Showing papers on "Cost effectiveness published in 2012"

Cognitive behavior therapy via the Internet: a systematic review of applications, clinical efficacy and cost–effectiveness

Abstract: Internet-based cognitive behavior therapy (ICBT) is a promising treatment that may increase availability of cognitive behavior therapy (CBT) for psychiatric disorders and other clinical problems. T...

Mass media campaigns to promote smoking cessation among adults: an integrative review

Abstract: Objective This review summarises the impact of mass media campaigns on promoting quitting among adult smokers overall and for subgroups; the influence of campaign intensity and different channels; the effects of different message types. Methods The present work updates two reviews published in 2008 by searching databases using a standard search string. Articles in languages other than English were excluded, as well as letters and editorials. Screening of abstracts yielded 194 potentially relevant articles. Abstracts were evaluated by 2 authors, excluding articles that focused on populations other than adults and according to other specified criteria, resulting in 26 studies reported in 29 articles. Studies were categorised as (a) population-based studies of campaign effects and (b) studies comparing message types, using either population-based or forced exposure methods. Findings of subgroup differences for each study were noted, as well as study strengths and limitations. Results Overall, the studies have strengthened the evidence that mass media campaigns conducted in the context of comprehensive tobacco control programmes can promote quitting and reduce adult smoking prevalence, but that campaign reach, intensity, duration and message type may influence success. Achievement of sufficient population exposure is vital, especially for lower socioeconomic status smokers, with television remaining the primary channel to effectively reach and influence adult smokers. Studies comparing different message types found negative health effects messages most effective at generating increased knowledge, beliefs, positive perceived effectiveness ratings, or quitting behaviour, while there was more mixed evidence for other message types. A few studies further suggest that negative health effects messages may also contribute to reductions in socioeconomic disparities in smoking. Conclusions Mass media campaigns to promote quitting are important investments as part of comprehensive tobacco control programmes to educate about the harms of smoking, set the agenda for discussion, change smoking attitudes and beliefs, increase quitting intentions and quit attempts, and reduce adult smoking prevalence. Jurisdictions should aim for high reach and consistent exposure over time with preference towards negative health effects messages.

Development of suitable photobioreactor for algae production – A review

Abstract: Microalgal species are recently in the spotlight for biofuels production like biodiesel, bioethanol and biohydrogen. Algae are also used as a biofertiliser, source of nutrient and for controlling pollution. Algae being a photosynthetic organism are produced in the photo bioreactors. Hence the design and development of photobioreactors for maximum production of algae is very important. Apart from maximum production, other factors such as design, cost effectiveness of the bioreactor, purity of the algae produced, user friendly, low maintenance and space convenience need to be optimized. The bioreactors which are used for the purpose of growing algae are bubble column photobioreactor, airlift photo bioreactor, flat panel bioreactor, horizontal tubular photobioreactor, stirred tank photobioreactor etc. These bioreactors have their own advantages and disadvantages. Work is on for developing hybrid type of bioreactors which may overcome the limitations of the developed photobioreactors. This paper covers the salient features, limitations of developed photobioreactors and recent developments in the field of photobioreactors.

Behavioural and cognitive‐behavioural group‐based parenting programmes for early‐onset conduct problems in children aged 3 to 12 years

Abstract: To assess the effectiveness and cost-effectiveness of behavioural and cognitive-behavioural group-based parenting programmes for improving child conduct problems, parental mental health and parenting skills. Parenting programmes that are delivered in group settings have the potential to help parents develop parenting skills that improve the behaviour of their young children. This review provides evidence that group-based parenting programmes improve childhood behaviour problems and the development of positive parenting skills in the short-term, whilst also reducing parental anxiety, stress and depression. Evidence for the longer-term effects of these programmes is unavailable. These group-based parenting programmes achieve good results at a cost of approximately $2500 (£1712 or â,¬2217) per family. These costs are modest when compared with the long-term social, educational and legal costs associated with childhood conduct problems.

