Cost effectiveness

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

Global epidemiology, ecology and control of soil-transmitted helminth infections

Abstract: Soil-transmitted helminth (STH) infections are among the most prevalent of chronic human infections worldwide. Based on the demonstrable impact on child development, there is a global commitment to finance and implement control strategies with a focus on school-based chemotherapy programmes. The major obstacle to the implementation of cost-effective control is the lack of accurate descriptions of the geographical distribution of infection. In recent years, considerable progress has been made in the use of geographical information systems (GIS) and remote sensing (RS) to better understand helminth ecology and epidemiology, and to develop low-cost ways to identify target populations for treatment. This review explores how this information has been used practically to guide large-scale control programmes. The use of satellite-derived environmental data has yielded new insights into the ecology of infection at a geographical scale that has proven impossible to address using more traditional approaches, and has in turn allowed spatial distributions of infection prevalence to be predicted robustly by statistical approaches. GIS/RS have increasingly been used in the context of large-scale helminth control programmes, including not only STH infections but also those focusing on schistosomiasis, filariasis and onchocerciasis. The experience indicates that GIS/RS provides a cost-effective approach to designing and monitoring programmes at realistic scales. Importantly, the use of this approach has begun to transition from being a specialist approach of international vertical programmes to becoming a routine tool in developing public sector control programmes. GIS/RS is used here to describe the global distribution of STH infections and to estimate the number of infections in school-age children in sub-Saharan Africa (89.9 million) and the annual cost of providing a single anthelmintic treatment using a school-based approach (US$5.0-7.6 million). These are the first estimates at a continental scale to explicitly include the fine spatial distribution of infection prevalence and population, and suggest that traditional methods have overestimated the situation. The results suggest that continent-wide control of parasites is, from a financial perspective, an attainable goal.

The effectiveness of coral reefs for coastal hazard risk reduction and adaptation

Abstract: The world’s coastal zones are experiencing rapid development and an increase in storms and flooding. These hazards put coastal communities at heightened risk, which may increase with habitat loss. Here we analyse globally the role and cost effectiveness of coral reefs in risk reduction. Meta-analyses reveal that coral reefs provide substantial protection against natural hazards by reducing wave energy by an average of 97%. Reef crests alone dissipate most of this energy (86%). There are 100 million or more people who may receive risk reduction benefits from reefs or bear hazard mitigation and adaptation costs if reefs are degraded. We show that coral reefs can provide comparable wave attenuation benefits to artificial defences such as breakwaters, and reef defences can be enhanced cost effectively. Reefs face growing threats yet there is opportunity to guide adaptation and hazard mitigation investments towards reef restoration to strengthen this first line of coastal defence.

Randomised factorial trial of falls prevention among older people living in their own homes

Abstract: OBJECTIVE: To test the effectiveness of, and explore interactions between, three interventions to prevent falls among older people. DESIGN: A randomised controlled trial with a full factorial design. SETTING: Urban community in Melbourne, Australia. PARTICIPANTS: 1090 aged 70 years and over and living at home. Most were Australian born and rated their health as good to excellent; just over half lived alone. INTERVENTIONS: Three interventions (group based exercise, home hazard management, and vision improvement) delivered to eight groups defined by the presence or absence of each intervention. MAIN OUTCOME MEASURE: Time to first fall ascertained by an 18 month falls calendar and analysed with survival analysis techniques. Changes to targeted risk factors were assessed by using measures of quadriceps strength, balance, vision, and number of hazards in the home. RESULTS: The rate ratio for exercise was 0.82 (95% confidence interval 0.70 to 0.97, P=0.02), and a significant effect (P<0.05) was observed for the combinations of interventions that involved exercise. Balance measures improved significantly among the exercise group. Neither home hazard management nor treatment of poor vision showed a significant effect. The strongest effect was observed for all three interventions combined (rate ratio 0.67 (0.51 to 0.88, P=0.004)), producing an estimated 14.0% reduction in the annual fall rate. The number of people needed to be treated to prevent one fall a year ranged from 32 for home hazard management to 7 for all three interventions combined. CONCLUSIONS: Group based exercise was the most potent single intervention tested, and the reduction in falls among this group seems to have been associated with improved balance. Falls were further reduced by the addition of home hazard management or reduced vision management, or both of these. Cost effectiveness is yet to be examined. These findings are most applicable to Australian born adults aged 70-84 years living at home who rate their health as good.

Advances in controlled-release fertilizers.

Abstract: The steady increase in population growth and food demand and the continuous reduction in cultivated land per capita induce steady intensification of fertilizer application worldwide. Despite improvements in the practices of nutrient application, the use efficiency (UE) of essential elements such as N and P is not satisfactory, resulting in an increase of environmental problems. The use of controlled-release fertilizers (CRFs) starts to evolve as a promising direction offering an excellent means to improve management of nutrient application and by this reducing significantly environmental threats while maintaining high crop yields of good quality. Low cost effectiveness and limited recognition of the potential benefits to be gained from the CRFs were so far the main reasons for their limited consumption. A systematic classification of the slow- and controlled-release fertilizers (SRF/CRFs) and details about the production and action mechanisms of the more common products is given in this chapter. The difference between slow and controlled release is emphasized, stressing the importance of proper synchronization of nutrient supply with plant demand as crucial for achieving the expected benefits from SRF/CRFs. Fertilizers based on polymer coating are singled out as the CRFs offering the best control over release. These are also the ones with the largest growth rate among the SRF/CRFs. Special attention is devoted to the description of release mechanisms and recent developments in modeling release which are essential for predicting nutrient release under real conditions and which can provide the technologists with tools for better design of CRFs. The use of SRF/CRFs in agriculture and nonfarm applications is described, stressing the need to better assess the agronomic and the environmental benefits to be gained. This, together with technological improvements in production of CRFs, is believed to significantly promote the future use of SRF/CRFs in practice. Finally, the efforts to improve the characterization of CRFs are described and a scheme for a systematic evaluation and classification of CRFs is offered. These efforts are likely to promote standardization of the different SR/CR products. By proper labeling, they will also assist legislators and producers in educating consumers about the relevant features of CRFs (e.g., release pattern and duration, and content of available forms).