Cost effectiveness

About: Cost effectiveness is a research topic. Over the lifetime, 69775 publications have been published within this topic receiving 1531477 citations.

Costs and Benefits of Different Strategies to Screen for Cervical Cancer in Less-Developed Countries

Abstract: Background About 80% of cervical cancers occur in less-developed countries. This disproportionate burden of cervical cancer in such countries is due mainly to the lack of well-organized screening programs. Several cervical cancer screening strategies have been proposed as more cost-effective than cytology screening. We compared the costs and benefits of different strategies and their effectiveness in saving lives in a less-developed country. Methods We used a population-based simulation model to evaluate the incremental societal costs and benefits in Thailand of seven screening techniques, including visual inspection of the cervix after applying acetic acid (VIA), human papillomavirus (HPV) testing, Pap smear, and combinations of screening tests, and examined the discounted costs per year of life saved (LYS). Results Compared with no (i.e., not well-organized) screening, all strategies saved lives, at costs ranging from 121 US dollars to 6720 US dollars per LYS, and reduced mortality, by up to 58%. Comparing each strategy with the next least expensive alternative, VIA performed at 5-year intervals in women of ages 35-55 with immediate treatment if abnormalities are found was the least expensive option and saved the greatest number of lives, with a cost of 517 US dollars per LYS. HPV screening resulted in similar costs and benefits, if the test cost is 5 US dollars and if 90% of women undergo follow-up after an abnormal screen. Cytology (Pap smear) was a reasonable alternative if sensitivity exceeds 80% and if 90% of women undergo follow-up. Compared with no screening, use of a combination of Pap smear and HPV testing at 5-year intervals in women of ages 20-70 could achieve greater than 90% reduction in cervical cancer mortality at a cost of 1683 US dollars per LYS, and VIA could achieve 83% reduction at 524 US dollars per LYS. Conclusions Well-organized screening programs can reduce cervical cancer mortality in less-developed countries at low costs. These cost-effectiveness data can enhance decision-making about optimal policies for a given setting.

Heavy Metal Pollution: Source, Impact, and Remedies

Abstract: Although some heavy metals are essential trace elements, most of them can be toxic to all forms of life at high concentrations due to formation of complex compounds within the cell. Unlike organic pollutants, heavy metals once introduced into the environment cannot be biodegraded. They persist indefinitely and cause pollution of air, water, and soils. Thus, the main strategies of pollution control are to reduce the bioavailability, mobility, and toxicity of metals. Methods for remediation of heavy metal-contaminated environments include physical removal, detoxification, bioleaching, and phytoremediation. Because heavy metals are increasingly found in microbial habitats due to natural and industrial processes, microorganisms have evolved several mechanisms to tolerate their presence by adsorption, complexation, or chemical reduction of metal ions or to use them as terminal electron acceptors in anaerobic respiration. In heavy metals, pollution abatement, microbial sensors, and transformations are getting increased focus because of high efficiency and cost effectiveness. The sources and impacts of heavy metal pollution as well as various remediation techniques are described.

Health systems, systems thinking and innovation.

Abstract: Health systems play a critically important role in improving health. Well-functioning health systems enable achievement of good health with efficient use of available resources. Effective health systems also enable responsiveness to legitimate expectations of citizens and fairness of financing. By helping produce good health effectively, health systems also contribute to economic growth (McKee et al. 2009). Well-functioning health systems are critical in mounting effective responses to emerging public health emergencies, and addressing burden of disease, ill health and poverty due to communicable (Coker et al. 2004) and non-communicable diseases and cancers (Farmer et al. 2010; Samb et al. 2010). A number of factors influence ways in which health systems achieve good health efficiently. These factors include the capacity of both individuals and institutions within health systems, continuity of stewardship, ability to seize opportunities, and contextual characteristics such as path-dependency, sociocultural beliefs, economic set up, and history of the country concerned (Balabanova et al. 2011). However, ‘linking good health and successful health systems, in particular how health systems might be distinguished from other determinants of health, or ultimately how health systems are linked to good health, has proved challenging’ (Chen 2012). A further challenge relates to understanding how innovations (such as new policies, new knowledge and novel technologies) can be effectively introduced in health systems and how these innovations interact with health system variables to influence health outcomes. Resource scarcity, coupled with global economic crisis, has necessitated adoption of innovations in health systems to sustain effective responses and improvements in health outcomes. Yet, weak health systems hinder adoption and diffusion of innovations. Evidence-informed guidance and policies are needed to strengthen health systems and improve their receptiveness to innovations. However, there is limited understanding on how best to develop health system guidance and to translate it to policy while accounting for the complexity of health systems and varied contexts in which health systems are embedded (Lavis et al. 2012). There is also limited understanding of why many well-intentioned policies and managerial decisions aimed at improving health systems do not achieve desired outcomes, but lead to unexpected or unintended consequences. One explanation for this phenomenon is that too often the tools used for analysing health systems and the heuristics used to generate managerial decisions are too simplistic for health systems that are complex. Inadequately considered interventions often upset the equilibrium within complex systems to resist such interventions, leading to ‘policy resistance’. This paper briefly discusses health systems and dynamic complexity. It examines complex adaptive systems created through the dynamic interaction of evolving contexts, health systems and institutions within health systems. The paper explores, through illustrative case studies, how adoption and diffusion of innovations are influenced in complex adaptive systems created through interaction between innovations, institutions, health systems and contexts, using a framework that helps unpack complexity, and enables systems thinking when developing solutions to address factors that hinder or enable adoption and diffusion of innovations in health systems.

