Showing papers on "Cost effectiveness published in 2008"

Heterogeneous photocatalytic degradation of organic contaminants over titanium dioxide : A review of fundamentals, progress and problems

Abstract: Even though heterogeneous photocatalysis appeared in many forms, photodegradation of organic pollutants has recently been the most widely investigated. By far, titania has played a much larger role in this scenario compared to other semiconductor photocatalysts due to its cost effectiveness, inert nature and photostability. Extensive literature analysis has shown many possibilities of improving the efficiency of photodecomposition over titania by combining the photoprocess with either physical or chemical operations. The resulting combined processes revealed a flexible line of action for wastewater treatment technologies. The choice of treatment method usually depends upon the composition of the wastewater. However, a lot more is needed from engineering design and modelling for successful application of the laboratory scale techniques to large-scale operation. The present review paper seeks to offer an overview of the dramatic trend in the use of the TiO 2 photocatalyst for remediation and decontamination of wastewater, report the recent work done, important achievements and problems.

Conducting discrete choice experiments to inform healthcare decision making: a user's guide.

Abstract: Discrete choice experiments (DCEs) are regularly used in health economics to elicit preferences for healthcare products and programmes. There is growing recognition that DCEs can provide more than information on preferences and, in particular, they have the potential to contribute more directly to outcome measurement for use in economic evaluation. Almost uniquely, DCEs could potentially contribute to outcome measurement for use in both cost-benefit and cost-utility analysis. Within this expanding remit, our intention is to provide a resource for current practitioners as well as those considering undertaking a DCE, using DCE results in a policy/commercial context, or reviewing a DCE. We present the fundamental principles and theory underlying DCEs. To aid in undertaking and assessing the quality of DCEs, we discuss the process of carrying out a choice study and have developed a checklist covering conceptualizing the choice process, selecting attributes and levels, experimental design, questionnaire design, pilot testing, sampling and sample size, data collection, coding of data, econometric analysis, validity, interpretation and welfare and policy analysis. In this fast-moving area, a number of issues remain on the research frontier. We therefore outline potentially fruitful areas for future research associated both with DCEs in general, and with health applications specifically, paying attention to how the results of DCEs can be used in economic evaluation. We also discuss emerging research trends. We conclude that if appropriately designed, implemented, analysed and interpreted, DCEs offer several advantages in the health sector, the most important of which is that they provide rich data sources for economic evaluation and decision making, allowing investigation of many types of questions, some of which otherwise would be intractable analytically. Thus, they offer viable alternatives and complements to existing methods of valuation and preference elicitation.

Mindfulness-based cognitive therapy to prevent relapse in recurrent depression.

Abstract: For people at risk of depressive relapse, mindfulness-based cognitive therapy (MBCT) has an additive benefit to usual care (H. F. Coelho, P. H. Canter, & E. Ernst, 2007). This study asked if, among patients with recurrent depression who are treated with antidepressant medication (ADM), MBCT is comparable to treatment with maintenance ADM (m-ADM) in (a) depressive relapse prevention, (b) key secondary outcomes, and (c) cost effectiveness. The study design was a parallel 2-group randomized controlled trial comparing those on m-ADM (N = 62) with those receiving MBCT plus support to taper/discontinue antidepressants (N = 61). Relapse/recurrence rates over 15-month follow-ups in MBCT were 47%, compared with 60% in the m-ADM group (hazard ratio = 0.63; 95% confidence interval: 0.39 to 1.04). MBCT was more effective than m-ADM in reducing residual depressive symptoms and psychiatric comorbidity and in improving quality of life in the physical and psychological domains. There was no difference in average annual cost between the 2 groups. Rates of ADM usage in the MBCT group was significantly reduced, and 46 patients (75%) completely discontinued their ADM. For patients treated with ADM, MBCT may provide an alternative approach for relapse prevention.

The NICE cost-effectiveness threshold: what it is and what that means.