The 10-year cost-effectiveness of lifestyle intervention or metformin for diabetes prevention: An intent-to-treat analysis of the DPP/DPPOS

Abstract: OBJECTIVE The Diabetes Prevention Program (DPP) and its Outcomes Study (DPPOS) demonstrated that either intensive lifestyle intervention or metformin could prevent type 2 diabetes in high-risk adults for at least 10 years after randomization. We report the 10-year within-trial cost-effectiveness of the interventions. RESEARCH DESIGN AND METHODS Data on resource utilization, cost, and quality of life were collected prospectively. Economic analyses were performed from health system and societal perspectives. RESULTS Over 10 years, the cumulative, undiscounted per capita direct medical costs of the interventions, as implemented during the DPP, were greater for lifestyle ($4,572) than metformin ($2,281) or placebo ($752). The cumulative direct medical costs of care outside the DPP/DPPOS were least for lifestyle ($26,810 lifestyle vs. $27,384 metformin vs. $29,007 placebo). The cumulative, combined total direct medical costs were greatest for lifestyle and least for metformin ($31,382 lifestyle vs. $29,665 metformin vs. $29,759 placebo). The cumulative quality-adjusted life-years (QALYs) accrued over 10 years were greater for lifestyle (6.89) than metformin (6.79) or placebo (6.74). When costs and outcomes were discounted at 3% and adjusted for survival, lifestyle cost $12,878 per QALY, and metformin had slightly lower costs and nearly the same QALYs as placebo. CONCLUSIONS Over 10 years, from a payer perspective, lifestyle was cost-effective and metformin was marginally cost-saving compared with placebo. Investment in lifestyle and metformin interventions for diabetes prevention in high-risk adults provides good value for the money spent.

Improvements in risk stratification for the occurrence of cardiovascular disease by imaging subclinical atherosclerosis: a systematic review

Abstract: Context Imaging for subclinical atherosclerosis on top of conventional risk factor assessment may improve risk prediction for the occurrence of cardiovascular disease events in asymptomatic individuals. Objective To systematically review the available evidence on this issue. Data Sources PubMed MEDLINE was systematically searched on 7 September 2011. Study selection Studies were included that evaluated the added value of flow mediated dilation (FMD), carotid intima-media thickness (CIMT), carotid plaques and/or coronary artery calcification (CAC) scoring in the prediction of risk for developing fatal or non-fatal cardiovascular events. Data extraction Data on general study characteristics and the added predictive performance of imaging markers in terms of discrimination, calibration and (re)classification were extracted. Results 25 studies were selected that provided information on added predictive value of FMD (n=2), CIMT (n=12), carotid plaques (n=6) and/or CAC (n=9). Heterogeneity existed across studies in the conventional risk models that were used and in the measurements of the imaging marker. The added predictive value, quantified by the difference in c-index, of FMD, CIMT, carotid plaques or CAC ranged from 0.00 to 0.01 for FMD, from 0.00 to 0.03 for CIMT, from 0.01 to 0.05 for carotid plaque and from 0.05 to 0.13 for CAC. The reported net reclassification improvement (NRI) by the imaging markers ranged from −1.4% to 12% for CIMT, 8% to 11% for carotid plaques, 14% to 25% for CAC and 29% for FMD). Although the definition of intermediate cardiovascular risk varied across studies, the NRI was the highest in those at intermediate cardiovascular risk. Conclusions Published evidence on the added value of atherosclerosis imaging varies across the different markers, with limited evidence for FMD and considerable evidence for CIMT, carotid plaque and CAC. The added predictive value of additional screening may be primarily found in asymptomatic individuals at intermediate cardiovascular risk. Additional research in asymptomatic individuals is needed to quantify the cost effectiveness and impact of imaging for subclinical atherosclerosis on cardiovascular risk factor management and patient outcomes.