Clinical and cost-effectiveness of autologous chondrocyte implantation for cartilage defects in knee joints: systematic review and economic evaluation

Abstract: Objective: To support a review of the guidance issued by the National Institute for Health and Clinical Excellence (NICE) in December 2000 by examining the current clinical and cost-effectiveness evidence on autologous cartilage transplantation. Data sources: Electronic databases. Review methods: Evidence on clinical effectiveness was obtained from randomised trials, supplemented by data from selected observational studies for longer term results, and for the natural history of chondral lesions. Because of a lack of long-term results on outcomes such as later osteoarthritis and knee replacement, only illustrative modelling was done, using a range of assumptions that seemed reasonable, but were not evidence based. Results: Four randomised controlled trials were included, as well as observational data from case series. The trials studied a total of 266 patients and the observational studies up to 101 patients. Two studies compared autologous chondrocyte implantation (ACI) with mosaicplasty, the third compared ACI with microfracture, and the fourth compared matrix-guided ACI (MACI®) with microfracture. Follow-up was 1 year in one study, and up to 3 years in the remaining three studies. The first trial of ACI versus mosaicplasty found that ACI gave better results than mosaicplasty at 1 year. Overall, 88% had excellent or good results with ACI versus 69% with mosaicplasty. About half of the biopsies after ACI showed hyaline cartilage. The second trial of ACI versus mosaicplasty found little difference in clinical outcomes at 2 years. Disappointingly, biopsies from the ACI group showed fibrocartilage rather than hyaline cartilage. The trial of ACI versus microfracture also found only small differences in outcomes at 2 years. Finally, the trial of MACI versus microfracture contained insufficient long-term results at present, but the study does show the feasibility of doing ACI by the MACI technique. It also suggested that after ACI, it takes 2 years for full-thickness cartilage to be produced. Reliable costs per quality-adjusted life-year (QALY) could not be calculated owing to the absence of necessary data. Simple short-term modelling suggests that the quality of life gain from ACI versus microfracture would have to be between 70 and 100% greater over 2 years for it to be more cost-effective within the £20,000–30,000 per QALY costeffectiveness thresholds. However, if the quality of life gains could be maintained for a decade, increments relative to microfracture would only have to be 10–20% greater to justify additional treatment costs within the cost-effectiveness band indicated above. Follow-up from the trials so far has only been up to 2 years, with longer term outcomes being uncertain. Conclusions: There is insufficient evidence at present to say that ACI is cost-effective compared with microfracture or mosaicplasty. Longer term outcomes are required. Economic modelling using some assumptions about long-term outcomes that seem reasonable suggests that ACI would be cost-effective because it is more likely to produce hyaline cartilage, which is more likely to be durable and to prevent osteoarthritis in the longer term (e.g. 20 years). Further research is needed into earlier methods of predicting long-term results. Basic science research is also needed into factors that influence stem cells to become chondrocytes and to produce high-quality cartilage, as it may be possible to have more patients developing hyaline cartilage after microfracture. Study is also needed into cost-effective methods of rehabilitation and the effect of early mobilisation on cartilage growth.

Delivering the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cost effectiveness analysis

Abstract: Objectives To assess the long term clinical and cost effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) intervention compared with usual care in people with newly diagnosed type 2 diabetes. Design We undertook a cost-utility analysis that used data from a 12 month, multicentre, cluster randomised controlled trial and, using the Sheffield type 2 diabetes model, modelled long term outcomes in terms of use of therapies, incidence of complications, mortality, and associated effect on costs and health related quality of life. A further cost-utility analysis was also conducted using current “real world” costs of delivering the intervention estimated for a hypothetical primary care trust. Setting Primary care trusts in the United Kingdom. Participants Patients with newly diagnosed type 2 diabetes. Intervention A six hour structured group education programme delivered in the community by two professional healthcare educators. Main outcome measures Incremental costs and quality adjusted life years (QALYs) gained. Results On the basis of the data in the trial, the estimated mean incremental lifetime cost per person receiving the DESMOND intervention is £209 (95% confidence interval −£704 to £1137; €251, −€844 to €1363; $326, −$1098 to $1773), the incremental gain in QALYs per person is 0.0392 (−0.0813 to 0.1786), and the mean incremental cost per QALY is £5387. Using “real world” intervention costs, the lifetime incremental cost of the DESMOND intervention is £82 (−£831 to £1010) and the mean incremental cost per QALY gained is £2092. A probabilistic sensitivity analysis indicated that the likelihood that the DESMOND programme is cost effective at a threshold of £20 000 per QALY is 66% using trial based intervention costs and 70% using “real world” costs. Results from a one way sensitivity analysis suggest that the DESMOND intervention is cost effective even under more modest assumptions that include the effects of the intervention being lost after one year. Conclusion Our results suggest that the DESMOND intervention is likely to be cost effective compared with usual care, especially with respect to the real world cost of the intervention to primary care trusts, with reductions in weight and smoking being the main benefits delivered.