–66. http://dx.doi.org/10.1177/0272989x19866415.
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Diagnostic tests are expensive and time-consuming to develop. Early economic evaluation using decision modeling can reduce commercial risk by providing early evidence on cost-effectiveness. The National Institute for Health Research Diagnostic Evidence Co-operatives (DECs) was established to catalyze evidence generation for diagnostic tests by collaborating with commercial developers; DEC researchers have consequently made extensive use of early modeling. The aim of this article is to summarize the experiences of the DECs using early modeling for diagnostics. We draw on 8 case studies to illustrate the methods, highlight methodological strengths and weaknesses particular to diagnostics, and provide advice. The case studies covered diagnosis, screening, and treatment stratification. Treatment effectiveness was a crucial determinant of cost-effectiveness in all cases, but robust evidence to inform this parameter was sparse. This risked limiting the usability of the results, although characterization of this uncertainty in turn highlighted the value of further evidence generation. Researchers evaluating early models must be aware of the importance of treatment effect evidence when reviewing the cost-effectiveness of diagnostics. Researchers planning to develop an early model of a test should also 1) consult widely with clinicians to ensure the model reflects real-world patient care; 2) develop comprehensive models that can be updated as the technology develops, rather than taking a “quick and dirty” approach that may risk producing misleading results; and 3) use flexible methods of reviewing evidence and evaluating model results, to fit the needs of multiple decision makers. Decision models can provide vital information for developers at an early stage, although limited evidence mean researchers should proceed with caution.
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Boodoo, Chris, Qi Zhang, Heather J. Ross, Ana Carolina Alba, Audrey Laporte, and Emily Seto. "Evaluation of a Heart Failure Telemonitoring Program Through a Microsimulation Model: Cost-Utility Analysis." Journal of Medical Internet Research 22, no. 10 (October 6, 2020): e18917. http://dx.doi.org/10.2196/18917.
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Background Heart failure (HF) is a major public health issue in Canada that is associated with high prevalence, morbidity, and mortality rates and high financial and social burdens. Telemonitoring (TM) has been shown to improve all-cause mortality and hospitalization rates in patients with HF. The Medly program is a TM intervention integrated as standard of care at a large Canadian academic hospital for ambulatory patients with HF that has been found to improve patient outcomes. However, the cost-effectiveness of the Medly program is yet to be determined. Objective This study aims to conduct a cost-utility analysis of the Medly program compared with the standard of care for HF in Ontario, Canada, from the perspective of the public health care payer. Methods Using a microsimulation model, individual patient data were simulated over a 25-year time horizon to compare the costs and quality-adjusted life years (QALYs) between the Medly program and standard care for patients with HF treated in the ambulatory care setting. Data were sourced from a Medly Program Evaluation study and literature to inform model parameters, such as Medly’s effectiveness in reducing mortality and hospitalizations, health care and intervention costs, and model transition probabilities. Scenario analyses were conducted in relation to HF severity and TM deployment models. One-way deterministic effectiveness analysis and probabilistic sensitivity analysis were performed to explore the impact on the results of uncertainty in model parameters. Results The Medly program was associated with an average total cost of Can $102,508 (US $77,626) per patient and total QALYs of 5.51 per patient compared with the average cost of Can $97,497 (US $73,831) and QALYs of 4.95 per patient in the Standard Care Group. This led to an incremental cost of Can $5011 (US $3794) and incremental QALY of 0.566, resulting in an incremental cost-effectiveness ratio of Can $8850 (US $6701)/QALY. Cost-effectiveness improved in relation to patients with advanced HF and with deployment models in which patients used their own equipment. Baseline and alternative scenarios consistently showed probabilities of cost-effectiveness greater than 85% at a willingness-to-pay threshold of Can $50,000 (US $37,718). Although the results showed some sensitivity to assumptions about effectiveness parameters, the intervention was found to remain cost-effective. Conclusions The Medly program for patients with HF is cost-effective compared with standard care using commonly reported willingness-to-pay thresholds. This study provides evidence for decision makers on the use of TM for HF, supports the use of a nurse-led model of TM that embeds clinically validated algorithms, and informs the use of economic modeling for future evaluations of early-stage health informatics technology.
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Roentgen, Uta R., Loek A. van der Heide, Ingrid E. H. Kremer, Huub Creemers, Merel A. Brehm, Jan T. Groothuis, Edith A. V. Hagedoren, Ramon Daniëls, and Silvia M. A. A. Evers. "Effectiveness and cost-effectiveness of an optimized process of providing assistive technology for impaired upper extremity function: Protocol of a prospective, quasi-experimental non-randomized study (OMARM)." Technology and Disability 33, no. 3 (August 17, 2021): 207–20. http://dx.doi.org/10.3233/tad-210335.
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BACKGROUND: Impaired upper extremity function due to muscle paresis or paralysis has a major impact on independent living and quality of life (QoL). Assistive technology (AT) for upper extremity function (i.e. dynamic arm supports and robotic arms) can increase a client’s independence. Previous studies revealed that clients often use AT not to their full potential, due to suboptimal provision of these devices in usual care. OBJECTIVE: To optimize the process of providing AT for impaired upper extremity function and to evaluate its (cost-) effectiveness compared with care as usual. METHODS: Development of a protocol to guide the AT provision process in an optimized way according to generic Dutch guidelines; a quasi-experimental study with non-randomized, consecutive inclusion of a control group (n= 48) receiving care as usual and of an intervention group (optimized provision process) (n= 48); and a cost-effectiveness and cost-utility analysis from societal perspective will be performed. The primary outcome is clients’ satisfaction with the AT and related services, measured with the Quebec User Evaluation of Satisfaction with AT (Dutch version; D-QUEST). Secondary outcomes comprise complaints of the upper extremity, restrictions in activities, QoL, medical consumption and societal cost. Measurements are taken at baseline and at 3, 6 and 9 months follow-up.
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Chong, Alberto, Marco Gonzalez-Navarro, Dean Karlan, and Martín Valdivia. "Do Information Technologies Improve Teenagers’ Sexual Education? Evidence from a Randomized Evaluation in Colombia." World Bank Economic Review 34, no. 2 (July 18, 2019): 371–92. http://dx.doi.org/10.1093/wber/lhy031.
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Abstract This study reports results from a randomized evaluation of a mandatory six-month Internet-based sexual education course implemented across public junior high schools in 21 Colombian cities. Six months after finishing the course, the study finds a 0.4 standard deviation improvement in knowledge, a 0.2 standard deviation improvement in attitudes, and a 55 percent increase in the likelihood of redeeming vouchers for condoms as a result of taking the course. The data provide no evidence of spillovers to control classrooms within treatment schools. However, the analysis provides compelling evidence that treatment effects are enhanced when a larger share of a student's friends also takes the course. The low cost of the online course along with the effectiveness the study documents suggests this technology is a viable alternative for improving sexual education in middle-income countries.
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Beks, Hannah, Olivia King, Renee Clapham, Laura Alston, Kristen Glenister, Carol McKinstry, Claire Quilliam, Ian Wellwood, Catherine Williams, and Anna Wong Shee. "Community Health Programs Delivered Through Information and Communications Technology in High-Income Countries: Scoping Review." Journal of Medical Internet Research 24, no. 3 (March 9, 2022): e26515. http://dx.doi.org/10.2196/26515.
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Background The COVID-19 pandemic has required widespread and rapid adoption of information and communications technology (ICT) platforms by health professionals. Transitioning health programs from face-to-face to remote delivery using ICT platforms has introduced new challenges. Objective The objective of this review is to scope for ICT-delivered health programs implemented within the community health setting in high-income countries and rapidly disseminate findings to health professionals. Methods The Joanna Briggs Institute’s scoping review methodology guided the review of the literature. Results The search retrieved 7110 unique citations. Each title and abstract was screened by at least two reviewers, resulting in 399 citations for full-text review. Of these 399 citations, 72 (18%) were included. An additional 27 citations were identified through reviewing the reference lists of the included studies, resulting in 99 citations. Citations examined 83 ICT-delivered programs from 19 high-income countries. Variations in program design, ICT platforms, research design, and outcomes were evident. Conclusions Included programs and research were heterogeneous, addressing prevalent chronic diseases. Evidence was retrieved for the effectiveness of nurse and allied health ICT-delivered programs. Findings indicated that outcomes for participants receiving ICT-delivered programs, when compared with participants receiving in-person programs, were either equivalent or better. Gaps included a paucity of co-designed programs, qualitative research around group programs, programs for patients and carers, and evaluation of cost-effectiveness. During COVID-19 and beyond, health professionals in the community health setting are encouraged to build on existing knowledge and address evidence gaps by developing and evaluating innovative ICT-delivered programs in collaboration with consumers and carers.
