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Bao TD, Van Cuong N, Mai NN, Ha LTT, Phu DH, Kiet BT, Carrique-Mas J, Rushton J. Economic assessment of an intervention strategy to reduce antimicrobial usage in small-scale chicken farms in Vietnam. One Health 2024; 18:100699. [PMID: 38496339 PMCID: PMC10943031 DOI: 10.1016/j.onehlt.2024.100699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/31/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024] Open
Abstract
Antimicrobials are a core aspect of most livestock production systems, especially in low-and middle-income countries. They underpin the efficient use of scarce feed resources and stabilize returns on capital and labor inputs. Antimicrobial use (AMU) contributes to the production of healthy animals, yet AMU in livestock is linked to antimicrobial resistance (AMR) in animals, humans and the environment. The Vietnamese Platform for Antimicrobial Reduction in Chicken Production was implemented during 2016-2019 and was one of Southeast Asia's first interventions focused on AMU reductions in livestock production. The project targeted small-scale commercial poultry farms in the Mekong Delta region of Vietnam using a "randomized before-and-after controlled" study design. It provided farmers with a locally adapted support service (farmer training plan, advisory visits, biosecurity, and antimicrobial replacement products) to help them reduce their reliance on antimicrobials. A partial budget analysis was performed comparing the control group (status-quo) and intervention group (alternative). The median net farm-level benefit of the intervention strategies with the project's support was VND 6.78 million (interquartile range (IR) VND -71.9-89 million) per farm. Without project support the benefit was reduced to VND 5.1 million (IR VND -69.1-87.2 million) to VND 5.3 million (IR -VND 68.9-87.5 million) depending on the antimicrobial alternative product used. At the project level with a focus on AMU and its reduction, subsequently influence on the resistance reduction, our results showed that achieving resistance reduction benefits with the current knowledge and technologies required investment of at least VND 9.1 million (US$ 395.10) per farm during the project's lifetime. The results highlight the positive net profit for the majority of enrolled farms and a reasonable investments from the project. The recommendation focuses on the implementation of policies on financial support, legislation, and information as potential solutions to facilitate the application of intervention strategies to reduce AMU in poultry production.
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Affiliation(s)
- Truong Dinh Bao
- Faculty of Animal Science and Veterinary Medicine, University of Agriculture and Forestry, HCMC, Viet Nam
| | | | - Nguyen Nhu Mai
- Faculty of Animal Science and Veterinary Medicine, University of Agriculture and Forestry, HCMC, Viet Nam
| | | | - Doan Hoang Phu
- Oxford University Clinical Research Unit, Ho Chi Minh, Viet Nam
| | - Bach Tuan Kiet
- Sub Department of Animal Health and Production, Cao Lanh, Viet Nam
| | - Juan Carrique-Mas
- Oxford University Clinical Research Unit, Ho Chi Minh, Viet Nam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Jonathan Rushton
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
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Sun HY, Gu Y, Sebaratnam DF. Avoiding severe drug hypersensitivity reactions: a case for HLA genotyping for at-risk patients. Med J Aust 2023; 219:285. [PMID: 37543844 DOI: 10.5694/mja2.52065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 08/07/2023]
Affiliation(s)
- Helen Y Sun
- University of New South Wales, Sydney, NSW
- Liverpool Hospital, Sydney, NSW
| | - Yaron Gu
- University of New South Wales, Sydney, NSW
- Liverpool Hospital, Sydney, NSW
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Buja A, De Luca G, Gatti M, Bonaldi F, Gardi M, Bortolami A, Sepulcri M, Bimbatti D, Baldo V, Scioni M, Maruzzo M, Basso U, Zagonel V. Estimated Direct Costs of Renal Cancer by Stage of Disease at Diagnosis and Phase of Its Management: A Whole-Disease Model. Clin Genitourin Cancer 2023:S1558-7673(23)00034-4. [PMID: 36906433 DOI: 10.1016/j.clgc.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Renal cell carcinoma (RCC) is the seventh most common neoplasm in high-income countries. New clinical pathways have been developed to deal with this tumor, which includes costly drugs that pose an economic threat to the sustainability of healthcare services. This study provides an estimate of the direct costs of care for patients with RCC by stage of disease (early vs. advanced) at diagnosis, and disease management phase along the pathway recommended by local and international guidelines. MATERIALS AND METHODS Considering the clinical pathway for RCC adopted in the Veneto region (north-east Italy) and the latest guidelines, we developed a very detailed "whole-disease" model that covers the probabilities of all potentially necessary diagnostic and therapeutic actions involved in the management of RCC. Based on the cost of each procedure according to the Veneto Regional Authority's official reimbursement tariffs, we estimated the total and average per-patient costs by stage of disease (early or advanced) and phase of its management. RESULTS In the first year after diagnosis, the mean expected cost of a patient with RCC is €12,991 if it is localized or locally-advanced and reaches €40,586 if it is advanced. For early disease, the main cost is incurred by surgery, whereas medical therapy (first and second line) and supportive care become increasingly important for metastatic disease. CONCLUSION It is crucially important to examine the direct costs of care for RCC, and to predict the burden on healthcare services of new oncological therapies and treatments, as the findings could be useful for policy-makers planning the allocation of resources.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padua, Padova, Italy.