Photosynthetic production of ethanol from carbon dioxide in genetically engineered cyanobacteria

Abstract: The rapidly growing demand for energy and the environmental concerns about carbon dioxide emissions make the development of renewable biofuels more and more attractive. Tremendous academic and industrial efforts have been made to produce bioethanol, which is one major type of biofuel. The current production of bioethanol is limited for commercialization because of issues with food competition (from food-based biomass) or cost effectiveness (from lignocellulose-based biomass). In this report we applied a consolidated bioprocessing strategy to integrate photosynthetic biomass production and microbial conversion producing ethanol together into the photosynthetic bacterium, Synechocystis sp. PCC6803, which can directly convert carbon dioxide to ethanol in one single biological system. A Synechocystis sp. PCC6803 mutant strain with significantly higher ethanol-producing efficiency (5.50 g L−1, 212 mg L−1 day−1) compared to previous research was constructed by genetically introducing pyruvate decarboxylase from Zymomonas mobilis and overexpressing endogenous alcohol dehydrogenase through homologous recombination at two different sites of the chromosome, and disrupting the biosynthetic pathway of poly-β-hydroxybutyrate. In total, nine alcohol dehydrogenases from different cyanobacterial strains were cloned and expressed in E. coli to test ethanol-producing efficiency. The effects of different culturing conditions including tap water, metal ions, and anoxic aeration on ethanol production were evaluated.

The Cost-Effectiveness of Birth-Cohort Screening for Hepatitis C Antibody in U.S. Primary Care Settings

Abstract: Hepatitis C virus (HCV) infection is most prevalent among adults born from 1945 through 1965, and most of them are currently undiagnosed. Whether screening based on birth cohort is more cost-effect...

Highly sensitive NO2 gas sensor based on ozone treated graphene

Abstract: In the present study, we report a simple and reproducible method to improve the sensing performance of a graphene gas sensor using ozone treatment and demonstrate it with nitrogen dioxide (NO2) gas. The ozone-treated graphene (OTG) sensor demonstrated remarkable enhancement of the sensing performances such as percentage response, detection limit and response time. The percentage response of the OTG sensor was twofold higher than that of a pristine graphene sensor when it was exposed to 200 ppm concentration of NO2 at room temperature. It is noteworthy that significant improvement was achieved in the response time by a factor of 8. Extremely low parts-per-billion (ppb) concentrations were clearly detectable, while the pristine graphene sensor could not detect NO2 molecules below 10 ppm concentration. The detection limit of the OTG sensor was estimated to be 1.3 ppb based on the signal to noise ratio, which is the cutting-edge resolution. The present ozone treatment may provide an effective way to improve the performance of the graphene-based sensor, given its simple process, practical usability and cost effectiveness.

Prospective Evaluation of a Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry System in a Hospital Clinical Microbiology Laboratory for Identification of Bacteria and Yeasts: a Bench-by-Bench Study for Assessing the Impact on Time to Identification and Cost-Effectiveness

Abstract: Matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) has been found to be an accurate, rapid, and inexpensive method for the identification of bacteria and yeasts. Previous evaluations have compared the accuracy, time to identification, and costs of the MALDI-TOF MS method against standard identification systems or commercial panels. In this prospective study, we compared a protocol incorporating MALDI-TOF MS (MALDI protocol) with the current standard identification protocols (standard protocol) to determine the performance in actual practice using a specimen-based, bench-by-bench approach. The potential impact on time to identification (TTI) and costs had MALDI-TOF MS been the first-line identification method was quantitated. The MALDI protocol includes supplementary tests, notably for Streptococcus pneumoniae and Shigella, and indications for repeat MALDI-TOF MS attempts, often not measured in previous studies. A total of 952 isolates (824 bacterial isolates and 128 yeast isolates) recovered from 2,214 specimens were assessed using the MALDI protocol. Compared with standard protocols, the MALDI protocol provided identifications 1.45 days earlier on average (P < 0.001). In our laboratory, we anticipate that the incorporation of the MALDI protocol can reduce reagent and labor costs of identification by $102,424 or 56.9% within 12 months. The model included the fixed annual costs of the MALDI-TOF MS, such as the cost of protein standards and instrument maintenance, and the annual prevalence of organisms encountered in our laboratory. This comprehensive cost analysis model can be generalized to other moderate- to high-volume laboratories.