Abstract: The National Institute for Health and Clinical Excellence (NICE) has been using a cost-effectiveness threshold range between 20,000 pound sterling and 30,000 pound sterling for over 7 years. What the cost-effectiveness threshold represents, what the appropriate level is for NICE to use, and what the other factors are that NICE should consider have all been the subject of much discussion. In this article, we briefly review these questions, provide a critical assessment of NICE's utilization of the incremental cost-effectiveness ratio (ICER) threshold to inform its guidance, and suggest ways in which NICE's utilization of the ICER threshold could be developed to promote the efficient use of health service resources. We conclude that it is feasible and probably desirable to operate an explicit single threshold rather than the current range; the threshold should be seen as a threshold at which 'other' criteria beyond the ICER itself are taken into account; interventions with a large budgetary impact may need to be subject to a lower threshold as they are likely to displace more than the marginal activities; reimbursement at the threshold transfers the full value of an innovation to the manufacturer. Positive decisions above the threshold on the grounds of innovation reduce population health; the value of the threshold should be reconsidered regularly to ensure that it captures the impact of changes in efficiency and budget over time; the use of equity weights to sustain a positive recommendation when the ICER is above the threshold requires knowledge of the equity characteristics of those patients who bear the opportunity cost. Given the barriers to obtaining this knowledge and knowledge about the characteristics of typical beneficiaries of UK NHS care, caution is warranted before accepting claims from special pleaders; uncertainty in the evidence base should not be used to justify a positive recommendation when the ICER is above the threshold. The development of a programme of disinvestment guidance would enable NICE and the NHS to be more confident that the net health benefit of the Technology Appraisal Programme is positive.

Evidence for the impact of quality improvement collaboratives: systematic review

Abstract: Objective To evaluate the effectiveness of quality improvement collaboratives in improving the quality of care. Data sources Relevant studies through Medline, Embase, PsycINFO, CINAHL, and Cochrane databases. Study selection Two reviewers independently extracted data on topics, participants, setting, study design, and outcomes. Data synthesis Of 1104 articles identified, 72 were included in the study. Twelve reports representing nine studies (including two randomised controlled trials) used a controlled design to measure the effects of the quality improvement collaborative intervention on care processes or outcomes of care. Systematic review of these nine studies showed moderate positive results. Seven studies (including one randomised controlled trial) reported an effect on some of the selected outcome measures. Two studies (including one randomised controlled trial) did not show any significant effect. Conclusions The evidence underlying quality improvement collaboratives is positive but limited and the effects cannot be predicted with great certainty. Considering that quality improvement collaboratives seem to play a key part in current strategies focused on accelerating improvement, but may have only modest effects on outcomes at best, further knowledge of the basic components effectiveness, cost effectiveness, and success factors is crucial to determine the value of quality improvement collaboratives.

Assessing cost-effectiveness in healthcare: history of the $50,000 per QALY threshold.

Abstract: Cost-effectiveness analyses, particularly in the USA, commonly use a figure of $50,000 per life-year or quality-adjusted life-year gained as a threshold for assessing the cost-effectiveness of an intervention. The history of this practice is ill defined, although it has been linked to the end-stage renal disease kidney dialysis cost-effectiveness literature from the 1980s. The use of $50,000 as a benchmark for assessing the cost-effectiveness of an intervention first emerged in 1992 and became widely used after 1996. The appeal of the $50,000 figure appears to lie in the convenience of a round number rather than in the value of renal dialysis. Rather than arbitrary thresholds, estimates of willingness to pay and the opportunity cost of healthcare resources are needed.

What does the value of modern medicine say about the $50,000 per quality-adjusted life-year decision rule?

