Does Cost-Effectiveness Analysis Have a Role in US Managed Care Drug Formularies? An Empirical Study of Utilization, Costs, Outcomes, and Elasticity of Demand of a Value-Based Formulary

Thesis (Ph.D.)--University of Washington, 2015

A cost-benefit analysis of culling badgers to control bovine tuberculosis

Bovine tuberculosis (TB) is an important economic problem. The incidence of TB in cattle herds has steadily risen in the UK, and badgers are strongly implicated in spreading disease. Since the mid-1970s the UK government has adopted a number of badger culling strategies to attempt to reduce infection in cattle. In this report, an established model has been used to simulate TB in badgers, transmission to cattle, and control by badger culling. Costs were supplied by the UK Government's Department for Environment Food and Rural Affairs (Defra) for badger trapping and gassing. Regardless of culling intensity or area simulated, an overall reduction in the herd breakdown rate was seen. With a high culling efficacy and no social perturbation, the mean Net Present Value of a few simulated culling strategies in an "ideal world" was positive, meaning the economic benefits outweighed the costs. Further work is required before these results could be considered definitive, as it is necessary to evaluate uncertainties and simulate less than perfect conditions. (c) 2005 Elsevier Ltd. All rights reserved.

A cost-effectiveness analysis of a telephone-linked care intervention for individuals with Type 2 diabetes

AIM: To assess the cost-effectiveness of an automated telephone-linked care intervention, Australian TLC Diabetes, delivered over 6 months to patients with established Type 2 diabetes mellitus and high glycated haemoglobin level, compared to usual care. METHODS: A Markov model was designed to synthesize data from a randomized controlled trial of TLC Diabetes (n=120) and other published evidence. The 5-year model consisted of three health states related to glycaemic control: 'sub-optimal' HbA1c ≥58mmol/mol (7.5%); 'average' ≥48-57mmol/mol (6.5-7.4%) and 'optimal' <48mmol/mol (6.5%) and a fourth state 'all-cause death'. Key outcomes of the model include discounted health system costs and quality-adjusted life years (QALYS) using SF-6D utility weights. Univariate and probabilistic sensitivity analyses were undertaken. RESULTS: Annual medication costs for the intervention group were lower than usual care [Intervention: £1076 (95%CI: £947, £1206) versus usual care £1271 (95%CI: £1115, £1428) p=0.052]. The estimated mean cost for intervention group participants over five years, including the intervention cost, was £17,152 versus £17,835 for the usual care group. The corresponding mean QALYs were 3.381 (SD 0.40) for the intervention group and 3.377 (SD 0.41) for the usual care group. Results were sensitive to the model duration, utility values and medication costs. CONCLUSION: The Australian TLC Diabetes intervention was a low-cost investment for individuals with established diabetes and may result in medication cost-savings to the health system. Although QALYs were similar between groups, other benefits arising from the intervention should also be considered when determining the overall value of this strategy.

Impact of control strategies on bellyache bush (Jatropha gossypiifolia L.) mortality, seedling recruitment, population dynamics, pasture yield and cost analysis

Bellyache bush (Jatropha gossypiifolia L.) is an invasive weed that has the potential to greatly reduce biodiversity and pasture productivity in northern Australia’s rangelands. This paper reports an approach to develop best practice options for controlling medium to dense infestations of bellyache bush using combinations of control methods. The efficacy of five single treatments including foliar spraying, slashing, stick raking, burning and do nothing (control) were compared against 15 combinations of these treatments over 4 successive years. Treatments were evaluated using several attributes, including plant mortality, changes in population demographics, seedling recruitment, pasture yield and cost of treatment. Foliar spraying once each year for 4 years proved the most cost-effective control strategy, with no bellyache bush plants recorded at the end of the study. Single applications of slashing, stick raking and to a lesser extent burning, when followed up with foliar spraying also led to significantly reduced densities of bellyache bush and changed the population from a growing one to a declining one. Total experimental cost estimates over 4 successive years for treatments where burning, stick raking, foliar spraying, and slashing were followed with foliar spraying were AU$408, AU$584, AU$802 and AU$789 ha–1, respectively. Maximum pasture yield of 5.4 t ha–1 occurred with repeated foliar spraying. This study recommends that treatment combinations using either foliar spraying alone or as a follow up with slashing, stick raking or burning are best practice options following consideration of the level of control, changes in pasture yield and cost effectiveness.

Risk-based surveillance for avian influenza control along poultry market chains in South China: The value of social network analysis.