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Pickett, Karen, Emma Loveman, Neelam Kalita, Geoff K. Frampton, and Jeremy Jones. "Educational interventions to improve quality of life in people with chronic inflammatory skin diseases: systematic reviews of clinical effectiveness and cost-effectiveness." Health Technology Assessment 19, no. 86 (October 2015): 1–176. http://dx.doi.org/10.3310/hta19860.
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BackgroundInflammatory skin diseases include a broad range of disorders. For some people, these conditions lead to psychological comorbidities and reduced quality of life (QoL). Patient education is recommended in the management of these conditions and may improve QoL.ObjectivesTo assess the clinical effectiveness and cost-effectiveness of educational interventions to improve health-related quality of life (HRQoL) in people with chronic inflammatory skin diseases.Data sourcesTwelve electronic bibliographic databases, including The Cochrane Library, MEDLINE and EMBASE, were searched to July 2014. Bibliographies of retrieved papers were searched and an Advisory Group contacted.Review methodsSystematic reviews were conducted following standard methodologies. Clinical effectiveness studies were included if they were undertaken in people with a chronic inflammatory skin condition. Educational interventions that aimed to, or could, improve HRQoL were eligible. Studies were required to measure HRQoL, and other outcomes such as disease severity were also included. Randomised controlled trials (RCTs) or controlled clinical trials were eligible. For the review of cost-effectiveness, studies were eligible if they were full economic evaluations, cost–consequence or cost analyses.ResultsSeven RCTs were included in the review of clinical effectiveness. Two RCTs focused on children with eczema and their carers. Five RCTs were in adults. Of these, two were of people with psoriasis, one was of people with acne and two were of people with a range of conditions. There were few similarities in the interventions (e.g. the delivery mode, the topics covered, the duration of the education), which precluded any quantitative synthesis. Follow-up ranged from 4 weeks to 12 months, samples sizes were generally small and, overall, the study quality was poor. There appeared to be positive effects on HRQoL in participants with psoriasis in one trial, but no difference between groups in another trial in which participants had less severe psoriasis. Carers of children in one RCT of eczema showed improvement in HRQoL; however, in a RCT evaluating a website intervention there were no demonstrable effects on HRQoL. Neither the RCT in those adults with acne nor the RCT in those adults with mixed skin conditions demonstrated an effect on HRQoL. One RCT reported subgroups with atopic dermatitis or psoriasis and education was effective for psoriasis only. Other outcomes also showed mixed results. It is unclear how clinically meaningful any of the observed improvements are. Three studies of cost-effectiveness were included. The interventions, comparators and populations varied across the studies and, overall, the studies provided limited information on cost-effectiveness. The studies did provide detailed information on resources and costs that could be useful to inform a future cost-effectiveness evaluation in this area.LimitationsThe application of the inclusion criterion around whether the interventions were aimed at improving HRQoL or the inference that they could improve HRQoL was difficult as information was rarely reported.ConclusionsThere is uncertainty regarding whether educational interventions addressing issues that could improve HRQoL in people with chronic skin conditions are effective. Tentative conclusions about the best approach to delivering these kinds of interventions are that face-to-face, group, sessions may be beneficial; however, text messages may also be effective. Delivery over a period of time and by a multidisciplinary team may also be associated with positive outcomes. There is uncertainty over whether or not educational interventions are cost-effective.Study registrationThis study is registered as PROSPERO CRD42014007426.FundingThe National Institute for Health Research Health Technology Assessment programme.
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Khanal, Arjun, Punya Prasad Regmi, Gopal Bahadur KC, Dilli Bahadur KC, and Kishor Chandra Dahal. "Cost Effective Strategy to Disseminate IPM Technology: A Case of Banke and Surkhet District of Nepal." International Journal of Social Sciences and Management 8, no. 1 (January 25, 2021): 272–78. http://dx.doi.org/10.3126/ijssm.v8i1.34129.
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Integrated Pest Management (IPM) is a holistic approach in reducing damage caused by pests without harming the environment. A study on cost effectiveness strategy to disseminate IPM technology was conducted in the Banke and Surkhet districts of Nepal. For assessing the spread of information, farmers were asked a series of questions during the survey to determine knowledge of IPM and degree of IPM adoption. Using descriptive statistics and differences in means, analysis was done on relationships among access to information, IPM knowledge and adoption, and word-of-mouth diffusion of IPM techniques to neighboring farmers. For the evaluation of dissemination methods efficiency and to examine the cost for using the different dissemination methods of IPM technology followed by IPM IL project in Banke and Surkhet district, the cost measurements was focused only on the dissemination methods of IPM technology with a public cost such as mass media, agricultural officers, MPC, collection centre, FFS, CBFs, cooperatives, neighboring farmers, agro-vets and field days. When the number of farmers needing to receive training for one farmer to adopt IPM practices is known, and then that value can be multiplied by the cost per farmer trained which allows in providing the cost per farmer adopting the technology by transfer method. Capacity building in IPM technology development and dissemination in the study area was I/NGOs working in that area. Market Planning Committee of Banke and Surkhet district has played a vital role in disseminating IPM technology in cost effective and efficiently.
Int. J. Soc. Sc. Manage. Vol. 8, Issue-1: 272-276
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Tsatsaronis, G., L. Lin, T. Tawfik, and D. T. Gallaspy. "Exergoeconomic Evaluation of a KRW-Based IGCC Power Plant." Journal of Engineering for Gas Turbines and Power 116, no. 2 (April 1, 1994): 300–306. http://dx.doi.org/10.1115/1.2906820.
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In a study supported by the U. S. Department of Energy, several design configurations of Kellogg-Rust-Westinghouse (KRW)-based Integrated Gasification-Combined-Cycle (IGCC) power plants were developed. One of these configurations was analyzed from the exergoeconomic (thermoeconomic) viewpoint. This design configuration uses an air-blown KRW gasifier, hot gas cleanup, and two General Electric MS7001F advanced combustion turbines. Operation at three different gasification temperatures was considered. The detailed exergoeconomic evaluation identified several changes for improving the cost effectiveness of this IGCC design configuration. These changes include the following: decreasing the gasifier operating temperature, enhancing the high-pressure steam generation in the gasification island, improving the efficiency of the steam cycle, and redesigning the entire heat exchanger network. Based on the cost information supplied by the M. W. Kellogg Company, an attempt was made to calculate the economically optimal exergetic efficiency for some of the most important plant components.
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Fraser, Hannah, Daniel Gallacher, Felix Achana, Rachel Court, Sian Taylor-Phillips, Chidozie Nduka, Chris Stinton, Rebecca Willans, Paramjit Gill, and Hema Mistry. "Rapid antigen detection and molecular tests for group A streptococcal infections for acute sore throat: systematic reviews and economic evaluation." Health Technology Assessment 24, no. 31 (June 2020): 1–232. http://dx.doi.org/10.3310/hta24310.
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Background Sore throat is a common condition caused by an infection of the airway. Most cases are of a viral nature; however, a number of these infections may be caused by the group A Streptococcus bacterium. Most viral and bacterial sore throat infections resolve spontaneously within a few weeks. Point-of-care testing in primary care has been recognised as an emerging technology for aiding targeted antibiotic prescribing for sore throat in cases that do not spontaneously resolve. Objective Systematically review the evidence for 21 point-of-care tests for detecting group A Streptococcus bacteria and develop a de novo economic model to compare the cost-effectiveness of point-of-care tests alongside clinical scoring tools with the cost-effectiveness of clinical scoring tools alone for patients managed in primary care and hospital settings. Data sources Multiple electronic databases were searched from inception to March 2019. The following databases were searched in November and December 2018 and searches were updated in March 2019: MEDLINE [via OvidSP (Health First, Rockledge, FL, USA)], MEDLINE In-Process & Other Non-Indexed Citations (via OvidSP), MEDLINE Epub Ahead of Print (via OvidSP), MEDLINE Daily Update (via OvidSP), EMBASE (via OvidSP), Cochrane Database of Systematic Reviews [via Wiley Online Library (John Wiley & Sons, Inc., Hoboken, NJ, USA)], Cochrane Central Register of Controlled Trials (CENTRAL) (via Wiley Online Library), Database of Abstracts of Reviews of Effects (DARE) (via Centre for Reviews and Dissemination), Health Technology Assessment database (via the Centre for Reviews and Dissemination), Science Citation Index and Conference Proceedings [via the Web of Science™ (Clarivate Analytics, Philadelphia, PA, USA)] and the PROSPERO International Prospective Register of Systematic Reviews (via the Centre for Reviews and Dissemination). Review methods Eligible studies included those of people aged ≥ 5 years presenting with sore throat symptoms, studies comparing point-of-care testing with antibiotic-prescribing decisions, studies of test accuracy and studies of cost-effectiveness. Quality assessment of eligible studies was undertaken. Meta-analysis of sensitivity and specificity was carried out for tests with sufficient data. A decision tree model estimated costs and quality-adjusted life-years from an NHS and Personal Social Services perspective. Results The searches identified 38 studies of clinical effectiveness and three studies of cost-effectiveness. Twenty-six full-text articles and abstracts reported on the test accuracy of point-of-care tests and/or clinical scores with biological culture as a reference standard. In the population of interest (patients with Centor/McIsaac scores of ≥ 3 points or FeverPAIN scores of ≥ 4 points), point estimates were 0.829 to 0.946 for sensitivity and 0.849 to 0.991 for specificity. There was considerable heterogeneity, even for studies using the same point-of-care test, suggesting that is unlikely that any single study will have accurately captured a test’s true performance. There is some randomised controlled trial evidence to suggest that the use of rapid antigen detection tests may help to reduce antibiotic-prescribing rates. Sensitivity and specificity estimates for each test in each age group and care setting combination were obtained using meta-analyses where appropriate. Any apparent differences in test accuracy may not be attributable to the tests, and may have been caused by known differences in the studies, latent characteristics or chance. Fourteen of the 21 tests reviewed were included in the economic modelling, and these tests were not cost-effective within the current National Institute for Health and Care Excellence’s cost-effectiveness thresholds. Uncertainties in the cost-effectiveness estimates included model parameter inputs and assumptions that increase the cost of testing, and the penalty for antibiotic overprescriptions. Limitations No information was identified for the elderly population or pharmacy setting. It was not possible to identify which test is the most accurate owing to the paucity of evidence. Conclusions The systematic review and the cost-effectiveness models identified uncertainties around the adoption of point-of-care tests in primary and secondary care settings. Although sensitivity and specificity estimates are promising, we have little information to establish the most accurate point-of-care test. Further research is needed to understand the test accuracy of point-of-care tests in the proposed NHS pathway and in comparable settings and patient groups. Study registration The protocol of the review is registered as PROSPERO CRD42018118653. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 31. See the NIHR Journals Library website for further project information.