Abstract: Background: In the United States, $50,000 per Quality-Adjusted Life-Year (QALY) is a decision rule that is often used to guide interpretation of cost-effectiveness analyses. However, many investigators have questioned the scientific basis of this rule, and it has not been updated. Methods: We used 2 separate approaches to investigate whether the $50,000 per QALY rule is consistent with current resource allocation decisions. To infer a lower bound for the decision rule, we estimated the incremental cost-effectiveness of recent (2003) versus pre-“modern era” (1950) medical care in the United States. To infer an upper bound for the decision rule, we estimated the incremental cost-effectiveness of unsubsidized health insurance versus self-pay for nonelderly adults (ages 21‐64) without health insurance. We discounted both costs and benefits, following recommendations of the Panel on Cost-Effectiveness in Health and Medicine. Results: Our base case analyses suggest that plausible lower and upper bounds for a cost-effectiveness decision rule are $183,000 per life-year and $264,000 per life-year, respectively. Our sensitivity analyses widen the plausible range (between $95,000 per life-year saved and $264,000 per life-year saved when we considered only health care’s impact on quantity of life, and between $109,000 per QALY saved and $297,000 per QALY saved when we considered health care’s impact on quality as well as quantity of life) but it remained substantially higher than $50,000 per QALY. Conclusions: It is very unlikely that $50,000 per QALY is consistent with societal preferences in the United States.

Case finding for the management of osteoporosis with FRAX®—assessment and intervention thresholds for the UK

Abstract: Assessment and intervention thresholds are developed and proposed in men aged over 50 years and postmenopausal women for the UK based on fracture probability from the WHO fracture risk assessment tool (FRAX®). The FRAX® tool has recently become available to compute the 10-year probability of fractures in men and women from clinical risk factors (CRFs) with or without the measurement of femoral neck bone mineral density (BMD). The aim of this study was to develop a case-finding strategy for men and women from the UK at high risk of osteoporotic fracture by delineating the fracture probabilities at which BMD testing or intervention should be recommended. Fracture probabilities were computed using the FRAX® tool calibrated to the epidemiology of fracture and death in the UK. The relationship between cost effectiveness and fracture probability used the source data from a prior publication that examined the cost effectiveness of generic alendronate in the UK. An intervention threshold was set by age in men and women, based on the fracture probability equivalent to that of women with a history of a prior osteoporosis related fracture. In addition, assessment thresholds for the use of BMD testing were explored. Assessment thresholds for the measurement of BMD followed current practice guidelines where individuals were considered to be eligible for assessment in the presence of one or more CRF. An upper assessment threshold (i.e. a fracture probability above which patients could be treated without recourse to BMD) was based on optimisation of the positive predictive value of the assessment tool. The consequences of assessment and intervention thresholds on the requirement for BMD test and interventions were assessed using the distribution of clinical risk factors and femoral neck BMD for women in the source cohorts used for the development of the FRAX® models Treatment was cost effective at all ages when the 10-year probability of a major fracture exceeded 7%. The intervention threshold at the age of 50 years corresponded to a 10-year probability of a major osteoporotic fracture of 7.5%. This rose progressively with age to 30% at the age of 80 years, so that intervention was cost effective at all ages. Assessment thresholds for testing with BMD (6–9% at the age of 50 years) also rose with age (18–36% at the age of 80 years). The use of these thresholds in a case-finding strategy would identify 6–20% of women as eligible for BMD testing and 23–46% as eligible for treatment, depending on age. The same threshold can be used in men. The study provides a method of developing management algorithms for osteoporosis from the estimation of fracture probabilities, rather than those based on BMD alone or BMD with single or multiple CRFs.

The cost-effectiveness of biodiversity surveys in tropical forests

Abstract: The identification of high-performance indicator taxa that combine practical feasibility and ecological value requires an understanding of the costs and benefits of surveying different taxa. We present a generic and novel framework for identifying such taxa, and illustrate our approach using a large-scale assessment of 14 different higher taxa across three forest types in the Brazilian Amazon, estimating both the standardized survey cost and the ecological and biodiversity indicator value for each taxon. Survey costs varied by three orders of magnitude, and dung beetles and birds were identified as especially suitable for evaluating and monitoring the ecological consequences of habitat change in our study region. However, an exclusive focus on such taxa occurs at the expense of understanding patterns of diversity in other groups. To improve the cost-effectiveness of biodiversity research we encourage a combination of clearer research goals and the use of an objective evidence-based approach to selecting study taxa.