| | - Giuseppe De Luca
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padua, Padova, Italy
| | - Maura Gatti
- Statistics Department, University of Padua, Padova, Italy; Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Filippo Bonaldi
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padua, Padova, Italy
| | - Mario Gardi
- Urology Clinic, Azienda Ospedale Universita Padova, Padova, Italy
| | - Alberto Bortolami
- Coordinamento Rete Oncologica Veneta ROV, Istituto Oncologico Veneto IOV IRCCS, Padova
| | - Matteo Sepulcri
- Radiotherapy Unit, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Davide Bimbatti
- Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Vincenzo Baldo
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padua, Padova, Italy
| | - Manuela Scioni
- Statistics Department, University of Padua, Padova, Italy
| | - Marco Maruzzo
- Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Umberto Basso
- Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Vittorina Zagonel
- Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
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Balmaseda M. The multiple hats of a Global Business Economist. Bus Econ 2022; 57:2-5. [PMID: 35125504 PMCID: PMC8801556 DOI: 10.1057/s11369-022-00252-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A Global Business Economist should look at the world as it is, not as it ought to be. We need to be mind-readers, anticipating questions to come and pre-emptively searching for answers. Global interactions are making economic analysis increasingly complex. We must incorporate these linkages into the analysis, enriching the models and the story with global flavour and supplementing both with on-the-field expert assessment. Our most valuable asset is our independence and credibility, so we must tell it just how it is. Finally, communication is key. It is paramount to make the story and our deliberations easy to understand, regardless of the complexity of the analysis.
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Cocco P, Messenger MP, Smith AF, West RM, Shinkins B. Integrating Early Economic Evaluation into Target Product Profile development for medical tests: advantages and potential applications. Int J Technol Assess Health Care 2021; 37:e68. [PMID: 34096483 DOI: 10.1017/S0266462321000374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Target Product Profiles (TPPs) outline the characteristics that new health technologies require to address an unmet clinical need. To date, published TPPs for medical tests have focused on infectious diseases, mostly in the context of low- and middle-income countries. Recently, there have been calls for a broader use of TPPs as a mechanism to ensure that diagnostic innovation is aligned with clinical needs, yet the methodology underpinning TPP development remains suboptimal. Here, we propose that early economic evaluation (EEE) should be integrated within the TPP methodology to create a more rigorous framework for the development of "fit-for-purpose" tests. We discuss the potential benefits that EEE could bring to the core activities underpinning TPP development-scoping, drafting, consensus building, and updating-and argue that using EEE to help inform TPPs provides a more objective, evidence-based, and transparent approach to defining test specifications.