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Hill, Anne, and Deborah Theodoros. "Research into telehealth applications in speech-language pathology." Journal of Telemedicine and Telecare 8, no. 4 (August 1, 2002): 187–96. http://dx.doi.org/10.1258/135763302320272158.
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A literature review was conducted to investigate the extent to which telehealth has been researched within the domain of speech-language pathology and the outcomes of this research. A total of 13 studies were identified. Three early studies demonstrated that telehealth was feasible, although there was no discussion of the cost-effectiveness of this process in terms of patient outcomes. The majority of the subsequent studies indicated positive or encouraging outcomes resulting from telehealth. However, there were a number of shortcomings in the research, including a lack of cost benefit information, failure to evaluate the technology itself, an absence of studies of the educational and informational aspects of telehealth in relation to speech-language pathology, and the use of telehealth in a limited range of communication disorders. Future research into the application of telehealth to speech-language pathology services must adopt a scientific approach, and have a well defined development and evaluation framework that addresses the effectiveness of the technique, patient outcomes and satisfaction, and the cost benefit relationship.
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Omelyanovskiy, V. V., E. S. Saybel, T. P. Bezdenezhnykh, and G. R. Khachatryan. "The health technology assessment system in Australia." FARMAKOEKONOMIKA. Modern Pharmacoeconomic and Pharmacoepidemiology 12, no. 4 (February 18, 2020): 333–41. http://dx.doi.org/10.17749/2070-4909.2019.12.4.333-341.
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In Australia, the federal government is in charge of providing the health care to patients. The government agencies determine the list of reimbursable pharmaceuticals and medical services and also define the preferential categories of the population. The states and territories may have their own health care programs in addition to the federal ones. The Pharmaceutical Benefits Advisory Committee (PBAC) is responsible for the health technology assessment (HTA) and decides which technology is eligible for reimbursement by the federal budget. The drug evaluation process includes five stages: a review of general information about the product, assessment of its clinical efficacy, cost-effectiveness analysis, assessment of financial implications of including the drug in the reimbursement list, and consideration of any other factors that may influence the committee decision. In addition to the full reimbursement of pharmaceuticals, the committee may decide to provide funding based on a managed entry agreement.
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Duarte, Ana, Mark Corbett, Hollie Melton, Melissa Harden, Stephen Palmer, Marta Soares, and Mark Simmonds. "EarlyCDT Lung blood test for risk classification of solid pulmonary nodules: systematic review and economic evaluation." Health Technology Assessment 26, no. 49 (December 2022): 1–184. http://dx.doi.org/10.3310/ijfm4802.
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Background EarlyCDT Lung (Oncimmune Holdings plc, Nottingham, UK) is a blood test to assess malignancy risk in people with solid pulmonary nodules. It measures the presence of seven lung cancer-associated autoantibodies. Elevated levels of these autoantibodies may indicate malignant disease. The results of the test might be used to modify the risk of malignancy estimated by existing risk calculators, including the Brock and Herder models. Objectives The objectives were to determine the diagnostic accuracy, clinical effectiveness and cost-effectiveness of EarlyCDT Lung; and to develop a conceptual model and identify evidence requirements for a robust cost-effectiveness analysis. Data sources MEDLINE (including Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily and Ovid MEDLINE), EMBASE, Cochrane Central Register of Controlled Trials, Science Citation Index, EconLit, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment database, NHS Economic Evaluation Database (NHS EED) and the international Health Technology Assessment database were searched on 8 March 2021. Review methods A systematic review was performed of evidence on EarlyCDT Lung, including diagnostic accuracy, clinical effectiveness and cost-effectiveness. Study quality was assessed with the quality assessment of diagnostic accuracy studies-2 tool. Evidence on other components of the pulmonary nodule diagnostic pathway (computerised tomography surveillance, Brock risk, Herder risk, positron emission tomography–computerised tomography and biopsy) was also reviewed. When feasible, bivariate meta-analyses of diagnostic accuracy were performed. Clinical outcomes were synthesised narratively. A simulation study investigated the clinical impact of using EarlyCDT Lung. Additional reviews of cost-effectiveness studies evaluated (1) other diagnostic strategies for lung cancer and (2) screening approaches for lung cancer. A conceptual model was developed. Results A total of 47 clinical publications on EarlyCDT Lung were identified, but only five cohorts (695 patients) reported diagnostic accuracy data on patients with pulmonary nodules. All cohorts were small or at high risk of bias. EarlyCDT Lung on its own was found to have poor diagnostic accuracy, with a summary sensitivity of 20.2% (95% confidence interval 10.5% to 35.5%) and specificity of 92.2% (95% confidence interval 86.2% to 95.8%). This sensitivity was substantially lower than that estimated by the manufacturer (41.3%). No evidence on the clinical impact of EarlyCDT Lung was identified. The simulation study suggested that EarlyCDT Lung might potentially have some benefit when considering intermediate risk nodules (10–70% risk) after Herder risk analysis. Two cost-effectiveness studies on EarlyCDT Lung for pulmonary nodules were identified; none was considered suitable to inform the current decision problem. The conceptualisation process identified three core components for a future cost-effectiveness assessment of EarlyCDT Lung: (1) the features of the subpopulations and relevant heterogeneity, (2) the way EarlyCDT Lung test results affect subsequent clinical management decisions and (3) how changes in these decisions can affect outcomes. All reviewed studies linked earlier diagnosis to stage progression and stage shift to final outcomes, but evidence on these components was sparse. Limitations The evidence on EarlyCDT Lung among patients with pulmonary nodules was very limited, preventing meta-analyses and economic analyses. Conclusions The evidence on EarlyCDT Lung among patients with pulmonary nodules is insufficient to draw any firm conclusions as to its diagnostic accuracy or clinical or economic value. Future work Prospective cohort studies, in which EarlyCDT Lung is used among patients with identified pulmonary nodules, are required to support a future assessment of the clinical and economic value of this test. Studies should investigate the diagnostic accuracy and clinical impact of EarlyCDT Lung in combination with Brock and Herder risk assessments. A well-designed cost-effectiveness study is also required, integrating emerging relevant evidence with the recommendations in this report. Study registration This study is registered as PROSPERO CRD42021242248. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 49. See the NIHR Journals Library website for further project information.
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Elkafoury, Ahmed, Abdelazim Negm, Mohamed Hafez, Mahmoud Bady, and Teijiro Ichimurac. "Operational and environmental evaluation of traffic movement on urban streets using GPS floating-car data." International Journal of Engineering & Technology 4, no. 1 (December 24, 2014): 20. http://dx.doi.org/10.14419/ijet.v4i1.3794.
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Evaluating traffic networks is vital for the management of traffic systems. Nowadays, Global Positioning System (GPS) technology, by independent GPS devices or GPS enabled cellular phones, is properly used in most vehicles, especially on urban streets, due to its cost effectiveness, ease of use, and real-time services. With its ability to detect the time position of the floating car, GPS devices introduces a new prospective to gather vehicle information. Collected information can be utilized for traffic management and for Intelligent Transportation System (ITS) to deduce evaluation indicators, and to achieve suitable measures. This paper brings up a framework for using real-time data collected by GPS-floating car technique for evaluating traffic conditions on urban streets. It utilizes GPS data of time, longitude, latitude to estimate evaluation indicators of street segments. This incorporates operational evaluation of street segment by characterizing Level of Service and level of congestion, and incorporates environmental evaluation by estimating the road-side concentration of pollutants emitted by traffic. Framework formation has been described. Different models used within every step of the framework have been investigated. Including models used in GPS data sample analysis, through models used to identify of street segments, and finally models used for street segments evaluation.