For Protection and Promotion: The Design and Implementation of Effective Safety Nets

Abstract: All countries fund safety net programs for the protection of their people Though an increasing number of safety net programs are extremely well thought out, adroitly implemented, and demonstrably effective, many others are not This book aims to assist those concerned with social policy to understand why countries need social assistance, what kind of safety programs will serve those best and how to develop such programs for maximum effectiveness Safety nets are part of a broader poverty reduction strategy interacting with and working alongside of social insurance; health, education, and financial services; the provision of utilities and roads; and other policies aimed at reducing poverty and managing risk Though useful, safety nets are not a panacea, and there are real concerns over whether they are affordable and administratively feasible or desirable in light of the various negative incentives they might create In most settings where there is political will to do so, such concerns can be managed through a number of prudent design and implementation features Much information and innovation exist on these topics; this book summarizes, references, and builds on this knowledge base to promote well-crafted safety nets and safety net policy

Efficiency of numerical basis sets for predicting the binding energies of hydrogen bonded complexes: evidence of small basis set superposition error compared to Gaussian basis sets.

Abstract: Binding energies of selected hydrogen bonded complexes have been calculated within the framework of density functional theory (DFT) method to discuss the efficiency of numerical basis sets implemented in the DFT code DMol3 in comparison with Gaussian basis sets. The corrections of basis set superposition error (BSSE) are evaluated by means of counterpoise method. Two kinds of different numerical basis sets in size are examined; the size of the one is comparable to Gaussian double zeta plus polarization function basis set (DNP), and that of the other is comparable to triple zeta plus double polarization functions basis set (TNDP). We have confirmed that the magnitudes of BSSE in these numerical basis sets are comparative to or smaller than those in Gaussian basis sets whose sizes are much larger than the corresponding numerical basis sets; the BSSE corrections in DNP are less than those in the Gaussian 6-311+G(3df,2pd) basis set, and those in TNDP are comparable to those in the substantially large scale Gaussian basis set aug-cc-pVTZ. The differences in counterpoise corrected binding energies between calculated using DNP and calculated using aug-cc-pVTZ are less than 9 kJ/mol for all of the complexes studied in the present work. The present results have shown that the cost effectiveness in the numerical basis sets in DMol3 is superior to that in Gaussian basis sets in terms of accuracy per computational cost.

Cost-effective osteoporosis treatment thresholds: the United States perspective

Abstract: A United States-specific cost-effectiveness analysis, which incorporated the cost and health consequences of clinical fractures of the hip, spine, forearm, shoulder, rib, pelvis and lower leg, was undertaken to identify the 10-year hip fracture probability required for osteoporosis treatment to be cost-effective for cohorts defined by age, sex, and race/ethnicity. A 3% 10-year risk of hip fracture was generally required for osteoporosis treatment to cost less than $60,000 per QALY gained. Rapid growth of the elderly United States population will result in so many at risk of osteoporosis that economically efficient approaches to osteoporosis care warrant consideration. A Markov-cohort model of annual United States age-specific incidence of clinical hip, spine, forearm, shoulder, rib, pelvis and lower leg fractures, costs (2005 US dollars), and quality-adjusted life years (QALYs) was used to assess the cost-effectiveness of osteoporosis treatment ($600/yr drug cost for 5 years with 35% fracture reduction) by gender and race/ethnicity groups. To determine the 10-year hip fracture probability at which treatment became cost-effective, average annual age-specific probabilities for all fractures were multiplied by a relative risk (RR) that was systematically varied from 0 to 10 until a cost of $60,000 per QALY gained was observed for treatment relative to no intervention. Osteoporosis treatment was cost-effective when the 10-year hip fracture probability reached approximately 3%. Although the RR at which treatment became cost-effective varied markedly between genders and by race/ethnicity, the absolute 10-year hip fracture probability at which intervention became cost-effective was similar across race/ethnicity groups, but tended to be slightly higher for men than for women. Application of the WHO risk prediction algorithm to identify individuals with a 3% 10-year hip fracture probability may facilitate efficient osteoporosis treatment.