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Yap SJ, Forero R, Greenfield D, Hillman KM. Implementing value-based health care at scale: the NSW experience. Med J Aust 2020; 213:285-285.e1. [PMID: 32846461 DOI: 10.5694/mja2.50745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Su-Jen Yap
- Simpson Centre for Health Services Research, UNSW, Sydney, NSW
| | - Roberto Forero
- Simpson Centre for Health Services Research, UNSW, Sydney, NSW.,UNSW, Sydney, NSW
| | - David Greenfield
- Australian institute of Health Service Management, University of Tasmania, Sydney, NSW
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Radeva D, Hopkin G, Mossialos E, Borrill J, Osipenko L, Naci H. Assessment of technical errors and validation processes in economic models submitted by the company for NICE technology appraisals. Int J Technol Assess Health Care 2020; 36:1-6. [PMID: 32618536 DOI: 10.1017/s0266462320000422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Economic models play a central role in the decision-making process of the National Institute for Health and Care Excellence (NICE). Inadequate validation methods allow for errors to be included in economic models. These errors may alter the final recommendations and have a significant impact on outcomes for stakeholders. OBJECTIVE To describe the patterns of technical errors found in NICE submissions and to provide an insight into the validation exercises carried out by the companies prior to submission. METHODS All forty-one single technology appraisals (STAs) completed in 2017 by NICE were reviewed and all were on medicines. The frequency of errors and information on their type, magnitude, and impact was extracted from publicly available NICE documentation along with the details of model validation methods used. RESULTS Two STAs (5 percent) had no reported errors, nineteen (46 percent) had between one and four errors, sixteen (39 percent) had between five and nine errors, and four (10 percent) had more than ten errors. The most common errors were transcription errors (29 percent), logic errors (29 percent), and computational errors (25 percent). All STAs went through at least one type of validation. Moreover, errors that were notable enough were reported in the final appraisal document (FAD) in eight (20 percent) of the STAs assessed but each of these eight STAs received positive recommendations. CONCLUSIONS Technical errors are common in the economic models submitted to NICE. Some errors were considered important enough to be reported in the FAD. Improvements are needed in the model development process to ensure technical errors are kept to a minimum.
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Affiliation(s)
- Demi Radeva
- Department of Health Policy, London School of Economics and Political Science, London, UK
- United Health Group, Eden Prairie, Minnesota, USA
| | - Gareth Hopkin
- Department of Health Policy, London School of Economics and Political Science, London, UK
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - Leeza Osipenko
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, London, UK
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Affiliation(s)
| | - Amanda Barnard
- Rural Clinical School, Australian National University, Canberra, ACT
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9
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Patel B, Peiris DP, Patel A, Jan S, Harris MF, Usherwood T, Panaretto K, Lung T. A computer-guided quality improvement tool for primary health care: cost-effectiveness analysis based on TORPEDO trial data. Med J Aust 2020; 213:73-78. [PMID: 32594567 DOI: 10.5694/mja2.50667] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 05/04/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of a computer-guided quality improvement intervention for primary health care management of cardiovascular disease (CVD) in people at high risk. DESIGN Modelled cost-effectiveness analysis of the HealthTracker intervention and usual care for people with high CVD risk, based on TORPEDO trial data on prescribing patterns, changes in intermediate risk factors (low-density lipoprotein cholesterol, systolic blood pressure), and Framingham risk scores. PARTICIPANTS Hypothetical population of people with high CVD risk attending primary health care services in a New South Wales primary health network (PHN) of mean size. INTERVENTION HealthTracker, integrated into health care provider electronic health record systems, provides real time decision support, risk communication, a clinical audit tool, and a web portal for performance feedback. MAIN OUTCOME MEASURES Incremental cost-effectiveness ratios (ICERs): difference in costs of the intervention and usual care divided by number of CVD events averted with HealthTracker. RESULTS The estimated numbers of major CVD events over five years per 1000 patients at high CVD risk were lower in PHNs using HealthTracker, both for patients with prior CVD events (secondary prevention; 259 v 267 with usual care) and for those without prior events (primary prevention; 168 v 176). Medication costs were higher and hospitalisation costs lower with HealthTracker than with usual care for both primary and secondary prevention. The estimated ICER for one averted CVD event was $7406 for primary prevention and $17 988 for secondary prevention. CONCLUSION Modelled cost-effectiveness analyses provide information that can assist decisions about investing in health care quality improvement interventions. We estimate that HealthTracker could prevent major CVD events for less than $20 000 per event averted. TRIAL REGISTRATION (TORPEDO) Australian New Zealand Clinical Trials Registry, ACTRN 12611000478910.