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Kostyuk, Alexander, Alexandr Kostyuk, and Amangali Akanov. "PP023 Applying Oncology Patient Registries As A Health Technology Assessment Tool." International Journal of Technology Assessment in Health Care 33, S1 (2017): 80. http://dx.doi.org/10.1017/s0266462317002148.
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INTRODUCTION:The limited healthcare resources have to be invested efficiently; Health Technology Assessment (HTA) is applied ever more often in many health care systems for “rational decision-making”. The oncology patient registries (OPR) track the eligibility of patients and the complete flow of treatments, guaranteeing appropriateness in use of pharmaceutical products, according to approved indications.METHODS:Normative legal acts and other regulatory documents in the field of oncology medical and pharmaceutical activity, include content and maintenance oncology registries. The system, process and information analysis, direct observation, comparative analysis, logical modelling, sociological methods (surveys and expert opinions) are applied.RESULTS:A temporary coverage/funding of oncology drugs often requires additional collection of data on safety, effectiveness, cost-effectiveness, and the appropriate use of the drug. Many of the oncology drugs show little or marginal effectiveness at time of approval and reimbursement agencies demand further data before deciding whether to cover the new drug. Pragmatic clinical trials, patient access schemes and standard data requirements on patient relevant outcomes in OPR are some of the approaches to generate further evidence and to fill the gap between knowledge on efficacy at time of approval and demanded knowledge on effectiveness for coverage decisions. For each monitored drug, patients eligible for treatment are registered in the specific therapeutic indication dynamic monitoring database to collect epidemiologic and clinical data, including data on the safety profile, and ex-post information missing at first evaluation stage.CONCLUSIONS:OPR provide a detailed view of the morbidity, mortality and resource utilization associated with an oncologies diseases entity. This data is of prime importance in coming to decisions on coverage of a drug or treatment. The collation of information is also quick and efficient owing to better methods of data management. OPR of Kazakhstan are equipped with sophisticated data processing software and technologies.
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Thurgar, Elizabeth, Samantha Barton, Charlotta Karner, and Steven J. Edwards. "Clinical effectiveness and cost-effectiveness of interventions for the treatment of anogenital warts: systematic review and economic evaluation." Health Technology Assessment 20, no. 24 (March 2016): 1–486. http://dx.doi.org/10.3310/hta20240.
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BackgroundTypically occurring on the external genitalia, anogenital warts (AGWs) are benign epithelial skin lesions caused by human papillomavirus infection. AGWs are usually painless but can be unsightly and physically uncomfortable, and affected people might experience psychological distress. The evidence base on the clinical effectiveness and cost-effectiveness of treatments for AGWs is limited.ObjectivesTo systematically review the evidence on the clinical effectiveness of medical and surgical treatments for AGWs and to develop an economic model to estimate the cost-effectiveness of the treatments.Data sourcesElectronic databases (MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, The Cochrane Library databases and Web of Science) were searched from inception (or January 2000 for Web of Science) to September 2014. Bibliographies of relevant systematic reviews were hand-searched to identify potentially relevant studies. The World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov were searched for ongoing and planned studies.Review methodsA systematic review of the clinical effectiveness literature was carried out according to standard methods and a mixed-treatment comparison (MTC) undertaken. The model implemented for each outcome was that with the lowest deviance information criterion. A de novo economic model was developed to assess cost-effectiveness from the perspective of the UK NHS. The model structure was informed through a systematic review of the economic literature and in consultation with clinical experts. Effectiveness data were obtained from the MTC. Costs were obtained from the literature and standard UK sources.ResultsOf 4232 titles and abstracts screened for inclusion in the review of clinical effectiveness, 60 randomised controlled trials (RCTs) evaluating 19 interventions were included. Analysis by MTC indicated that ablative techniques were typically more effective than topical interventions at completely clearing AGWs at the end of treatment. Podophyllotoxin 0.5% solution (Condyline®, Takeda Pharmaceutical Company Ltd; Warticon®solution, Stiefel Laboratories Ltd) was found to be the most effective topical treatment evaluated. Networks for other outcomes included fewer treatments, which restrict conclusions on the comparative effectiveness of interventions. In total, 84 treatment strategies were assessed using the economic model. Podophyllotoxin 0.5% solution first line followed by carbon dioxide (CO2) laser therapy second line if AGWs did not clear was most likely to be considered a cost-effective use of resources at a willingness to pay of £20,000–30,000 per additional quality-adjusted life-year gained. The result was robust to most sensitivity analyses conducted.LimitationsLimited reporting in identified studies of baseline characteristics for the enrolled population generates uncertainty around the comparability of the study populations and therefore the generalisability of the results to clinical practice. Subgroup analyses were planned based on type, number and size of AGWs, all of which are factors thought to influence treatment effect. Lack of data on clinical effectiveness based on these characteristics precluded analysis of the differential effects of treatments in the subgroups of interest. Despite identification of 60 studies, most comparisons in the MTC are informed by only one RCT. Additionally, lack of head-to-head RCTs comparing key treatments, together with minimal reporting of results in some studies, precluded comprehensive analysis of all treatments for AGWs.ConclusionsThe results generated by the MTC are in agreement with consensus opinion that ablative techniques are clinically more effective at completely clearing AGWs after treatment. However, the evidence base informing the MTC is limited. A head-to-head RCT that evaluates the comparative effectiveness of interventions used in clinical practice would help to discern the potential advantages and disadvantages of the individual treatments. The results of the economic analysis suggest that podophyllotoxin 0.5% solution is likely to represent a cost-effective first-line treatment option. More expensive effective treatments, such as CO2laser therapy or surgery, may represent cost-effective second-line treatment options. No treatment and podophyllin are unlikely to be considered cost-effective treatment options. There is uncertainty around the cost-effectiveness of treatment with imiquimod, trichloroacetic acid and cryotherapy.Study registrationThis study is registered as PROSPERO CRD42013005457.FundingThe National Institute for Health Research Health Technology Assessment programme.
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Bounthavong, Mark, Larry D. Pruitt, Derek J. Smolenski, Gregory A. Gahm, Aasthaa Bansal, and Ryan N. Hansen. "Economic evaluation of home-based telebehavioural health care compared to in-person treatment delivery for depression." Journal of Telemedicine and Telecare 24, no. 2 (November 12, 2016): 84–92. http://dx.doi.org/10.1177/1357633x16678147.
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Introduction Home-based telebehavioural healthcare improves access to mental health care for patients restricted by travel burden. However, there is limited evidence assessing the economic value of home-based telebehavioural health care compared to in-person care. We sought to compare the economic impact of home-based telebehavioural health care and in-person care for depression among current and former US service members. Methods We performed trial-based cost-minimisation and cost-utility analyses to assess the economic impact of home-based telebehavioural health care versus in-person behavioural care for depression. Our analyses focused on the payer perspective (Department of Defense and Department of Veterans Affairs) at three months. We also performed a scenario analysis where all patients possessed video-conferencing technology that was approved by these agencies. The cost-utility analysis evaluated the impact of different depression categories on the incremental cost-effectiveness ratio. One-way and probabilistic sensitivity analyses were performed to test the robustness of the model assumptions. Results In the base case analysis the total direct cost of home-based telebehavioural health care was higher than in-person care (US$71,974 versus US$20,322). Assuming that patients possessed government-approved video-conferencing technology, home-based telebehavioural health care was less costly compared to in-person care (US$19,177 versus US$20,322). In one-way sensitivity analyses, the proportion of patients possessing personal computers was a major driver of direct costs. In the cost-utility analysis, home-based telebehavioural health care was dominant when patients possessed video-conferencing technology. Results from probabilistic sensitivity analyses did not differ substantially from base case results. Discussion Home-based telebehavioural health care is dependent on the cost of supplying video-conferencing technology to patients but offers the opportunity to increase access to care. Health-care policies centred on implementation of home-based telebehavioural health care should ensure that these technologies are able to be successfully deployed on patients’ existing technology.
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Wortman, Paul M., and William H. Yeaton. "Using Research Synthesis in Medical Technology Assessment." International Journal of Technology Assessment in Health Care 3, no. 4 (October 1987): 509–22. http://dx.doi.org/10.1017/s0266462300011144.