Comparison of the Outcomes Between Open and Minimally Invasive Esophagectomy

Abstract: Esophageal resection for cancer remains the gold standard, not only in providing the optimal chance for cure but also the best palliation for dysphagia. Because of the substantial morbidity from the open surgical approach to the chest, there have been attempts to use approaches that avoid a thoracotomy. However, to date there has been no clear evidence that the avoidance of thoracotomy using a transhiatal approach to resect the esophagus improves outcomes either in relation to morbidity1,2 or survival with the disease.3 The latter randomized trial showed a trend to a benefit for the transthoracic approach thought to be due to the ability to perform a more complete lymph node dissection.3 The extent to which the lymph nodes should be dissected remains contentious.4 Promoters of the open approaches to esophageal resection strongly support a radical approach to a mediastinal lymphadenectomy, whereas the advocates of the transhiatal approach hold the view that a more extensive lymphadenectomy does not influence survival.5 With improved experience and skills for performing laparoscopic and thoracoscopic surgery, there have been a number of reports where these approaches have been used in association with the thoracic dissection of the esophagus6–8 or gastric mobilization,9,10 or for both.11,12 These reports have confirmed that these approaches are possible, safe and have reasonable outcomes when compared with the literature. Conceptually, a minimally invasive approach to esophageal resection (MIE) does appear to offer the potential for a more radical approach to mediastinal resection, under vision, when compared with transhiatal esophagectomy. Recent reviews of the role of MIE have maintained that the benefits from this approach are controversial because the operations are more complex than those required for other malignancies. There are concerns relating to the adequacy of tumor and lymph node clearance, and most series reported to date have not shown an apparent reduction in morbidity or mortality.4 Wu and Posner identified issues such as the optimal approach, cost effectiveness, advantages over open techniques and the role of MIE in combined modality therapy and call for more comparative studies to determine the worth of MIE.13 There has been very little written about the oncological impact and the impact on prognosis from the resected cancer using MIE. Our unit has been performing thoracoscopic mobilization for esophageal cancer since 1993. The results from our first 162 cases have been reported previously.13 We concluded that the procedure was safe with acceptable outcomes. We subsequently embarked upon a pilot study of a consecutive series of patients having Total MIE using thoracoscopic esophageal mobilization and laparoscopic gastric mobilization and a small right upper quadrant incision to create the gastric tube. We felt that there was little benefit over the thoracoscopic and laparotomy approach, so this operation was discontinued. We have recently reported this series with short- and medium-term follow-up data questioning whether there is a significant benefit from Total MIE.14 In both of these series of patients, the tumors were in the intrathoracic esophagus or localized in the esophagogastric junction (EGJ) allowing resection and a gastric pull-up to the neck. Prior to using MIE techniques, we had used an open approach via laparotomy and thoracotomy to resect these cancers. Concurrent with those series of patients in which MIE techniques were used, we have used the open approach for cancers located at the EGJ (Siewert Type II and III) as well as the lower esophagus, where a substantive resection of the upper stomach was required, to allow appropriate tumor clearance and necessitating an intrathoracic anastomosis. In this report, we wish to compare the outcomes from two approaches to MIE with open esophageal resection in a contemporary series of patients from a single unit. Aside from the amount of esophagus and stomach resected, the dissection within the abdomen and the chest was similar allowing assessment of the potential benefits or otherwise for the MIE approach over open surgery. We report the peri-operative outcomes as well as longer-term outcomes in relation to the cancers that were treated.

Stroke and thromboembolism in atrial fibrillation: a systematic review of stroke risk factors, risk stratification schema and cost effectiveness data.