Over the past two decades, the poultry sector in China went through a phase of tremendous growth as well as rapid intensification and concentration. Highly pathogenic avian influenza virus (HPAIV) subtype H5N1 was first detected in 1996 in Guangdong province, South China and started spreading throughout Asia in early 2004. Since then, control of the disease in China has relied heavily on wide-scale preventive vaccination combined with movement control, quarantine and stamping out. This strategy has been successful in drastically reducing the number of outbreaks during the past 5 years. However, HPAIV H5N1 is still circulating and is regularly isolated in traditional live bird markets (LBMs) where viral infection can persist, which represent a public health hazard for people visiting them. The use of social network analysis in combination with epidemiological surveillance in South China has identified areas where the success of current strategies for HPAI control in the poultry production sector may benefit from better knowledge of poultry trading patterns and the LBM network configuration as well as their capacity for maintaining HPAIV H5N1 infection. We produced a set of LBM network maps and estimated the associated risk of HPAIV H5N1 within LBMs and along poultry market chains, providing new insights into how live poultry trade and infection are intertwined. More specifically, our study provides evidence that several biosecurity factors such as daily cage cleaning, daily cage disinfection or manure processing contribute to a reduction in HPAIV H5N1 presence in LBMs. Of significant importance is that the results of our study also show the association between social network indicators and the presence of HPAIV H5N1 in specific network configurations such as the one represented by the counties of origin of the birds traded in LBMs. This new information could be used to develop more targeted and effective control interventions.

Multicentre randomised control trial comparing real time teledermatology with conventional outpatient dermatological care:societal cost-benefit analysis

Comparison of real time teledermatology with outpatient dermatology in terms of clinical outcomes, cost-benefits, and patient reattendance.

A value chain analysis of tuna industry in Ghana

Every can of tuna purchased by the consumer has taken a long journey before reaching the supermarket shelves. For each can bought there is a lengthy process from sea to shelf. A large proportion of the tuna cans purchased in the European Union come all the way from West Africa; a developing region with a high dependency on fisheries. Amidst an ever-increasing demand for tuna products the global tuna fisheries are set to continue expanding, apparently one of the last natural resource based industries fit to do so in West Africa. Tuna is the biggest fisheries export and dominates the fisheries sector in Ghana, a country situated in West Africa. This thesis aims to understand how this globally important industrial fisheries functions in terms of procedures, practices, Governance and finance. Socioeconomic influences, in the setting of a developing country, were also examined. For these purposes a Value Chain Analysis was employed. A Value Chain Analysis is a tool commonly used to understand how different companies and organizations participate in a domestic policy environment, which directs conclusion in the global economy. This analysis has the potential to allow researchers to fully understand a commodity chain and hence identify realistic opportunities for consequential improvements. Interviews and questionnaires were employed in-field Ghana along with secondary data collection techniques. It was found that the fisheries functions at the production level under influences from large multinational companies and tends to operate with a certain degree of lawlessness. Governance over the value chain is well defined, however implementation is poor or non-existent. The processors, whom are also dominated by multinationals, exert some control over the producers and their sales, however the high value links which are highlighted occur at the retail stage. Socioeconomic dynamics acting in the chain included the lack of communication between the public and private sector, power imbalances amongst players at production, the role of local businesswomen as actors in the chain and the general characteristics of the workers in the industry. Value addition and upgrading are needed the most in Governance over the chain, especially within Monitoring, Control and Surveillance. The results of the study provide a wealth of material about the components of a cost-heavy fishing industry in a developing country; an industry on which many eyes have recently turned due to illegal fishing activities. It highlights clearly where funding and future focus are needed. This value chain can be used as a guide for those that need to comprehend the financial complexities and real life dynamics of the Ghanaian tuna fishing industry today.

Economic efficiency analysis of different strategies to control post-weaning multi-systemic wasting syndrome and porcine circovirus type 2 subclinical infection in 3-weekly batch system farms.

The study assessed the economic efficiency of different strategies for the control of post-weaning multi-systemic wasting syndrome (PMWS) and porcine circovirus type 2 subclinical infection (PCV2SI), which have a major economic impact on the pig farming industry worldwide. The control strategies investigated consisted on the combination of up to 5 different control measures. The control measures considered were: (1) PCV2 vaccination of piglets (vac); (2) ensuring age adjusted diet for growers (diets); (3) reduction of stocking density (stock); (4) improvement of biosecurity measures (bios); and (5) total depopulation and repopulation of the farm for the elimination of other major pathogens (DPRP). A model was developed to simulate 5 years production of a pig farm with a 3-weekly batch system and with 100 sows. A PMWS/PCV2SI disease and economic model, based on PMWS severity scores, was linked to the production model in order to assess disease losses. This PMWS severity scores depends on the combination post-weaning mortality, PMWS morbidity in younger pigs and proportion of PCV2 infected pigs observed on farms. The economic analysis investigated eleven different farm scenarios, depending on the number of risk factors present before the intervention. For each strategy, an investment appraisal assessed the extra costs and benefits of reducing a given PMWS severity score to the average score of a slightly affected farm. The net present value obtained for each strategy was then multiplied by the corresponding probability of success to obtain an expected value. A stochastic simulation was performed to account for uncertainty and variability. For moderately affected farms PCV2 vaccination alone was the most cost-efficient strategy, but for highly affected farms it was either PCV2 vaccination alone or in combination with biosecurity measures, with the marginal profitability between 'vac' and 'vac+bios' being small. Other strategies such as 'diets', 'vac+diets' and 'bios+diets' were frequently identified as the second or third best strategy. The mean expected values of the best strategy for a moderately and a highly affected farm were £14,739 and £57,648 after 5 years, respectively. This is the first study to compare economic efficiency of control strategies for PMWS and PCV2SI. The results demonstrate the economic value of PCV2 vaccination, and highlight that on highly affected farms biosecurity measures are required to achieve optimal profitability. The model developed has potential as a farm-level decision support tool for the control of this economically important syndrome.