Comparison of response rates and cost-effectiveness for a community-based survey: postal, internet and telephone modes with generic or personalised recruitment approaches

Abstract: Epidemiological research often requires collection of data from a representative sample of the community or recruitment of specific groups through broad community approaches The population coverage of traditional survey methods such as mail-outs to residential addresses, and telephone contact via public directories or random-digit-dialing is declining and survey response rates are falling There is a need to explore new sampling frames and consider multiple response modes including those offered by changes in telecommunications and internet technology We evaluated response rates and cost-effectiveness for three modes of survey administration (postal invitation/postal survey, postal invitation/internet survey and postal invitation/telephone survey) and two styles of contact approach (personalised and generic) in a community survey of greywater use Potential respondents were contacted only once, with no follow up of non-responders The telephone survey produced the highest adjusted response rate (302%), followed by the personalised postal survey (105%), generic postal survey (75%) and then the internet survey (47% for the personalised approach and 22% for the generic approach) There were some differences in household characteristics and greywater use rates between respondents to different survey modes, and between respondents to personalised and generic approaches These may be attributable to the differing levels of motivations needed for a response, and varying levels of interest in the survey topic among greywater users and non-users The generic postal survey had the lowest costs per valid survey received (Australian $2293), followed by the personalised postal survey ($2475) Our findings suggest that postal surveys currently remain the most economic option for population-based studies, with similar costs for personalised and generic approaches Internet surveys may be effective for specialised groups where email lists are available for initial contact, but barriers other than household internet access still exist for community-based surveys Given the increasing recruitment challenges facing community-based studies, there is an imperative to gather contemporary comparative data on different survey modes and recruitment approaches in order to determine their strengths, limitations and costs Researchers also need to document and report on the potential biases in the target and respondent populations and how this may affect the data collected

Physiotherapy intervention in Parkinson's disease: systematic review and meta-analysis.

Abstract: Objective To assess the effectiveness of physiotherapy compared with no intervention in patients with Parkinson’s disease. Design Systematic review and meta-analysis of randomised controlled trials. Data sources Literature databases, trial registries, journals, abstract books, and conference proceedings, and reference lists, searched up to the end of January 2012. Review methods Randomised controlled trials comparing physiotherapy with no intervention in patients with Parkinson’s disease were eligible. Two authors independently abstracted data from each trial. Standard meta-analysis methods were used to assess the effectiveness of physiotherapy compared with no intervention. Tests for heterogeneity were used to assess for differences in treatment effect across different physiotherapy interventions used. Outcome measures were gait, functional mobility and balance, falls, clinician rated impairment and disability measures, patient rated quality of life, adverse events, compliance, and economic analysis outcomes. Results 39 trials of 1827 participants met the inclusion criteria, of which 29 trials provided data for the meta-analyses. Significant benefit from physiotherapy was reported for nine of 18 outcomes assessed. Outcomes which may be clinically significant were speed (0.04 m/s, 95% confidence interval 0.02 to 0.06, P Conclusions Physiotherapy has short term benefits in Parkinson’s disease. A wide range of physiotherapy techniques are currently used to treat Parkinson’s disease, with little difference in treatment effects. Large, well designed, randomised controlled trials with improved methodology and reporting are needed to assess the efficacy and cost effectiveness of physiotherapy for treating Parkinson’s disease in the longer term.

The cost-effectiveness of total joint arthroplasty: a systematic review of published literature.