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AbstractThis article describes the use of research synthesis procedures (e.g., meta-analysis) in evaluating medical technologies. The synthesis process involves retrieval, extraction, and analysis of pertinent information from a set of research studies. There are several advantages of research synthesis: determining overall effectiveness, explaining seemingly contradictory findings, providing a standard measure of effect, and increasing statistical power. In addition, such syntheses provide timely results that can assist various policy decisions such as initiating clinical trials at NIH, reimbursement at HCFA, and answering NIH consensus conference questions. The authors' synthesis of the research literature on coronary artery bypass graft surgery (CABGS) illustrates how this method can address the various elements of a technology assessment such as safety, efficacy, and cost-effectiveness. The paper concludes by noting how research synthesis can be particularly advantageous in assessing technologies that are rapidly evolving (e.g., lytic agents for acute myocardial infarction).
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Chen, Yingyao, Xu Qian, Jun Li, Jie Zhang, Annie Chu, and Stuart O. Schweitzer. "Cost-effectiveness analysis of prenatal diagnosis intervention for Down's syndrome in China." International Journal of Technology Assessment in Health Care 23, no. 1 (January 2007): 138–45. http://dx.doi.org/10.1017/s0266462307051689.
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Objectives: The cost-effectiveness of prenatal diagnosis intervention for Down's syndrome (DS) in China was assessed and evidence-based information for policy makers and providers is presented.Methods: Based on field surveys in four selected cities in China and a literature review, the economic evaluation of prenatal diagnosis for DS from a societal perspective is conducted by cost-effectiveness analysis.Results: In current clinical practice, for a cohort of 10,000 pregnant women, the strategy that delivers karyotyping by chorionic villus sampling (CVS) or amniocentesis (AC) only to those pregnant women 35 years of age and older (maternal age screening strategy) can detect .67 DS births. The strategy that offers the diagnostic test after maternal serum screening with α-fetoprotein and human chorionic gonadotrophin (maternal serum screening strategy) can detect 1.41 DS births. The cost per prevented DS birth by the maternal age screening strategy and maternal serum screening strategy is US$13,091 and US$56,048, respectively. Sensitivity analysis shows that the maternal serum screening strategy can be cost-effective if uptake rate of CVS or AC for patients with positive serum tests increase while the cost of serum screening decreases.Conclusions: Although, in general, serum screening has been found to be more cost-effective than maternal age screening, this appears not to be the case in China. The reasons appear to be low uptake rate of the maternal serum strategy, low uptake rate of CVS or AC, and the high price of serum screening. Our findings are that health system factors concerning technology utilization are important determinants of the technology's efficiency.
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Luo, Xueyan, Wei Xu, Wai-Kit Ming, Xinchan Jiang, Quan Yuan, Han Lai, Chunji Huang, and Xiaoni Zhong. "Cost-Effectiveness of Mobile Health–Based Integrated Care for Atrial Fibrillation: Model Development and Data Analysis." Journal of Medical Internet Research 24, no. 4 (April 19, 2022): e29408. http://dx.doi.org/10.2196/29408.
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Background Mobile health (mHealth) technology is increasingly used in disease management. Using mHealth tools to integrate and streamline care has improved clinical outcomes of patients with atrial fibrillation (AF). Objective The aim of this study was to investigate the potential clinical and health economic outcomes of mHealth-based integrated care for AF from the perspective of a public health care provider in China. Methods A Markov model was designed to compare outcomes of mHealth-based care and usual care in a hypothetical cohort of patients with AF in China. The time horizon was 30 years with monthly cycles. Model outcomes measured were direct medical cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed to examine the robustness of the base-case results. Results In the base-case analysis, mHealth-based care gained higher QALYs of 0.0730 with an incurred cost of US $1090. Using US $33,438 per QALY (three times the gross domestic product) as the willingness-to-pay threshold, mHealth-based care was cost-effective, with an ICER of US $14,936 per QALY. In one-way sensitivity analysis, no influential factor with a threshold value was identified. In probabilistic sensitivity analysis, mHealth-based care was accepted as cost-effective in 92.33% of 10,000 iterations. Conclusions This study assessed the expected cost-effectiveness of applying mHealth-based integrated care for AF according to a model-based health economic evaluation. The exploration suggested the potential cost-effective use of mHealth apps in streamlining and integrating care via the Atrial fibrillation Better Care (ABC) pathway for AF in China. Future economic evaluation alongside randomized clinical trials is highly warranted to verify the suggestion and investigate affecting factors such as geographical variations in patient characteristics, identification of subgroups, and constraints on local implementation.
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Haasova, Marcela, Tristan Snowsill, Tracey Jones-Hughes, Louise Crathorne, Chris Cooper, Jo Varley-Campbell, Ruben Mujica-Mota, et al. "Immunosuppressive therapy for kidney transplantation in children and adolescents: systematic review and economic evaluation." Health Technology Assessment 20, no. 61 (August 2016): 1–324. http://dx.doi.org/10.3310/hta20610.
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BackgroundEnd-stage renal disease is a long-term irreversible decline in kidney function requiring kidney transplantation, haemodialysis or peritoneal dialysis. The preferred option is kidney transplantation followed by induction and maintenance immunosuppressive therapy to reduce the risk of kidney rejection and prolong graft survival.ObjectivesTo systematically review and update the evidence for the clinical effectiveness and cost-effectiveness of basiliximab (BAS) (Simulect,®Novartis Pharmaceuticals) and rabbit antihuman thymocyte immunoglobulin (Thymoglobuline,®Sanofi) as induction therapy and immediate-release tacrolimus [Adoport®(Sandoz); Capexion®(Mylan); Modigraf®(Astellas Pharma); Perixis®(Accord Healthcare); Prograf®(Astellas Pharma); Tacni®(Teva); Vivadex®(Dexcel Pharma)], prolonged-release tacrolimus (Advagraf,®Astellas Pharma); belatacept (BEL) (Nulojix,®Bristol-Myers Squibb), mycophenolate mofetil (MMF) [Arzip®(Zentiva), CellCept®(Roche Products), Myfenax®(Teva), generic MMF is manufactured by Accord Healthcare, Actavis, Arrow Pharmaceuticals, Dr Reddy’s Laboratories, Mylan, Sandoz and Wockhardt], mycophenolate sodium, sirolimus (Rapamune,®Pfizer) and everolimus (Certican,®Novartis Pharmaceuticals) as maintenance therapy in children and adolescents undergoing renal transplantation.Data sourcesClinical effectiveness searches were conducted to 7 January 2015 in MEDLINE (via Ovid), EMBASE (via Ovid), Cochrane Central Register of Controlled Trials (via Wiley Online Library) and Web of Science [via Institute for Scientific Information (ISI)], Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Health Technology Assessment (HTA) (The Cochrane Library via Wiley Online Library) and Health Management Information Consortium (via Ovid). Cost-effectiveness searches were conducted to 15 January 2015 using a costs or economic literature search filter in MEDLINE (via Ovid), EMBASE (via Ovid), NHS Economic Evaluation Databases (via Wiley Online Library), Web of Science (via ISI), Health Economic Evaluations Database (via Wiley Online Library) and EconLit (via EBSCOhost).Review methodsTitles and abstracts were screened according to predefined inclusion criteria, as were full texts of identified studies. Included studies were extracted and quality appraised. Data were meta-analysed when appropriate. A new discrete time state transition economic model (semi-Markov) was developed; graft function, and incidences of acute rejection and new-onset diabetes mellitus were used to extrapolate graft survival. Recipients were assumed to be in one of three health states: functioning graft, graft loss or death.ResultsThree randomised controlled trials (RCTs) and four non-RCTs were included. The RCTs only evaluated BAS and tacrolimus (TAC). No statistically significant differences in key outcomes were found between BAS and placebo/no induction. Statistically significantly higher graft function (p < 0.01) and less biopsy-proven acute rejection (odds ratio 0.29, 95% confidence interval 0.15 to 0.57) was found between TAC and ciclosporin (CSA). Only one cost-effectiveness study was identified, which informed NICE guidance TA99. BAS [with TAC and azathioprine (AZA)] was predicted to be cost-effective at £20,000–30,000 per quality-adjusted life year (QALY) versus no induction (BAS was dominant). BAS (with CSA and MMF) was not predicted to be cost-effective at £20,000–30,000 per QALY versus no induction (BAS was dominated). TAC (with AZA) was predicted to be cost-effective at £20,000–30,000 per QALY versus CSA (TAC was dominant). A model based on adult evidence suggests that at a cost-effectiveness threshold of £20,000–30,000 per QALY, BAS and TAC are cost-effective in all considered combinations; MMF was also cost-effective with CSA but not TAC.LimitationsThe RCT evidence is very limited; analyses comparing all interventions need to rely on adult evidence.ConclusionsTAC is likely to be cost-effective (vs. CSA, in combination with AZA) at £20,000–30,000 per QALY. Analysis based on one RCT found BAS to be dominant, but analysis based on another RCT found BAS to be dominated. BAS plus TAC and AZA was predicted to be cost-effective at £20,000–30,000 per QALY when all regimens were compared using extrapolated adult evidence. High-quality primary effectiveness research is needed. The UK Renal Registry could form the basis for a prospective primary study.Study registrationThis study is registered as PROSPERO CRD42014013544.FundingThe National Institute for Health Research HTA programme.