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Affiliation(s)
- Bindu Patel
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW
| | - David P Peiris
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW
| | - Anushka Patel
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW
| | - Stephen Jan
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW.,Sydney Medical School, the University of Sydney, Sydney, NSW
| | - Tim Usherwood
- Sydney Medical School, the University of Sydney, Sydney, NSW
| | - Kathryn Panaretto
- Centre for Chronic Disease, University of Queensland, Brisbane, QLD.,Medical Centre Queensland, University of Technology, Brisbane, QLD
| | - Thomas Lung
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW
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Shields RK, Dudley-Javoroski S. Physiotherapy education is a good financial investment, up to a certain level of student debt: an inter-professional economic analysis. J Physiother 2018; 64:183-191. [PMID: 29914805 DOI: 10.1016/j.jphys.2018.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/16/2018] [Indexed: 10/28/2022] Open
Abstract
QUESTIONS What is the economic value of a physiotherapy career relative to other healthcare professions? Is the graduate debt reported for physiotherapy manageable according to recommended salary-weighted debt service ratio benchmarks? DESIGN Net present value (NPV) is an economic modelling approach that compares costs and benefits of an investment such as healthcare education. An economic analysis using the NPV approach was conducted and reported in US dollars for the Doctor of Physical Therapy degree. Comparable calculations were made for a range of other healthcare qualifications. Debt service ratios were also calculated under a range of scenarios. OUTCOME MEASURES Entry-level salaries and rate of salary growth were obtained from government databases. Student debt levels were obtained from published sources. Because no national estimate exists for physical therapy student debt, debt was modelled for recent Doctor of Physical Therapy (DPT) graduates and for several hypothetical debt tiers. The NPV modelled future physical therapy earnings less the cost of education and the opportunity cost of foregone earnings from alternate careers. RESULTS At the debt level reported by recent graduates (US $86563), physical therapy NPV was higher than occupational therapy, optometry, veterinary medicine, and chiropractic but lower than dentistry, pharmacy, nurse practitioner, physician assistant, and all medical specialties. At $150000 debt, physical therapy NPV falls below all careers except veterinary medicine and chiropractic. Students with>$200000 debt may not achieve recommended repayment benchmarks. At high debt levels (>$266000), physical therapy NPV no longer exceeds that of a bachelor's degree. CONCLUSION Physiotherapy education is a good financial investment, up to a certain level of student debt. Students should carefully consider the amount of debt they are willing to incur in order to pursue a physiotherapy career. Likewise, physiotherapy education programs should consider the role they may play in bolstering the economic value of their graduates' future careers. [Shields RK, Dudley-Javoroski S (2018) Physiotherapy education is a good financial investment, up to a certain level of student debt: an inter-professional economic analysis. Journal of Physiotherapy 64: 182-190].
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Affiliation(s)
- Richard K Shields
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, USA
| | - Shauna Dudley-Javoroski
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, USA
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Pham CT, Karnon JD, Middleton PF, Bloomfield FH, Groom KM, Crowther CA, Mol BW. Randomised clinical trials in perinatal health care: a cost-effective investment. Med J Aust 2017; 207:289-293. [PMID: 28954615 DOI: 10.5694/mja16.01178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 04/28/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the health and economic impacts of implementing efficacious treatment interventions with maintaining standard practice in maternal and perinatal health care. DESIGN AND SETTING We identified randomised clinical trials (RCTs) in the Perinatal Society of Australia and New Zealand trials database that commenced recruitment during 2008 and had completed recruitment by 2015. Data from clinical trial registries and publications were collated to calculate the potential cost savings achievable by implementing efficacious treatment interventions. MAIN OUTCOME MEASURE Projected net cost savings over 5 years. RESULTS Twenty-three eligible RCTs covering a range of behavioural and clinical interventions were identified, of which six reported interventions superior to standard practice (four trials) or placebo (two). The outcomes (but not the costs) of 17 trials were excluded from analysis (no difference between intervention and comparator groups in seven trials, recruitment problems in six, findings not yet published in four). The total funding amount for the 23 trials was $20.3 million; the potential cost savings over 5 years if the findings of the six trials reporting superior interventions were implemented was estimated to be $26.3 million if 10% of the eligible populations received the effective interventions, and $262.8 million with 100% implementation. CONCLUSIONS Our retrospective analysis highlights the value of research in perinatal care and the importance of implementing positive findings for realising its value. Future trials in maternal and perinatal health care may provide significant returns on investment by informing clinical practice, improving patient outcomes and reducing health care costs.
