An economic evaluation of plasma production via erythroplasmapheresis and whole blood collection

This paper presents cost-effectiveness analyses (CEAs) of plasma collection via two alternative methods: whole blood collection (WBC) and erythroplasmapheresis collection (EPC). The objective of the study is to provide an answer to the question 'What is the least-cost method of plasma production'. This question is answered, both from the viewpoint of the blood collection agency (using financial CEA) and from that of 'society' as a whole (using economic CEA). We employ detailed financial data and economic survey data for collections made by a blood collection agency and to WBC and EPC donors in Brisbane, Australia. The results indicate that, despite the superior yield provided by EPC, WBC is actually more cost-effective. This result is robust to thorough sensitivity analysis and arises regardless of whether an economic or financial perspective is taken. We conclude that, ceteris paribus, the cost of recruiting new plasma donors would need to be quite substantial for marginal investments in EPC to be considered cost-effective. Crown Copyright (C) 2002 Published by Elsevier Science Ltd. All rights reserved.

Legal and political regulation of higher education in Portugal: an evolutionary perspective on the current policy issues and the problem of order

The higher education system in Europe is currently under stress and the debates over its reform and future are gaining momentum. Now that, for most countries, we are in a time for change, in the overall society and the whole education system, the legal and political dimensions have gained prominence, which has not been followed by a more integrative approach of the problem of order, its reform and the issue of regulation, beyond the typical static and classical cost-benefit analyses. The two classical approaches for studying (and for designing the policy measures of) the problem of the reform of the higher education system - the cost-benefit analysis and the legal scholarship description - have to be integrated. This is the argument of our paper that the very integration of economic and legal approaches, what Warren Samuels called the legal-economic nexus, is meaningful and necessary, especially if we want to address the problem of order (as formulated by Joseph Spengler) and the overall regulation of the system. On the one hand, and without neglecting the interest and insights gained from the cost-benefit analysis, or other approaches of value for money assessment, we will focus our study on the legal, social and political aspects of the regulation of the higher education system and its reform in Portugal. On the other hand, the economic and financial problems have to be taken into account, but in a more inclusive way with regard to the indirect and other socio-economic costs not contemplated in traditional or standard assessments of policies for the tertiary education sector. In the first section of the paper, we will discuss the theoretical and conceptual underpinning of our analysis, focusing on the evolutionary approach, the role of critical institutions, the legal-economic nexus and the problem of order. All these elements are related to the institutional tradition, from Veblen and Commons to Spengler and Samuels. The second section states the problem of regulation in the higher education system and the issue of policy formulation for tackling the problem. The current situation is clearly one of crisis with the expansion of the cohorts of young students coming to an end and the recurrent scandals in private institutions. In the last decade, after a protracted period of extension or expansion of the system, i. e., the continuous growth of students, universities and other institutions are competing harder to gain students and have seen their financial situation at risk. It seems that we are entering a period of radical uncertainty, higher competition and a new configuration that is slowly building up is the growth in intensity, which means upgrading the quality of the higher learning and getting more involvement in vocational training and life-long learning. With this change, and along with other deep ones in the Portuguese society and economy, the current regulation has shown signs of maladjustment. The third section consists of our conclusions on the current issue of regulation and policy challenge. First, we underline the importance of an evolutionary approach to a process of change that is essentially dynamic. A special attention will be given to the issues related to an evolutionary construe of policy analysis and formulation. Second, the integration of law and economics, through the notion of legal economic nexus, allows us to better define the issues of regulation and the concrete problems that the universities are facing. One aspect is the instability of the political measures regarding the public administration and on which the higher education system depends financially, legally and institutionally, to say the least. A corollary is the lack of clear strategy in the policy reforms. Third, our research criticizes several studies, such as the one made by the OECD in late 2006 for the Ministry of Science, Technology and Higher Education, for being too static and neglecting fundamental aspects of regulation such as the logic of actors, groups and organizations who are major players in the system. Finally, simply changing the legal rules will not necessary per se change the behaviors that the authorities want to change. By this, we mean that it is not only remiss of the policy maker to ignore some of the critical issues of regulation, namely the continuous non-respect by academic management and administrative bodies of universities of the legal rules that were once promulgated. Changing the rules does not change the problem, especially without the necessary debates form the different relevant quarters that make up the higher education system. The issues of social interaction remain as intact. Our treatment of the matter will be organized in the following way. In the first section, the theoretical principles are developed in order to be able to study more adequately the higher education transformation with a modest evolutionary theory and a legal and economic nexus of the interactions of the system and the policy challenges. After describing, in the second section, the recent evolution and current working of the higher education in Portugal, we will analyze the legal framework and the current regulatory practices and problems in light of the theoretical framework adopted. We will end with some conclusions on the current problems of regulation and the policy measures that are discusses in recent years.