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León-Salas, Beatriz, Ana Toledo-Chávarri, Yolanda Ramallo-Fariña, Claudia Morales-Manrique, Francisco Rivas-Ruiz, and María M. Trujillo-Martín. "PP228 Strategy For Including Information On The Research Priorities Of Patients And Experts In Health Technology Assessment Reports." International Journal of Technology Assessment in Health Care 37, S1 (December 2021): 29. http://dx.doi.org/10.1017/s0266462321001379.
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IntroductionThe process of health technology assessment (HTA) is an opportunity to identify gaps in the existing knowledge on the technology assessed. In January 2020, the Evaluation Unit of the Canary Islands Health Service, belonging to the Spanish Network of Agencies for Assessing National Health System Technologies and Performance, started a structured strategy to include in its HTA reports information on research priorities for the assessed technologies from the perspective of patients, clinicians, and researchers. The aim of this poster is to explain the methodology behind this strategy.MethodsThe following three-step process was proposed: (i)Identify the knowledge gaps regarding the technology from systematic reviews on effectiveness, safety, and cost effectiveness, in addition to ethical, patient, social, legal, and organizational aspects analyzed for the HTA report;(ii)Search for specific studies on research needs regarding the technology on the websites of specialized initiatives such as the Core Outcome Measures in Effectiveness Trials (COMET) and the James Lind Alliance; and(iiii)If no needs are identified in the previous two steps, consult a group of clinicians or researchers and patients related to the technology being assessed with two online survey rounds using the Delphi method. The first round identifies the research needs and the second round prioritizes the identified needs.ResultsSince the methodology to identify future research needs during a HTA process was designed, it has been used in three HTA reports during 2020 with satisfactory results. Only one of the three reports required a Delphi study.ConclusionsThe proposed strategy provides a comprehensive list of knowledge gaps on health technologies that need to be addressed in the near future from the point of view of patients, clinicians, and researchers.
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Ferraro, Simona, Elia Mario Biganzoli, Silvana Castaldi, and Mario Plebani. "Health Technology Assessment to assess value of biomarkers in the decision-making process." Clinical Chemistry and Laboratory Medicine (CCLM) 60, no. 5 (March 3, 2022): 647–54. http://dx.doi.org/10.1515/cclm-2021-1291.
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Abstract Clinical practice guidelines (CPGs) on screening, surveillance, and treatment of several diseases recommend the selective use of biomarkers with central role in clinical decision-making and move towards including patients in this process. To this aim we will clarify the multidisciplinary interactions required to properly measure the cost-effectiveness of biomarkers with regard to the risk-benefit of the patients and how Health Technology Assessment (HTA) approach may assess value of biomarkers integrated within the decision-making process. HTA through the interaction of different skills provides high-quality research information on the effectiveness, costs, and impact of health technologies, including biomarkers. The biostatistical methodology is relevant to HTA but only meta-analysis is covered in depth, whereas proper approaches are needed to estimate the benefit-risk balance ratio. Several biomarkers underwent HTA evaluation and the final reports have pragmatically addressed: 1) a redesign of the screening based on biomarker; 2) a de-implementation/replacement of the test in clinical practice; 3) a selection of biomarkers with potential predictive ability and prognostic value; and 4) a stronger monitoring of the appropriateness of test request. The COVID-19 pandemic has disclosed the need to create a robust and sustainable system to urgently deal with global health concerns and the HTA methodology enables rapid cost-effective implementation of diagnostic tests allowing healthcare providers to make critical patient-management decisions.
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Cohen, Mírian, Ana Flávia Lima, Sandro Miguel, Marina Aziz, Ricardo Bertoglio Cardoso, and Luciane Cruz. "PP99 Hospital-Based Health Technology Assessment Units In Brazil: Present And Future." International Journal of Technology Assessment in Health Care 35, S1 (2019): 56–57. http://dx.doi.org/10.1017/s0266462319002344.
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IntroductionSince 2007, 23 Núcleos de Avaliação de Tecnologias em Saúde or hospital-based health technology assessment (HB-HTA) units have been established in teaching hospitals across Brazil. These units aim to promote the development of health technology assessment in hospitals, assisting the decision-making process for implementing new technologies and evaluating and promoting the rational use of widespread technologies.MethodsAn online questionnaire was sent by e-mail to all HB-HTA units registered in the Brazilian Network for Evaluation of Health Technologies. Information was acquired to comprehensively assess the activity of the units.ResultsAll 23 HB-HTA units answered the questionnaire. Of these, 65 percent had a technology prioritization process. The technologies assessed included drug therapies (73%), equipment (64%), medical devices (64%), clinical protocols (46%), and emerging technologies (27%). The dimensions of health technology assessment (HTA) evaluated by these organizations were: efficacy (76%); effectiveness (67%); safety (67%); costs (52%); cost effectiveness or cost utility (52%); and budget impact (43%). The hospital departments that required more HTA studies were: cardiology (50%); infectious diseases (45%); hospital management (45%); oncology (40%); surgery (40%); and endocrinology (20%). HTA studies supported: incorporation of new technologies (81%); protocol or guideline development (57%); new indications for already approved technologies (38%); and withdrawal of obsolete technologies (29%). Half of the institutions also conducted educational or training activities. The main difficulties reported were a lack of trained professionals (78%), funding (70%), and material resources (48%).ConclusionsFor low- and middle-income countries, the process of implementing HB-HTA units remains a challenge. Even though human resources and funding are scarce, HB-HTA units continue to develop. Given their importance in the decision-making process, it is imperative that every effort is made to ensure their activities continue.
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Fosu, Agyei. "Technology Versus Quality Education in an Underdeveloped Region: A Case Study of UNISA Students in Former CISKEI Homeland in Eastern Cape." International Journal of Community Development and Management Studies 1 (2017): 001–11. http://dx.doi.org/10.31355/8.
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NOTE: THIS ARTICLE WAS PUBLISHED WITH THE INFORMING SCIENCE INSTITUTE. Aim/Purpose................................................................................................................................................................................................. This paper seeks to show how University of South Africa (UNISA) is using technology to connect lecturers, tutors and students of [UNISA] in an underdeveloped region in South Africa (SA) to reduce cost and time of travelling to access information, tutorials and help [available] in designated centers, hence making quality and higher education more accessible and less costly. Background................................................................................................................................................................................................. This empirical study gives evidence to back the effectiveness, helpfulness and cost reduction of using technology as a medium of making quality and higher education accessible to under developed regions. Methodology................................................................................................................................................................................................. Quantitative and purposeful sampling was deemed appropriate for the study, whereby 200 questionnaires was developed and specifically distributed to UNISA students from former Ciskei towns at East London Tutorial Center. Contribution................................................................................................................................................................................................. The paper is about the usage of mobile technology for knowledge creation and dissemination, instruction and learning, The data generated and presented add to the knowledge base about underdeveloped countries. This data and the conclusions reached based the analysis could be of interest to researchers, university administrators, politicians, planners and policy makers in underdeveloped countries. Findings......................................................................................................................................................................................................... Evaluation of the overall effectiveness, helpfulness and cost reduction of e-tutorials show a slight advantage over the face-face tutorials. Recommendations for Practitioners............................................................................................................................................................. In the quest for ways and means of making quality and higher education accessible to underdeveloped regions, no matter which medium is chosen, the periodic measurement of success in terms of effectiveness, helpfulness, and cost implication in relation to the learner cannot be over looked. Recommendation for Researchers.................................................................................................................................................................. More work needs to be done to check the effectiveness of technology as an efficient medium to provide access to quality and higher education to underdeveloped regional economies. Impact on Society.............................................................................................................................................................................................. The results could have significant implications for raising the level of education and advancing employment equity by improving the delivery and accessibility to quality and higher education to underdeveloped regional economies. Future Research................................................................................................................................................................................................. The analysis of cost efficiency and effectiveness done in this work is just representative of one point of view: the student one of accessibility and cost. There is, however, need in future work to research the implications for the institutions of higher education (in terms teaching design, curriculum design, knowledge of individual learning types, need for change in and rate of change in knowledge view, learning philosophies), individual stakeholders, and the competitive re-positioning of society.
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Pererva, Petro, and Stanislav Nazarenko. "Methodological approach to evaluation of efficiency of it outsourcing." Marketing and Digital Technologies 5, no. 3 (September 29, 2021): 18–29. http://dx.doi.org/10.15276/mdt.5.3.2021.2.