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Affiliation(s)
| | | | | | | | | | | | - Ben W Mol
- University of Auckland, Auckland, New Zealand
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Jones JW, Antle JM, Basso B, Boote KJ, Conant RT, Foster I, Godfray HCJ, Herrero M, Howitt RE, Janssen S, Keating BA, Munoz-Carpena R, Porter CH, Rosenzweig C, Wheeler TR. Toward a new generation of agricultural system data, models, and knowledge products: State of agricultural systems science. Agric Syst 2017; 155:269-288. [PMID: 28701818 PMCID: PMC5485672 DOI: 10.1016/j.agsy.2016.09.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 09/22/2016] [Accepted: 09/29/2016] [Indexed: 05/05/2023]
Abstract
We review the current state of agricultural systems science, focusing in particular on the capabilities and limitations of agricultural systems models. We discuss the state of models relative to five different Use Cases spanning field, farm, landscape, regional, and global spatial scales and engaging questions in past, current, and future time periods. Contributions from multiple disciplines have made major advances relevant to a wide range of agricultural system model applications at various spatial and temporal scales. Although current agricultural systems models have features that are needed for the Use Cases, we found that all of them have limitations and need to be improved. We identified common limitations across all Use Cases, namely 1) a scarcity of data for developing, evaluating, and applying agricultural system models and 2) inadequate knowledge systems that effectively communicate model results to society. We argue that these limitations are greater obstacles to progress than gaps in conceptual theory or available methods for using system models. New initiatives on open data show promise for addressing the data problem, but there also needs to be a cultural change among agricultural researchers to ensure that data for addressing the range of Use Cases are available for future model improvements and applications. We conclude that multiple platforms and multiple models are needed for model applications for different purposes. The Use Cases provide a useful framework for considering capabilities and limitations of existing models and data.
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Affiliation(s)
- James W. Jones
- University of Florida, Agricultural and Biological Engineering Department, Museum Road, Gainesville, FL 32611, USA
| | | | | | - Kenneth J. Boote
- University of Florida, Agricultural and Biological Engineering Department, Museum Road, Gainesville, FL 32611, USA
| | | | - Ian Foster
- University of Chicago and Argonne National Laboratory, USA
| | - H. Charles J. Godfray
- Oxford Martin Programme on the Future of Food, University of Oxford, Department of Zoology, South Parks Rd., Oxford OX1 3PS, UK
| | | | | | | | | | - Rafael Munoz-Carpena
- University of Florida, Agricultural and Biological Engineering Department, Museum Road, Gainesville, FL 32611, USA
| | - Cheryl H. Porter
- University of Florida, Agricultural and Biological Engineering Department, Museum Road, Gainesville, FL 32611, USA
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Spin P, Sketris I, Hill-Taylor B, Ward C, Hurley KF. A Cost Analysis of Salbutamol Administration by Metered-Dose Inhalers with Spacers versus Nebulization for Patients with Wheeze in the Pediatric Emergency Department: Evidence from Observational Data in Nova Scotia. CAN J EMERG MED 2017; 19:1-8. [PMID: 27506243 DOI: 10.1017/cem.2016.344] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Despite evidence demonstrating the advantages of metered-dose inhalers with spacers (MDI-s), nebulization (NEB) remains the primary method of asthma treatment in some pediatric emergency departments (PEDs). There is a perception that delivering salbutamol by MDI-s is more costly than by NEB. This research evaluates the relative costs of MDI-s and NEB using local, hospital-specific, patient-level data. METHODS Regression models estimated associations between the salbutamol inhalation method and costs, length of stay (LOS) in the PED and hospital, and the probability of admission. Our population was a random sample of 822 patients presenting with wheeze to the PED in 2008/2009. Control variables included age, sex, triage acuity, time of PED visit, other medications, and vitals. Costs were calculated using the prices and quantities of medical resources used per treatment. Probabilistic sensitivity analysis was used. RESULTS Treatment with MDI-s versus NEB was associated with an absolute decrease in hospitalization of 4.4% (p<0.05) and a 25-hour (p<0.001) reduction in average inpatient stay, after controlling for triage acuity and patient characteristics. This resulted in savings of $24/patient in the PED and $180/patient overall (p<0.001). Inpatient care accounted for more than 90% of total patient costs. CONCLUSIONS Our results suggest economic gains associated with MDI-s for salbutamol inhalation in PEDs. Sensitivity analyses show that this conclusion is not affected by changes in model parameters that may differ by jurisdiction. Since most facilities already collect the data used for this study, our methods could be adopted for a cross-jurisdictional account of the cost effectiveness of MDI-s.