Abstract: Objective To summarise the state of the literature evaluating the cost-effectiveness of elective total hip and knee arthroplasty (THA and TKA). Methods We conducted a systematic review of published cost-effectiveness analyses of THA and TKA. To limit our search to high-quality published papers, we selected those papers included in the Cost-Effectiveness Analysis Registry (created by the Center for the Evaluation of Value and Risk in Health at Tufts University) and augmented the search with papers listed in PubMed. The data abstracted included incremental cost-effectiveness ratios, perspective of the analysis, time frame, sensitivity analyses conducted, and utility assessment. All cost-effectiveness ratios were converted to 2011 USD. Results Seven studies presenting cost-effectiveness ratios for TKA and six studies for THA were included in our review. All economic evaluations of TKA were published between 2006 and 2012. By contrast, THA studies were published between 1996 and 2008. Out of the 13 studies evaluated in this review, four were from the societal perspective and eight were from the payer perspective. Five studies spanned the lifetime horizon. Of the selected studies, six used probabilistic sensitivity analysis to address uncertainty in data parameters. Both procedures have been shown to be highly cost-effective from the societal perspective over the entire lifespan. Conclusion THA and TKA have been found to be highly cost-effective in a number of high-quality studies. Further analyses are needed on the cost-effectiveness of alternative surgical options, particularly osteotomy. Future economic evaluations should address the expanding indications of THA and TKA to younger, more physically active individuals.

Cost-Effectiveness of Transcatheter Aortic Valve Replacement Compared With Standard Care Among Inoperable Patients With Severe Aortic Stenosis Results From the Placement of Aortic Transcatheter Valves (PARTNER) Trial (Cohort B)

Abstract: Background—In patients with severe aortic stenosis who cannot have surgery, transcatheter aortic valve replacement (TAVR) has been shown to improve survival and quality of life compared with standard therapy, but the costs and cost-effectiveness of this strategy are not yet known. Methods and Results—The PARTNER trial randomized patients with symptomatic, severe aortic stenosis who were not candidates for surgery to TAVR (n=179) or standard therapy (n=179). Empirical data regarding survival, quality of life, medical resource use, and hospital costs were collected during the trial and used to project life expectancy, quality-adjusted life expectancy, and lifetime medical care costs to estimate the incremental cost-effectiveness of TAVR from a US perspective. For patients treated with TAVR, mean costs for the initial procedure and hospitalization were $42 806 and $78 542, respectively. Follow-up costs through 12 months were lower with TAVR ($29 289 versus $53 621) because of reduced hospitalization rates, b...

Cost-effectiveness of a Multicondition Collaborative Care Intervention: A Randomized Controlled Trial

Abstract: Context Patients with depression and poorly controlled diabetes mellitus, coronary heart disease (CHD), or both have higher medical complication rates and higher health care costs, suggesting that more effective care management of psychiatric and medical disease control might also reduce medical service use and enhance quality of life. Objective To evaluate the cost-effectiveness of a multicondition collaborative treatment program (TEAMcare) compared with usual primary care (UC) in outpatients with depression and poorly controlled diabetes or CHD. Design Randomized controlled trial of a systematic care management program aimed at improving depression scores and hemoglobin A 1c (HbA 1c ), systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDL-C) levels. Setting Fourteen primary care clinics of an integrated health care system. Patients Population-based screening identified 214 adults with depressive disorder and poorly controlled diabetes or CHD. Intervention Physician-supervised nurses collaborated with primary care physicians to provide treatment of multiple disease risk factors. Main Outcome Measures Blinded assessments evaluated depressive symptoms, SBP, and HbA 1c at baseline and at 6, 12, 18, and 24 months. Fasting LDL-C concentration was assessed at baseline and at 12 and 24 months. Health plan accounting records were used to assess medical service costs. Quality-adjusted life-years (QALYs) were assessed using a previously developed regression model based on intervention vs UC differences in HbA 1c , LDL-C, and SBP levels over 24 months. Results Over 24 months, compared with UC controls, intervention patients had a mean of 114 (95% CI, 79 to 149) additional depression-free days and an estimated 0.335 (95% CI, −0.18 to 0.85) additional QALYs. Intervention patients also had lower mean outpatient health costs of $594 per patient (95% CI, −$3241 to $2053) relative to UC patients. Conclusions For adults with depression and poorly controlled diabetes, CHD, or both, a systematic intervention program aimed at improving depression scores and HbA 1c , SBP, and LDL-C levels seemed to be a high-value program that for no or modest additional cost markedly improved QALYs. Trial Registration clinicaltrials.gov Identifier: NCT00468676