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The aim of the article. When deciding on outsourcing, it is necessary to analyze the financial and organizational costs, without releasing from the analysis area the risks that arise when organizing the outsourcing of IT services. The lack of a full analysis in making this decision can instead of benefit cause significant losses. The purpose of the article is to develop methodological approaches to assessing the economic feasibility and effectiveness of the use of information technology outsourcing in the practice of domestic industrial enterprises. Analyses results. The article examines the existing scientific and methodological approaches to assessing the effectiveness of the use of information technology outsourcing in the production and commercial activities of industrial enterprises. Methodical recommendations for evaluating the effectiveness and efficiency of the IT outsourcing mechanism are formulated, which allows to determine the result of its implementation and the direction of its further development. Guidelines for deciding on IT outsourcing are proposed, the use of which is part of the decision-making process on the use of outsourcing in the enterprise and involves consistent implementation of measures to identify the business process for outsourcing to improve the quality and efficiency of delegated processes. A graphical comparative method for analyzing the effectiveness of decisions on the use of outsourcing by third-party companies and the practical implementation of the IT function by the company's own forces has been developed. The methodological approach to assessing the effectiveness of outsourcing management information systems in real business enterprises is sufficiently universal, as it takes into account the conceptual principles of outsourcing on the one hand and allows to adapt the structure of efficiency assessment depending on the complexity and cost of technologies used in business. enterprise, goals and scale of outsourcing. Conclusions and directions for further research. The proposed methodological approach allows to assess the economic efficiency of IT outsourcing to a greater extent in terms of economic justification of the management decision to accept services to IT outsourcers or perform them on their own. Graphoanalytical method for evaluating the effectiveness of outsourcing (Fig. 1) does not allow this. Its algorithm uses aggregated economic indicators (total costs, fixed costs, variable costs), the structure of which is not provided in the mechanism of using this method. Based on this, we consider as a direction of further development and research to develop guidelines for detailing these indicators in order to identify their components, to which the outsourcing company needs to pay special attention. Being based on the consideration of outsourcing as a process, the proposed approach has limitations that allow its application to assess the effectiveness of outsourcing only at a time when outsourcing is not yet implemented in practice. Additional research is needed to address this limitation.
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Zhang, Zhiying, and Huiju Zhu. "Evaluation of the Effect of Intensive Nursing Intervention Based on Process Analysis." Computational and Mathematical Methods in Medicine 2021 (December 6, 2021): 1–11. http://dx.doi.org/10.1155/2021/8769780.
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In order to achieve significant improvements in the evaluation of key indicators such as speed, quality, cost, and service, this paper fundamentally rethinks and completely redesigns the business process, and recreates a new business process. This study combines the particularity of AMI with emergency nursing to construct an in-hospital AMI emergency nursing process to further standardize the AMI rescue work. The implementation of the process helps to clarify the responsibilities and requirements of nurses in the AMI emergency process, reduce the delay time of AMI emergency, and improve the efficiency and effectiveness of emergency. In addition, after refactoring the business process, this paper builds an intelligent digital critical illness monitoring system. This system combines the original work flow of the ICU medical staff, optimizes the work flow of the medical staff through computer technology and information technology, and designs and completes the digital intensive nursing system software to run and use in the hospital and obtain significant results.
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Hounsome, Juliet, Gerlinde Pilkington, James Mahon, Angela Boland, Sophie Beale, Eleanor Kotas, Tara Renton, and Rumona Dickson. "Prophylactic removal of impacted mandibular third molars: a systematic review and economic evaluation." Health Technology Assessment 24, no. 30 (June 2020): 1–116. http://dx.doi.org/10.3310/hta24300.
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Background Impacted third molars are third molars that are blocked, by soft tissue or bone, from fully erupting through the gum. This can cause pain and disease. The treatment options for people with impacted third molars are removal or retention with standard care. If there are pathological changes, the current National Institute for Health and Care Excellence guidance states that the impacted third molar should be removed. Objective The objective of this study was to appraise the clinical effectiveness and cost-effectiveness of the prophylactic removal of impacted mandibular third molars compared with retention of, and standard care for, impacted third molars. Methods Five electronic databases were searched (1999 to 29 April 2016) to identify relevant evidence [The Cochrane Library (searched 4 April 2016 and 29 April 2016), MEDLINE (searched 4 April 2016 and 29 April 2016), EMBASE (searched 4 April 2016 and 29 April 2016), EconLit (searched 4 April 2016 and 29 April 2016) and NHS Economic Evaluation Database (searched 4 April 2016)]. Studies that compared the prophylactic removal of impacted mandibular third molars with retention and standard care or studies that assessed the outcomes from either approach were included. The clinical outcomes considered were pathology associated with retention, post-operative complications following extraction and adverse effects of treatment. Cost-effectiveness outcomes included UK costs and health-related quality-of-life measures. In addition, the assessment group constructed a de novo economic model to compare the cost-effectiveness of a prophylactic removal strategy with that of retention and standard care. Results The clinical review identified four cohort studies and nine systematic reviews. In the two studies that reported on surgical complications, no serious complications were reported. Pathological changes due to retention of asymptomatic impacted mandibular third molars were reported by three studies. In these studies, the extraction rate for retained impacted mandibular third molars varied from 5.5% to 31.4%; this variation can be explained by the differing follow-up periods (i.e. 1 and 5 years). The findings from this review are consistent with the findings from previous systematic reviews. Two published cost-effectiveness studies were identified. The authors of both studies concluded that, to their knowledge, there is currently no economic evidence to support the prophylactic removal of impacted mandibular third molars. The results generated by the assessment group’s lifetime economic model indicated that the incremental cost-effectiveness ratio per quality-adjusted life-year gained for the comparison of a prophylactic removal strategy with a retention and standard care strategy is £11,741 for people aged 20 years with asymptomatic impacted mandibular third molars. The incremental cost per person associated with prophylactic extraction is £55.71, with an incremental quality-adjusted life-year gain of 0.005 per person. The base-case incremental cost-effectiveness ratio per quality-adjusted life-year gained was found to be robust when a range of sensitivity and scenario analyses were carried out. Limitations Limitations of the study included that no head-to-head trials comparing the effectiveness of prophylactic removal of impacted mandibular third molars with retention and standard care were identified with the assessment group model that was built on observational data. Utility data on impacted mandibular third molars and their symptoms are lacking. Conclusions The evidence comparing the prophylactic removal of impacted mandibular third molars with retention and standard care is very limited. However, the results from an exploratory assessment group model, which uses available evidence on symptom development and extraction rates of retained impacted mandibular third molars, suggest that prophylactic removal may be the more cost-effective strategy. Future work Effectiveness evidence is lacking. Head-to-head trials comparing the prophylactic removal of trouble-free impacted mandibular third molars with retention and watchful waiting are required. If this is not possible, routine clinical data, using common definitions and outcome reporting methods, should be collected. Study registration This study is registered as PROSPERO CRD42016037776. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 30. See the NIHR Journals Library website for further project information.
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Barton, D. N., T. Saloranta, T. H. Bakken, A. Lyche Solheim, J. Moe, J. R. Selvik, and N. Vagstad. "Using Bayesian network models to incorporate uncertainty in the economic analysis of pollution abatement measures under the water framework directive." Water Supply 5, no. 6 (December 1, 2005): 95–104. http://dx.doi.org/10.2166/ws.2005.0054.
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The evaluation of water bodies “at risk” of not achieving the Water Framework Directive's (WFD) goal of “good status” begs the question of how big a risk is acceptable before a programme of measures should be implemented. Documentation of expert judgement and statistical uncertainty in pollution budgets and water quality modelling, combined with Monte Carlo simulation and Bayesian belief networks, make it possible to give a probabilistic interpretation of “at risk”. Combined with information on abatement costs, a cost-effective ranking of measures based on expected costs and effect can be undertaken. Combined with economic valuation of water quality, the definition of “disproportionate cost” of abatement measures compared to benefits of achieving “good status” can also be given a probabilistic interpretation. Explicit modelling of uncertainty helps visualize where research and consulting efforts are most critical for reducing uncertainty. Based on data from the Morsa catchment in South-Eastern Norway, this paper discusses the relative merits of using Bayesian belief networks when integrating biophysical modelling results in the benefit-cost analysis of derogations and cost-effectiveness ranking of abatement measures under the WFD.
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Sacristán, José A., Simon J. Day, Olga Navarro, José Ramos, and Jesûs M. Hernández. "Use of Confidence Intervals and Sample Size Calculations in Health Economic Studies." Annals of Pharmacotherapy 29, no. 7-8 (July 1995): 719–25. http://dx.doi.org/10.1177/106002809502907-815.
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Objective: To discuss the calculation and application of confidence intervals in pharmacoeconomic studies. Data Synthesis: The increasing frequency with which pharmacoeconomic evaluations are made within clinical trials makes it possible to obtain information on the outputs and costs of an intervention in each patient of a sample under study. This allows the same statistical principles commonly used in clinical trials to be applied to cost or cost-effectiveness data. The methodology described in this article would allow expression of cost-effectiveness ratios in the form of confidence intervals. The calculation of the cost-effectiveness ratio by means of a confidence interval may have important practical consequences, both in decision-making on the choice of 1 intervention versus another and in calculating the size of the sample necessary to identify statistically significant differences, from both clinical and economic points of view. Conclusions: The complementary use of confidence intervals and sensitivity analysis makes it possible to measure uncertainty related and unrelated to variability in sample data, allowing the decision to adopt 1 technology or another to be based on the most objective information available. Although several ethical and methodologic concerns remain to be addressed, this methodology may contribute to improving the more rational and efficient use of drugs.