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Madan J, Ades T, Barton P, Bojke L, Choy E, Helliwell P, Jobanputra P, Stein K, Stevens A, Tosh J, Verstappen S, Wailoo A. Consensus Decision Models for Biologics in Rheumatoid and Psoriatic Arthritis: Recommendations of a Multidisciplinary Working Party. Rheumatol Ther 2015; 2:113-25. [PMID: 27747536 DOI: 10.1007/s40744-015-0020-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Indexed: 11/16/2022] Open
Abstract
Introduction Biologic therapies are efficacious but costly. A number of health economic models have been developed to determine the most cost-effective way of using them in the treatment pathway. These models have produced conflicting results, driven by differences in assumptions, model structure, and data, which undermine the credibility of funding decisions based on modeling studies. A Consensus Working Party met to discuss recommendations and approaches for future models of biologic therapies. Methods Our working party consisted of clinical specialists, modelers, and policy makers. Two 1-day meetings were held for members to arrive at consensus positions on model structure, assumptions, and appropriate data sources. These views were guided by clinical aspects of rheumatoid and psoriatic arthritis and the principles of evidence-based medicine. Where opinions differed, we sought to identify a research agenda that would generate the evidence needed to reach consensus. Results We gained consensus in four areas of model development: initial response to treatment; long-term disease progression; lifetime costs and benefits; and model structure. Consensus was also achieved on some key parameters such as choices of outcome measures, methods for extrapolation beyond trial data, and treatment switching. A research agenda to support further consensus was also identified. Conclusion Consensus guidance that fully reflects current evidence and clinical understanding was gained successfully. In addition, research needs have been identified. Such guidance can be updated as evidence develops and policy questions change and need not be prescriptive as long as deviations from consensus are clearly explained and justified. Funding Arthritis Research UK and the UK Medical Research Council Network of Hubs for Trials Methodology Research. Electronic supplementary material The online version of this article (doi:10.1007/s40744-015-0020-0) contains supplementary material, which is available to authorized users.
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Akhmetov I, Bubnov RV. Assessing value of innovative molecular diagnostic tests in the concept of predictive, preventive, and personalized medicine. EPMA J 2015; 6:19. [PMID: 26425215 PMCID: PMC4588236 DOI: 10.1186/s13167-015-0041-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/08/2015] [Indexed: 02/07/2023]
Abstract
Molecular diagnostic tests drive the scientific and technological uplift in the field of predictive, preventive, and personalized medicine offering invaluable clinical and socioeconomic benefits to the key stakeholders. Although the results of diagnostic tests are immensely influential, molecular diagnostic tests (MDx) are still grudgingly reimbursed by payers and amount for less than 5 % of the overall healthcare costs. This paper aims at defining the value of molecular diagnostic test and outlining the most important components of "value" from miscellaneous assessment frameworks, which go beyond accuracy and feasibility and impact the clinical adoption, informing healthcare resource allocation decisions. The authors suggest that the industry should facilitate discussions with various stakeholders throughout the entire assessment process in order to arrive at a consensus about the depth of evidence required for positive marketing authorization or reimbursement decisions. In light of the evolving "value-based healthcare" delivery practices, it is also recommended to account for social and ethical parameters of value, since these are anticipated to become as critical for reimbursement decisions and test acceptance as economic and clinical criteria.