Abstract: The risk of stroke in atrial fibrillation (AF) needs to be assessed in each patient to determine the clinical and cost-effectiveness of thromboprophylaxis, with the aim of appropriate use of antithrombotic therapy. To achieve this, stroke risk factors in AF populations need to be identified and stroke risk stratification models have been devised on the basis of these risk factors. In this article, we firstly provide a systematic review of studies examining the attributable stroke risk of various clinical, demographic and echocardiographic patient characteristics in AF populations. Secondly, we performed a systematic review of published stroke risk stratification models, in terms of the results of the review of stroke risk factors and their ability to accurately discriminate between different levels of stroke risk. Thirdly, we review the health economic evidence relating to the cost-effectiveness of anticoagulation and antiplatelet therapy as thromboprophylaxis in AF patients. The studies included in the systematic review of stroke risk factors identified history of stroke or TIA, increasing age, hypertension and structural heart disease (left-ventricular dysfunction or hypertrophy) to be good predictors of stroke risk in AF patients. The evidence regarding diabetes mellitus, gender and other patient characteristics was less consistent. Three stroke risk stratification models were identified that were able to discriminate between different categories of stroke risk to at least 95% accuracy. Few models had addressed the cumulative nature of risk factors where a combination of risk factors would confer a greater risk than either factor alone. In patients at high risk of stroke, anticoagulation is cost effective, but not for those with a low risk of stroke. With the evidence available for stroke risk factors and the various alternative stroke risk stratification models, a review of these models in terms of the evidence on which they are devised and their performance in representative AF populations is important. The appropriate administration of thromboprophylaxis in AF patients would need to balance the risks and benefits of antithrombotic therapy with its cost-effectiveness.

Economic costs of diabetes in the US in 2007 — Implications for Europe

Abstract: In March 2008 the latest American Diabetes Association (ADA) commissioned economic study of the costs of diabetes in 2007 was published. The economic burden of diabetes was quantified in terms of its increased healthcare resource use (direct costs) and lost productivity (indirect costs) and provided a detailed breakdown of the costs attributed to diabetes. In the five years since the ADA published a similar analysis, the number of Americans with diagnosed diabetes has risen from 12.1 to 17.1 million and the economic cost has risen from $132 billion (equivalent to $153 billion in 2007 dollars) to $174 billion. This major analysis is reviewed and the implications for Europe are considered. The findings are similar to those described in earlier US studies and also landmark European economic studies in diabetes. The results are also discussed in the context of the well accepted association of type 2 diabetes and overweight and obesity and because obesity has reached epidemic proportions in developed and devel...

Eventually Consistent: Building reliable distributed systems at a worldwide scale demands trade-offs?between consistency and availability.

Abstract: At the foundation of Amazon’s cloud computing are infrastructure services such as Amazon’s S3 (Simple Storage Service), SimpleDB, and EC2 (Elastic Compute Cloud) that provide the resources for constructing Internet-scale computing platforms and a great variety of applications. The requirements placed on these infrastructure services are very strict; they need to score high marks in the areas of security, scalability, availability, performance, and cost effectiveness, and they need to meet these requirements while serving millions of customers around the globe, continuously.

The Perfect Storm of Overutilization

Abstract: The United States spends substantially more per person on health care than any other country, and yet US health outcomes are the same as or worse than those in other coutries. In 2005, the last year for which comparative statistics are available, the United States spent $6401 per person, whereas the next highest spending was in Norway and Switzerland, $4364 and $4177, respectively (TABLE). Overall, US health care expenditures are 2.4 times the average of those of all developed countries ($2759 per person), yet health outcomes for US patients, whether measured by life expectancy, disease-specific mortality rates, or other variables, are unimpressive (Table). There are many explanations for the higher costs of US health care. Because health insurance must be underwritten and sold to individual employers and self-insured individuals, administrative costs exceed $145 billion. This does not include employers’ costs for purchasing and managing employees’ health insurance. One estimate suggests that the private employer insurance market wastes more than $50 billion in administrative costs. A second factor is higher prices in the United States for important inputs to health care, such as physicians’ services, prescription drugs, and diagnostic testing. US physicians earn double the income of their peers in other industrialized countries (Table). Similarly, prices to the public for drugs in the United States are 10% to 30% higher than in other developed countries. Disparities in prices of inputs to health care account for at least $100 billion annually of higher spending in the United States. A third contributor to US costs is the abundance of amenities. Hospital rooms in the United States offer more privacy, comfort, and auxiliary services than do hospital rooms in most other countries. US physicians’ offices are typically more conveniently located and have parking nearby and more attractive waiting rooms. Overutilization of Health Care The most important contributor to the high cost of US health care, however, is overutilization. Overutilization can take 2 forms: higher volumes, such as more office visits, hospitalizations, tests, procedures, and prescriptions than are appropriate or more costly specialists, tests, procedures, and prescriptions than are appropriate. It ismorecostly care, rather thanhighvolume, that accounts for higher expenditures in the United States. The volume of services is not extreme. A hospitalization rate of 121 per 1000 US patients is higher than that of Japan (106) but considerably lower than the rate in Switzerland (157), Norway (173), and France (268) and lower than the Organisation for Economic Co-operation and Development (OECD) average (163) (Table). TheUShospitalizationrate is21stof30OECDcountries. Similarly, US patients have 3.8 physician visits annually per capita, fewer than the OECD average of 6.8. In contrast with volume, in which the United States is not the leader, there are almost 3 times as many magnetic resonance imaging scanners in the United States as the OECD average, higher only in Japan. US patients receive considerably more cardiac revascularization procedures (579 per 100 000 population)—coronary artery bypass grafts, angioplasties, and stents—45% more than patients in Norway, the country with the next highest number (Table). The United States has the fourth highest per capita consumption of pharmaceuticals. US patients utilize many more “new drugs”— those on the market 5 years or fewer—than patients in other countries. For instance, ezetimibe, which decreases lowdensity lipoprotein cholesterol level and was approved in October 2002, is not recommended by major guidelines as first-line therapy. Nevertheless, the use of ezetimibe in the United States is about 5 times higher than it is in Canada, constituting more than 15% of prescriptions for lipidlowering agents. Greater use of new, more expensive pharmaceuticals, as well as higher prices both for older and newer drugs, helps explain why the United States spent $752 per capita (2005) on drugs, whereas France, with the next highest expenditure, spent $559 and Japan just $425.