Economic analysis of surgical treatment of hip fracture in older adults

OBJECTIVE To analyze the incremental cost-utility ratio for the surgical treatment of hip fracture in older patients.METHODS This was a retrospective cohort study of a systematic sample of patients who underwent surgery for hip fracture at a central hospital of a macro-region in the state of Minas Gerais, Southeastern Brazil between January 1, 2009 and December 31, 2011. A decision tree creation was analyzed considering the direct medical costs. The study followed the healthcare provider’s perspective and had a one-year time horizon. Effectiveness was measured by the time elapsed between trauma and surgery after dividing the patients into early and late surgery groups. The utility was obtained in a cross-sectional and indirect manner using the EuroQOL 5 Dimensions generic questionnaire transformed into cardinal numbers using the national regulations established by the Center for the Development and Regional Planning of the State of Minas Gerais. The sample included 110 patients, 27 of whom were allocated in the early surgery group and 83 in the late surgery group. The groups were stratified by age, gender, type of fracture, type of surgery, and anesthetic risk.RESULTS The direct medical cost presented a statistically significant increase among patients in the late surgery group (p < 0.005), mainly because of ward costs (p < 0.001). In-hospital mortality was higher in the late surgery group (7.4% versus 16.9%). The decision tree demonstrated the dominance of the early surgery strategy over the late surgery strategy: R$9,854.34 (USD4,387.17) versus R$26,754.56 (USD11,911.03) per quality-adjusted life year. The sensitivity test with extreme values proved the robustness of the results.CONCLUSIONS After controlling for confounding variables, the strategy of early surgery for hip fracture in the older adults was proven to be dominant, because it presented a lower cost and better results than late surgery.

Economic Evaluation of Ticagrelor for Secondary Prevention Following Acute Coronary Syndromes

INTRODUCTION AND OBJECTIVES: To estimate the cost-effectiveness and cost-utility of ticagrelor in the treatment of patients with acute coronary syndromes (unstable angina or myocardial infarction with or without ST-segment elevation), including patients treated medically and those undergoing percutaneous coronary intervention or coronary artery bypass grafting. METHODS: A short-term decision tree and a long-term Markov model were used to simulate the evolution of patients' life-cycles. Clinical effectiveness data were collected from the PLATO trial and resource use data were obtained from the Hospital de Santa Marta database, disease-related group legislation and the literature. RESULTS: Ticagrelor provides increases of 0.1276 life years and 0.1106 quality-adjusted life years (QALYs) per patient. From a societal perspective these clinical gains entail an increase in expenditure of €610. Thus the incremental cost per life year saved is €4780 and the incremental cost per QALY is €5517. CONCLUSIONS: The simulation results show that ticagrelor reduces events compared to clopidogrel. The costs of ticagrelor are partially offset by lower costs arising from events prevented. The use of ticagrelor in clinical practice is therefore cost-effective compared to generic clopidogrel.

Implementação da Equipa de Emergência Médica Intra-hospitalar nos hospitais do Serviço Nacional de Saúde : análise de custo-efetividade perante a incidência da paragem cárdio-respiratória intra-hospitalar

RESUMO - Introdução: No âmbito das emergências intra-hospitalares investigou-se a hipótese da presença da Equipa Emergência Médica Intra-hospitalar (EEMI) (DGS, 2010) num Centro Hospitalar (CH), contribuir para a redução do número de mortos por Paragem Cárdiorespiratória (PCR) intra-hospitalar, quando comparado com outro CH dotado de uma equipa tradicional de resposta à PCR. Metodologia: Tratou-se de um estudo observacional, retrospetivo (2010 a 2014), com base nos dados do Grupo de Diagnóstico Homogéneo (GDH), analisado numa perspetiva de custo-efetividade no impacto sobre incidência de PCR e taxa de mortalidade. Resultados: Observou-se que o CH com EEMI apresentou uma Redução Risco Absoluto (RRA) de 9,01% de morte por PCR. A taxa de mortalidade calculada foi de 2,82 casos por 1000 episódios de internamento em que a incidência de PCR foi de 28,24 casos por cada 10 000 habitantes, duas vezes menor que CH em comparação. Quando introduzidas manobras de Ressuscitação Cárdiopulmonar (RCP), o mesmo CH teve um maior número de PCR revertidas, com uma taxa de mortalidade 2 vezes menor que o CH sem EEMI. Conclusão: Resultados demonstraram que os dois CH apresentaram riscos diferentes, em que a probabilidade do doente hospitalizado de morrer após ocorrência de PCR foi menor no grupo exposto à EEMI, com OR = 0,496 [IC 95% (0,372 a 0,662)] para dados populacionais (p = 0,0013), e OR = 0,618 [IC 95% (0,298 a 1,281)] para dados individuais, (p = 0,194). Face a melhores resultados em Saúde, considerou-se a implementação da EEMI, uma medida custo-efetiva, uma vez que o principal requisito traduz-se por reorganização das equipas tradicionais para uma vertente de prevenção da PCR.