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Affiliation(s)
- Ildar Akhmetov
- />Strategic Market Intelligence Dep., Unicorn, P.O.B. 91, Zhytomyr, 10020 Ukraine
| | - Rostyslav V. Bubnov
- />Clinical Hospital “Pheophania” of State Affairs Department, Zabolotny Str., 21, Kyiv, 03680 Ukraine
- />Zabolotny Institute of Microbiology and Virology, National Academy of Sciences of Ukraine, Zabolotny Str., 154, Kyiv, 03680 Ukraine
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Abstract
OBJECTIVES Economic evaluation is becoming more common and important as new biologic therapies for rheumatoid arthritis (RA) are developed. While much has been published about how to design cost-utility models for RA to conduct these evaluations, less has been written about the sources of data populating those models. The goal is to review the literature and to provide recommendations for future data collection efforts. METHODS This study reviewed RA cost-utility models published between January 2006 and February 2014 focusing on five key sources of data (health-related quality-of-life and utility, clinical outcomes, disease progression, course of treatment, and healthcare resource use and costs). It provided recommendations for collecting the appropriate data during clinical and other studies to support modeling of biologic treatments for RA. RESULTS Twenty-four publications met the selection criteria. Almost all used two steps to convert clinical outcomes data to utilities rather than more direct methods; most did not use clinical outcomes measures that captured absolute levels of disease activity and physical functioning; one-third of them, in contrast with clinical reality, assumed zero disease progression for biologic-treated patients; little more than half evaluated courses of treatment reflecting guideline-based or actual clinical care; and healthcare resource use and cost data were often incomplete. CONCLUSIONS Based on these findings, it is recommended that future studies collect clinical outcomes and health-related quality-of-life data using appropriate instruments that can convert directly to utilities; collect data on actual disease progression; be designed to capture real-world courses of treatment; and collect detailed data on a wide range of healthcare resources and costs.
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Perrin A, Sherman S, Pal S, Chua A, Gorritz M, Liu Z, Wang X, Culver K, Casciano R, Garrison LP. Lifetime cost of everolimus vs axitinib in patients with advanced renal cell carcinoma who failed prior sunitinib therapy in the US. J Med Econ 2015; 18:200-9. [PMID: 25422989 DOI: 10.3111/13696998.2014.985789] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Everolimus and axitinib are approved in the US to treat patients with advanced renal cell carcinoma (RCC) after failure on sunitinib or sorafenib, and one prior systemic therapy (e.g., sunitinib), respectively. Two indirect comparisons performed to evaluate progression-free survival in patients treated with everolimus vs axitinib suggested similar efficacy between the two treatments. Therefore, this analysis compares the lifetime costs of these two therapies among sunitinib-refractory advanced RCC patients from a US payer perspective. RESEARCH DESIGN AND METHODS A Markov model was developed to simulate a cohort of sunitinib-refractory advanced RCC patients and estimate the cost of treating patients with everolimus vs axitinib. The following health states were included: stable disease without adverse events (AEs), stable disease with AEs, disease progression (PD), and death. The model included the following resources: active treatments, post-progression treatments, adverse events, physician and nurse visits, scans and tests, and palliative care. Resource utilization inputs were derived from a US claims database analysis. Additionally, a 3% annual discount rate was applied to costs, and the robustness of the model results was tested by conducting sensitivity analyses, including those on dosing scheme and post-progression treatment costs. RESULTS Base case results demonstrated that patients treated with everolimus cost an average of $12,985 (11%) less over their lifetimes than patients treated with axitinib. The primary difference in costs was related to active treatment, which was largely driven by axitinib's higher dose intensity. RESULTS remained consistent across sensitivity analyses for AE and PD treatment costs, as well as dose intensity and discount rates. CONCLUSION The results suggest that everolimus likely leads to lower lifetime costs than axitinib for sunitinib-refractory advanced RCC patients in the US.