Biofilm formation, bacterial adhesion and host response on polymeric implants--issues and prevention.

Abstract: Several polymeric materials find application in biomedical implants and devices due to their superior physicochemical properties. The main requirement for these polymers is that they should be biocompatible, which means they prevent bacterial adhesion and are blood compatible. Many parameters contribute to the degree of biocompatibility. This paper discusses the mechanism of the formation of biofilms and lists the factors that influence the bacterial adhesion and haemocompatibility. Polymer surfaces are also modified to enhance adsorption of host cells. The physical, chemical and biological techniques are meant to modify the surface of the biomaterial but at the same time retain the key properties. The various polymer treatment processes have advantages and disadvantages and a few techniques have been proved to be both highly effective at treatment and found suitable for various in vivo environments. The current research focus pertaining to smart materials, biodegradable polymers, combinatorial chemistry, computational modelling and newer analytical techniques to understand polymer-cell interaction holds promise in designing better, cost effective and biocompatible polymers.

Application of the analytic hierarchy process (AHP) in multi-criteria analysis of the selection of intelligent building systems

Abstract: The availability of innumerable intelligent building (IB) products, and the current dearth of inclusive building component selection methods suggest that decision makers might be confronted with the quandary of forming a particular combination of components to suit the needs of a specific IB project. Despite this problem, few empirical studies have so far been undertaken to analyse the selection of the IB systems, and to identify key selection criteria for major IB systems. This study is designed to fill these research gaps. Two surveys: a general survey and the analytic hierarchy process (AHP) survey are proposed to achieve these objectives. The first general survey aims to collect general views from IB experts and practitioners to identify the perceived critical selection criteria, while the AHP survey was conducted to prioritize and assign the important weightings for the perceived criteria in the general survey. Results generally suggest that each IB system was determined by a disparate set of selection criteria with different weightings. ‘Work efficiency’ is perceived to be most important core selection criterion for various IB systems, while ‘user comfort’, ‘safety’ and ‘cost effectiveness’ are also considered to be significant. Two sub-criteria, ‘reliability’ and ‘operating and maintenance costs’, are regarded as prime factors to be considered in selecting IB systems. The current study contributes to the industry and IB research in at least two aspects. First, it widens the understanding of the selection criteria, as well as their degree of importance, of the IB systems. It also adopts a multi-criteria AHP approach which is a new method to analyse and select the building systems in IB. Further research would investigate the inter-relationship amongst the selection criteria.