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Davis, Sarah, Emma Simpson, Jean Hamilton, Marrissa Martyn-St James, Andrew Rawdin, Ruth Wong, Edward Goka, Neil Gittoes, and Peter Selby. "Denosumab, raloxifene, romosozumab and teriparatide to prevent osteoporotic fragility fractures: a systematic review and economic evaluation." Health Technology Assessment 24, no. 29 (June 2020): 1–314. http://dx.doi.org/10.3310/hta24290.
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Background Fragility fractures are fractures that result from mechanical forces that would not ordinarily result in fracture. Objectives The objectives were to evaluate the clinical effectiveness, safety and cost-effectiveness of non-bisphosphonates {denosumab [Prolia®; Amgen Inc., Thousand Oaks, CA, USA], raloxifene [Evista®; Daiichi Sankyo Company, Ltd, Tokyo, Japan], romosozumab [Evenity®; Union Chimique Belge (UCB) S.A. (Brussels, Belgium) and Amgen Inc.] and teriparatide [Forsteo®; Eli Lilly and Company, Indianapolis, IN, USA]}, compared with each other, bisphosphonates or no treatment, for the prevention of fragility fracture. Data sources For the clinical effectiveness review, nine electronic databases (including MEDLINE, EMBASE and the World Health Organization International Clinical Trials Registry Platform) were searched up to July 2018. Review methods A systematic review and network meta-analysis of fracture and femoral neck bone mineral density were conducted. A review of published economic analyses was undertaken and a model previously used to evaluate bisphosphonates was adapted. Discrete event simulation was used to estimate lifetime costs and quality-adjusted life-years for a simulated cohort of patients with heterogeneous characteristics. This was done for each non-bisphosphonate treatment, a strategy of no treatment, and the five bisphosphonate treatments previously evaluated. The model was populated with effectiveness evidence from the systematic review and network meta-analysis. All other parameters were estimated from published sources. An NHS and Personal Social Services perspective was taken, and costs and benefits were discounted at 3.5% per annum. Fracture risk was estimated from patient characteristics using the QFracture® (QFracture-2012 open source revision 38, Clinrisk Ltd, Leeds, UK) and FRAX® (web version 3.9, University of Sheffield, Sheffield, UK) tools. The relationship between fracture risk and incremental net monetary benefit was estimated using non-parametric regression. A probabilistic sensitivity analysis and scenario analyses were used to assess uncertainty. Results Fifty-two randomised controlled trials of non-bisphosphonates were included in the clinical effectiveness systematic review and an additional 51 randomised controlled trials of bisphosphonates were included in the network meta-analysis. All treatments had beneficial effects compared with placebo for vertebral, non-vertebral and hip fractures, with hazard ratios varying from 0.23 to 0.94, depending on treatment and fracture type. The effects on vertebral fractures and the percentage change in bone mineral density were statistically significant for all treatments. The rate of serious adverse events varied across trials (0–33%), with most between-group differences not being statistically significant for comparisons with placebo/no active treatment, non-bisphosphonates or bisphosphonates. The incremental cost-effectiveness ratios were > £20,000 per quality-adjusted life-year for all non-bisphosphonate interventions compared with no treatment across the range of QFracture and FRAX scores expected in the population eligible for fracture risk assessment. The incremental cost-effectiveness ratio for denosumab may fall below £30,000 per quality-adjusted life-year at very high levels of risk or for high-risk patients with specific characteristics. Raloxifene was dominated by no treatment (resulted in fewer quality-adjusted life-years) in most risk categories. Limitations The incremental cost-effectiveness ratios are uncertain for very high-risk patients. Conclusions Non-bisphosphonates are effective in preventing fragility fractures, but the incremental cost-effectiveness ratios are generally greater than the commonly applied threshold of £20,000–30,000 per quality-adjusted life-year. Study registration This study is registered as PROSPERO CRD42018107651. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 29. See the NIHR Journals Library website for further project information.
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Sandu, I. S., and I. P. Voiku. "Evaluation of the Effectiveness of the Digital Transformation of Crop Production of the Pskov Region." SHS Web of Conferences 62 (2019): 08005. http://dx.doi.org/10.1051/shsconf/20196208005.
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The article deals with the essence and advantages of digitalization – the introduction of digital computer technologies and information presented in digital form into production activities. The cost of economy digitalization and its individual industries is estimated. It is concluded that the decision on digitalization should be justified, supported by the necessary calculations. The article states that the use of computer technologies by Russian agrarians in production processes is the exception rather than the rule. The capacity of crop production as a long-term process, variable in terms of technological effectiveness, structure of operations and costs, for the introduction of advanced information technologies, is estimated. The article presents a description of the place of agriculture in the economy of the Pskov region, the characteristics of the main indicators of crop production. It is concluded that the growth of the gross output of the main types of agricultural products in crop production was largely due to a significant increase in yield index, but the acreage and provision of agricultural machinery in the region continue to decline. The study revealed that the power supply per production unit of agricultural producers combined with the level of digitalization reduce the size and change the structure of production costs. In addition, an assessment of the effect of the introduction of information technology in the chain of formation of the costs of crop production is given. The article describes the sequence of evaluation of the return on investment costs for digitalization of crop production in the Pskov region. The rate of payback due to savings in production costs is estimated at 5 years.
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Zanou, Barbara, Christodoulos Bellas, and Michalis Skourtos. "Implementation of the European Water Framework Directive: procedures and a simple model for the identification of the most cost-effective measures in eutrophicated catchments." Water Policy 12, no. 3 (November 19, 2009): 369–80. http://dx.doi.org/10.2166/wp.2009.120.
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According to the European Water Framework Directive (WFD), cost-effectiveness analysis (CEA) should be used for measuring the cost and the environmental effectiveness of a measure in water quality management. The purpose of this paper is to argue that, beyond the calculation of the cost efficiency of the measures, additional information related to the cost and the environmental characteristics is required. Such information provides important data for the decision makers to assess the feasibility of measures and renders the application of CEA more reliable. Moreover, considering that the WFD requires the encouragement of the active involvement of the stakeholders in the planning processes, a practical algorithm could be used for a user-friendly presentation and discussion of CEA results. Furthermore, if the evaluated measures are independent of each other, a simple model of integer programming solved by a simple software program is proposed as an alternative mathematical tool for evaluating a combined set of measures which meet a predetermined environmental objective at the lowest cost.
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Canter, Peter H., Joanna Thompson Coon, and Edzard Ernst. "Cost-Effectiveness of Complementary Therapies in the United Kingdom—A Systematic Review†." Evidence-Based Complementary and Alternative Medicine 3, no. 4 (2006): 425–32. http://dx.doi.org/10.1093/ecam/nel044.
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Objectives: The aim of this review is to systematically summarize and assess all prospective, controlled, cost-effectiveness studies of complementary therapies carried out in the UK.Data sources: Medline (via PubMed), Embase, CINAHL, Amed (Alternative and Allied Medicine Database, British Library Medical Information Centre), The Cochrane Library, National Health Service Economic Evaluation Database (via Cochrane) and Health Technology Assessments up to October 2005.Review methods: Articles describing prospective, controlled, cost-effectiveness studies of any type of complementary therapy for any medical condition carried out in the UK were included. Data extracted included the main outcomes for health benefit and cost. These data were extracted independently by two authors, described narratively and also presented as a table.Results: Six cost-effectiveness studies of complementary medicine in the UK were identified: four different types of spinal manipulation for back pain, one type of acupuncture for chronic headache and one type of acupuncture for chronic back pain. Four of the six studies compared the complementary therapy with usual conventional treatment in pragmatic, randomized clinical trials without sham or placebo arms. Main outcome measures of effectiveness favored the complementary therapies but in the case of spinal manipulation (four studies) and acupuncture (one study) for back pain, effect sizes were small and of uncertain clinical relevance. The same four studies included a cost-utility analyses in which the incremental cost per quality adjusted life year (QALY) was less than £10 000. The complementary therapy represented an additional health care cost in five of the six studies.Conclusions: Prospective, controlled, cost-effectiveness studies of complementary therapies have been carried out in the UK only for spinal manipulation (four studies) and acupuncture (two studies). The limited data available indicate that the use of these therapies usually represents an additional cost to conventional treatment. Estimates of the incremental cost of achieving improvements in quality of life compare favorably with other treatments approved for use in the National Health Service. Because the specific efficacy of the complementary therapies for these indications remains uncertain, and the studies did not include sham controls, the estimates obtained may represent the cost-effectiveness non-specific effects associated with the complementary therapies.