Systematic social observation of children's neighborhoods using Google Street View: a reliable and cost-effective method

Abstract: Background: Children growing up in poor versus affluent neighborhoods are more likely to spend time in prison, develop health problems and die at an early age. The question of how neighborhood conditions influence our behavior and health has attracted the attention of public health officials and scholars for generations. Online tools are now providing new opportunities to measure neighborhood features and may provide a cost effective way to advance our understanding of neighborhood effects on child health. Method: Avirtual systematic social observation (SSO) study wasconducted to test whether Google Street View could be used to reliably capture the neighborhood conditions of families participating in the Environmental-Risk (E-Risk) Longitudinal Twin Study. Multiple raters coded a subsample of 120 neighborhoods and convergent and discriminant validity was evaluated on the full sample of over 1,000 neighborhoodsbylinkingvirtualSSOmeasuresto:(a)consumerbasedgeo-demographicclassificationsof deprivation and health, (b) local resident surveys of disorder and safety, and (c) parent and teacher assessments of children’s antisocial behavior, prosocial behavior, and body mass index. Results: High levels of observed agreement were documented for signs of physical disorder, physical decay, dangerousness and street safety. Inter-rater agreement estimates fell within the moderate to substantial range for all of the scales (ICCs ranged from .48 to .91). Negative neighborhood features, including SSO-rated disorder and decay and dangerousness corresponded with local resident reports, demonstrated a graded relationship with census-defined indices of socioeconomic status, and predicted higher levels of antisocial behavior among local children. In addition, positive neighborhood features, includingSSO-ratedstreetsafetyandthepercentageofgreenspace,wereassociatedwithhigherprosocial behavior and healthy weight status among children. Conclusions: Our results support the use of Google Street View as a reliable and cost effective tool for measuring both negative and positive features of local neighborhoods. Keywords: Systematic social observation, Google Street View, neighborhood disorder, neighborhood deprivation, antisocial behavior, body mass index.

The effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease (review of Technology Appraisal No. 111): a systematic review and economic model.

Abstract: BACKGROUND: Alzheimer’s disease (AD) is the most commonly occurring form of dementia. It is predominantly a disease of later life, affecting 5% of those over 65 in the UK. OBJECTIVES: Review and update guidance to the NHS in England and Wales on the clinical effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine [acetylcholinesterase inhibitors (AChEIs)] and memantine within their licensed indications for the treatment of AD, which was issued in November 2006 (amended September 2007 and August 2009). DATA SOURCES: Electronic databases were searched for systematic reviews and/or metaanalyses, randomised controlled trials (RCTs) and ongoing research in November 2009 and updated in March 2010; this updated search revealed no new includable studies. The databases searched included The Cochrane Library (2009 Issue 4, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials), MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, PsycINFO, EconLit, ISI Web of Science Databases--Science Citation Index, Conference Proceedings Citation Index, and BIOSIS; the Centre for Reviews and Dissemination (CRD) databases--NHS Economic Evaluation Database, Health Technology Assessment, and Database of Abstracts of Reviews of Effects. REVIEW METHODS: The clinical effectiveness systematic review was undertaken following the principles published by the NHS CRD. We included RCTs whose population was people with AD. The intervention and comparators depended on disease severity, measured by the Mini Mental State Examination (MMSE). INTERVENTIONS: mild AD (MMSE 21-26)--donepezil, galantamine and rivastigmine; moderate AD (MMSE 10-20)--donepezil, galantamine, rivastigmine and memantine; severe AD (MMSE 99% probability that the AChEIs are more cost-effective than BSC. These analyses assume that the AChEIs have no effect on survival. For the AChEIs, in people with mild to moderate AD, the probabilistic sensitivity analyses suggested that donepezil is the most cost-effective, with a 28% probability of being the most cost-effective option at a WTP of £’30,000 per QALY (27% at a WTP of £’20,000 per QALY). In the deterministic results, donepezil dominates the other drugs and BSC, which, along with rivastigmine patches, are associated with greater costs and fewer QALYs. Thus, although galantamine has a slightly cheaper total cost than donepezil (£’69,592 vs £’69,624), the slightly greater QALY gains from donepezil (1.616 vs 1.617) are enough for donepezil to dominate galantamine.The probability that memantine is cost-effective in a moderate to severe cohort compared with BSC at a WTP of £’30,000 per QALY is 38% (and 28% at a WTP of £’20,000 per QALY). The deterministic ICER for memantine is £’32,100 per/QALY and the probabilistic ICER is £’36,700 per/QALY. LIMITATIONS: Trials were of 6 months maximum follow-up, lacked reporting of key outcomes, provided no subgroup analyses and used insensitive measures. Searches were limited to English language, The model does not include behavioural symptoms and there is uncertainty about the model structure and parameters. CONCLUSIONS: The additional clinical effectiveness evidence identified continues to suggest clinical benefit from the AChEIs in alleviating AD symptoms, although there is debate about the magnitude of the effect. Although there is also new evidence on the effectiveness of memantine, it remains less supportive of this drug’s use than the evidence for AChEIs. The conclusions concerning cost-effectiveness are quite different from the previous assessment. This is because both the changes in effectiveness and costs between drug use and non-drug use underlying the ICERs are very small. This leads to highly uncertain results, which are very sensitive to change. RESEARCH PRIORITIES: RCTs to include mortality, time to institutionalisation and quality of life, powered for subgroup analysis. FUNDING: The National Institute for Health Research Health Technology Assessment programme.