The Price We Pay: Economic and Social Consequences of Inadequate Education

Abstract: While the high cost of education draws headlines, the cost of not educating America's children goes largely ignored. The Price We Pay remedies this oversight by highlighting the private and public costs of inadequate education. In this volume, leading scholars from a broad range of fields uincluding economics, education, demography, and public health uattach hard numbers to the relationship between educational attainment and such critical indicators as income, health, crime, dependence on public assistance, and political participation. They explore policy interventions that could boost the education system's performance and explain why demographic trends make the challenge of educating our youth so urgent today. Improving educational outcomes for at-risk youth is more than a noble goal. It is an investment with the potential to yield benefits that far outstrip its costs. The Price We Pay provides the tools readers need to analyze both sides of the balance sheet and make informed decisions about which policies will pay off. Contributors include Thomas Bailey (Teachers College, Columbia University), Ronald F. Ferguson (Harvard University), Irwin Garfinkel (Columbia University), Jane Junn (Rutgers University), Brendan Kelly (Columbia University), Enrico Moretti (UCLA), Peter Muennig (Columbia University), Michael Rebell (Teachers College, Columbia University), Richard Rothstein (Teachers College, Columbia University), Cecilia E. Rouse (Princeton University), Marta Tienda (Princeton University), Jane Waldfogel (Columbia University), and Tamara Wilder (Teachers College, Columbia University).

Handbook of Performability Engineering

Abstract: The performance of a product, a system or a service is usually judged in terms of dependability (which can be defined as an aggregate of quality, reliability, and maintainability etc.) and safety, not overlooking the cost of achieving these attributes. As of now, dependability and cost effectiveness are primarily seen as instruments for conducting the international trade in the free market environment and thereby deciding the economic prosperity of a nation. However, the internalization of the hidden costs of environment preservation will have to be accounted for, sooner or later, in order to be able to produce sustainable products in the long run. These factors cannot be considered in isolation of each other. The Handbook of Performability Engineering considers all aspects of performability engineering, providing a holistic view of the entire life cycle of activities of the product, along with the associated cost of environmental preservation at each stage, while maximizing the performance.

SMS STI: a review of the uses of mobile phone text messaging in sexual health

Abstract: Short messaging service (SMS) (a.k.a. text messaging) is a fast, low cost and popular mode of communication among young people, and these advantages can be used in a variety of ways in the field of sexual health. This paper reviews the current published and grey literature and discusses applications of SMS in sexual health and the evidence base for their effectiveness. Examples of uses of SMS in sexual health include: communication between sexual health clinics and patients, partner notification and contact tracing, contraception reminders and sexual health promotion and education. However, although SMS has been applied in many ways to improve sexual health and there is some evidence of its effectiveness, very few of the applications described in this article have been evaluated. As SMS is likely to become more and more commonly used for sexual health purposes, evaluation of its benefits and effectiveness is essential.

Economic evaluation of human papillomavirus vaccination in the United Kingdom.

Abstract: Objective To assess the cost effectiveness of routine vaccination of 12 year old schoolgirls against human papillomavirus infection in the United Kingdom. Design Economic evaluation. Setting UK. Population Schoolgirls aged 12 or older. Main outcome measures Costs, quality adjusted life years (QALYs), and incremental cost effectiveness ratios for a range of vaccination options. Results Vaccinating 12 year old schoolgirls with a quadrivalent vaccine at 80% coverage is likely to be cost effective at a willingness to pay threshold of £30 000 (€37 700; $59 163) per QALY gained, if the average duration of protection from the vaccine is more than 10 years. Implementing a catch-up campaign of girls up to age 18 is likely to be cost effective. Vaccination of boys is unlikely to be cost effective. A bivalent vaccine with the same efficacy against human papillomavirus types 16 and 18 costing £13-£21 less per dose (depending on the duration of vaccine protection) may be as cost effective as the quadrivalent vaccine although less effective as it does not prevent anogenital warts. Conclusions Routine vaccination of 12 year old schoolgirls combined with an initial catch-up campaign up to age 18 is likely to be cost effective in the UK. The results are robust to uncertainty in many parameters and processes. A key influential variable is the duration of vaccine protection.