A unified framework for linear function approximation of value functions in stochastic control

This paper contributes with a unified formulation that merges previ- ous analysis on the prediction of the performance ( value function ) of certain sequence of actions ( policy ) when an agent operates a Markov decision process with large state-space. When the states are represented by features and the value function is linearly approxi- mated, our analysis reveals a new relationship between two common cost functions used to obtain the optimal approximation. In addition, this analysis allows us to propose an efficient adaptive algorithm that provides an unbiased linear estimate. The performance of the pro- posed algorithm is illustrated by simulation, showing competitive results when compared with the state-of-the-art solutions.

Cost effectiveness analysis of improved blood pressure control in hypertensive patients with type 2 diabetes: UKPDS 40

Objectives: To estimate the economic efficiency of tight blood pressure control, with angiotensin converting enzyme inhibitors or β blockers, compared with less tight control in hypertensive patients with type 2 diabetes.

Mennyit ér a zajterhelés csökkenése? Zajvédelmi intézkedések értékelése a haszonértékelések átvitelével (The value of silence. An application of benefit-transfer methodology for evaluating noise-control actions)

Mind ez ideig a gyakorlatban kevéssé aknázták ki azt a lehetőséget, hogy a természeti tőke pénzbeli értékelése számszerű, egzakt információt nyújthat a döntéshozóknak. A szerzők a zajvédelmi intézkedések példáján keresztül tekintik át a természeti tőkejavak közgazdasági értékelésében rejlő lehetőségeket. Ismertetik a költség-haszon elemzés környezeti javakkal bővített formájának előnyeit, majd az általában elhanyagolt, a nem piaci javak által nyújtott haszon közgazdasági értékelésére alkalmas eljárásokat, külön kitérve a zajterhelés területére. Nagy hangsúlyt helyeznek a haszonfelmérések átvitelének széles körben alkalmazható módszereire. Bemutatják az általuk gyakorlatban végzett kutatás során szerzett tapasztalatokat, különös tekintettel arra, hogy a haszonértékelések átvitele hogyan járulhat hozzá a természeti tőkejavakkal kapcsolatos döntések során a társadalmi haszon maximalizálásához. _____ The paper offers an overview of the economic valuation of transportation-induced noise and cost-benefit analysis of noise-control measures and actions. Although economic valuation can provide hard, monetized data for decision-makers, it is relatively underused in practice. The study focuses on benefit-transfer methodology, where values obtained in previous cases are used as the basis for current evaluation. A specific application of benefit transfer is presented by a recent pilot project in Hungary, whereby a tool was developed for LGOs, enabling them to make preliminary assessments of the benefits of potential noise-control measures and rank possible options. This can help to optimize the benefits to society using limited resources.

Transaction Cost Analysis of PPP Risk Share

PPP (Public Private Partnerships) is a new operation mode of infrastructure projects, which usually undergo long periods and have various kinds of risks in technology, market, politics, policy, finance, society, natural conditions and cooperation. So the government and the private agency should establish the risk-sharing mechanism to ensure the successful implementation of the project. As an important branch of the new institutional economics, transaction cost economics and its analysis method have been proved to be beneficial to the proper allocation of risks between the two parts in PPP projects and the improvement of operation efficiency of PPP risk-sharing mechanism. This paper analyzed the transaction cost of the projects risk-sharing method and the both risk carriers. It pointed out that the risk-sharing method of PPP projects not only reflected the spirit of cooperation between public sector and private agency, but also minimized the total transaction cost of the risk sharing mechanism itself. Meanwhile, the risk takers had to strike a balance between the beforehand cost and the afterwards cost so as to control the cost of risk management. The paper finally suggested three ways which might be useful to reduce the transaction cost: to choose appropriate type of contract of PPP risk-sharing mechanism, to prevent information asymmetry and to establish mutual trust between the two participants.