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Amin A, Jing Y, Trocio J, Lin J, Lingohr-Smith M, Graham J. Evaluation of medical costs associated with use of new oral anticoagulants compared with standard therapy among venous thromboembolism patients. J Med Econ 2014; 17:763-70. [PMID: 25078794 DOI: 10.3111/13696998.2014.950670] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study evaluated differences in medical costs associated with clinical end-points from randomized clinical trials that compared the new oral anticoagulants (NOACs), dabigatran, rivaroxaban, apixaban, and edoxaban, to standard therapy for treatment of patients with venous thromboembolism (VTE). RESEARCH DESIGN AND METHODS Event rates of efficacy and safety end-points from the clinical trials (RE-COVER, RE-COVER II, EINSTEIN-Pooled, AMPLIFY, Hokusai-VTE trial) were obtained from published literature. Incremental annual medical costs among patients with clinical events from a US payer perspective were obtained from the literature or healthcare claims databases and inflation adjusted to 2013 costs. Differences in total medical costs associated with clinical end-points for the NOACs vs standard therapy were then estimated. One-way and Monte Carlo sensitivity analyses were carried out. RESULTS A lower rate of major bleedings was associated with use of any of the NOACs vs standard therapy. Except for dabigatran, use of NOACs was also associated with a lower rate of recurrent VTE/death. As a result of the reduction in clinical event rates, the overall medical cost differences were -$146, -$482, -$918, and -$344 for VTE patients treated with dabigatran, rivaroxaban, apixaban, and edoxaban, respectively, vs patients treated with standard therapy. CONCLUSIONS When any of the four NOACs are used instead of standard therapy for acute VTE, treatment medical costs are reduced. Apixaban is associated with the greatest reduction in medical costs, which is driven by medical cost reductions associated with both efficacy and safety end-points. Further evaluation may be needed to validate these results in the real-world setting.
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Halpern MT, Brown RE, Drolet M, Sorensen SV, Mandell LA. Decision analysis modelling of costs and outcomes following cefepime monotherapy in Canada. Can J Infect Dis 1997; 8:19-27. [PMID: 22514473 PMCID: PMC3327332 DOI: 10.1155/1997/106462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/1996] [Accepted: 10/10/1996] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the comparative cost of treatment and intermediate outcomes (percentage resistant organisms, days in hospital, etc) among cefepime and alternative parenteral antibiotics used for empiric monotherapy. DESIGN Decision analysis model, based on published literature, clinical trial results and information from infectious disease clinicians. SETTING A Canadian tertiary care hospital. INTERVENTION Comparison of cefepime, ceftazidime, ceftriaxone, cefotaxime and ciprofloxacin in the treatment of lower respiratory tract infections, urinary tract infections, skin/soft tissue infections, septicemia and febrile neutropenia. MAIN RESULTS Cefepime treatment results in the lowest average cost per patient when used as initial empiric therapy for lower respiratory tract infections and for skin/soft tissue infections. Cefepime therapy is among the lowest cost treatments for the other infectious disease conditions and has the lowest cost for a weighted 'average' condition. Sensitivity analysis indicates that model results are most sensitive to duration of hospitalization. CONCLUSIONS Initial empiric monotherapy with cefepime for serious infectious disease conditions may result in cost savings compared with alternative parenteral agents.
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Affiliation(s)
- Michael T Halpern
- MEDTAP International, Bethesda, Maryland; Bristol-Myers Squibb, Montreal, Quebec; and Division of Infectious Diseases, McMaster University, Hamilton, Ontario
| | - Ruth E Brown
- MEDTAP International, Bethesda, Maryland; Bristol-Myers Squibb, Montreal, Quebec; and Division of Infectious Diseases, McMaster University, Hamilton, Ontario
| | - Martine Drolet
- MEDTAP International, Bethesda, Maryland; Bristol-Myers Squibb, Montreal, Quebec; and Division of Infectious Diseases, McMaster University, Hamilton, Ontario
| | - Sonja V Sorensen
- MEDTAP International, Bethesda, Maryland; Bristol-Myers Squibb, Montreal, Quebec; and Division of Infectious Diseases, McMaster University, Hamilton, Ontario
| | - Lionel A Mandell
- MEDTAP International, Bethesda, Maryland; Bristol-Myers Squibb, Montreal, Quebec; and Division of Infectious Diseases, McMaster University, Hamilton, Ontario
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