A watershed-scale design optimization model for stormwater best management practices

Abstract: U.S. Environmental Protection Agency developed a decision-support system, System for Urban Stormwater Treatment and Analysis Integration (SUSTAIN), to evaluate alternative plans for stormwater quality management and flow abatement techniques in urban and developing areas. SUSTAIN provides a public domain tool capable of evaluating the optimal location, type, and cost of stormwater best management practices (BMPs) needed to meet water quality and quantity goals. It is a tool designed to provide critically needed support to watershed practitioners in evaluating stormwater management options based on effectiveness and cost to meet their existing program needs. SUSTAIN is intended for users who have a fundamental understanding of watershed and BMP modeling processes. How SUSTAIN is setup described here using a case study, conducted by actual data from an existing urban watershed. The developed SUSTAIN model was calibrated by observed rainfall and flow data, representing the existing conditions. The SUSTAIN model developed two BMP cost-effectiveness curves for flow volume and pollutant load reductions. A sensitivity analysis was also conducted by varying important BMP implementation specifications.

A Systematic Review and Meta-Analysis of Efficacy, Cost-Effectiveness, and Safety of Selected Complementary and Alternative Medicine for Neck and Low-Back Pain

Abstract: Background. Back pain is a common problem and a major cause of disability and health care utilization. Purpose. To evaluate the efficacy, harms, and costs of the most common CAM treatments (acupuncture, massage, spinal manipulation, and mobilization) for neck/low-back pain. Data Sources. Records without language restriction from various databases up to February 2010. Data Extraction. The efficacy outcomes of interest were pain intensity and disability. Data Synthesis. Reports of 147 randomized trials and 5 nonrandomized studies were included. CAM treatments were more effective in reducing pain and disability compared to no treatment, physical therapy (exercise and/or electrotherapy) or usual care immediately or at short-term follow-up. Trials that applied sham-acupuncture tended towards statistically nonsignificant results. In several studies, acupuncture caused bleeding on the site of application, and manipulation and massage caused pain episodes of mild and transient nature. Conclusions. CAM treatments were significantly more efficacious than no treatment, placebo, physical therapy, or usual care in reducing pain immediately or at short-term after treatment. CAM therapies did not significantly reduce disability compared to sham. None of the CAM treatments was shown systematically as superior to one another. More efforts are needed to improve the conduct and reporting of studies of CAM treatments.