A consistency test of the time trade-off

This paper tests the internal consistency of time trade-off utilities.We find significant violations of consistency in the direction predictedby loss aversion. The violations disappear for higher gauge durations.We show that loss aversion can also explain that for short gaugedurations time trade-off utilities exceed standard gamble utilities. Ourresults suggest that time trade-off measurements that use relativelyshort gauge durations, like the widely used EuroQol algorithm(Dolan 1997), are affected by loss aversion and lead to utilities thatare too high.

A test of the predictive validity of non-linear QALY models using time trade-off utilities

This paper presents a test of the predictive validity of various classes ofQALY models (i.e., linear, power and exponential models). We first estimatedTTO utilities for 43 EQ-5D chronic health states and next these states wereembedded in health profiles. The chronic TTO utilities were then used topredict the responses to TTO questions with health profiles. We find that thepower QALY model clearly outperforms linear and exponential QALY models.Optimal power coefficient is 0.65. Our results suggest that TTO-based QALYcalculations may be biased. This bias can be avoided using a power QALY model.

Comparison and evaluation of states of health

Starting from a finite or countable set of states of health, and assumingthe existence of an objective transitive preference relation on that set,we propose a way of performing interpersonal comparisons of states ofhealth. In so doing, we first consider the population divided into types,and consider that two individuals of a different type have a comparablestate of health whenever they sit at the same centile of their respectivetype. A way of comparing and evaluating states of health for differentgroups is then proposed and rationalized. This can be viewed as both analternative and an extension of the traditional QALY approach.

Case management for frequent users of the emergency department: study protocol of a randomised controlled trial.

BACKGROUND: We devised a randomised controlled trial to evaluate the effectiveness and efficiency of an intervention based on case management care for frequent emergency department users. The aim of the intervention is to reduce such patients' emergency department use, to improve their quality of life, and to reduce costs consequent on frequent use. The intervention consists of a combination of comprehensive case management care and standard emergency care. It uses a clinical case management model that is patient-identified, patient-directed, and developed to provide high intensity services. It provides a continuum of hospital- and community-based patient services, which include clinical assessment, outreach referral, and coordination and communication with other service providers. METHODS/DESIGN: We aim to recruit, during the first year of the study, 250 patients who visit the emergency department of the University Hospital of Lausanne, Switzerland. Eligible patients will have visited the emergency department 5 or more times during the previous 12 months. Randomisation of the participants to the intervention or control groups will be computer generated and concealed. The statistician and each patient will be blinded to the patient's allocation. Participants in the intervention group (N = 125), additionally to standard emergency care, will receive case management from a team, 1 (ambulatory care) to 3 (hospitalization) times during their stay and after 1, 3, and 5 months, at their residence, in the hospital or in the ambulatory care setting. In between the consultations provided, the patients will have the opportunity to contact, at any moment, the case management team. Participants in the control group (N = 125) will receive standard emergency care only. Data will be collected at baseline and 2, 5.5, 9, and 12 months later, including: number of emergency department visits, quality of life (EuroQOL and WHOQOL), health services use, and relevant costs. Data on feelings of discrimination and patient's satisfaction will also be collected at the baseline and 12 months later. DISCUSSION: Our study will help to clarify knowledge gaps regarding the positive outcomes (emergency department visits, quality of life, efficiency, and cost-utility) of an intervention based on case management care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01934322.

Economic evaluation of the levonorgestrel-releasing intrauterine system for the treatment of dysfunctional uterine bleeding in Spain

To compare the cost and effectiveness of the levonorgestrel-releasing intrauterine system (LNG-IUS) versus combined oral contraception (COC) and progestogens (PROG) in first-line treatment of dysfunctional uterine bleeding (DUB) in Spain. STUDY DESIGN: A cost-effectiveness and cost-utility analysis of LNG-IUS, COC and PROG was carried out using a Markov model based on clinical data from the literature and expert opinion. The population studied were women with a previous diagnosis of idiopathic heavy menstrual bleeding. The analysis was performed from the National Health System perspective, discounting both costs and future effects at 3%. In addition, a sensitivity analysis (univariate and probabilistic) was conducted. RESULTS: The results show that the greater efficacy of LNG-IUS translates into a gain of 1.92 and 3.89 symptom-free months (SFM) after six months of treatment versus COC and PROG, respectively (which represents an increase of 33% and 60% of symptom-free time). Regarding costs, LNG-IUS produces savings of 174.2-309.95 and 230.54-577.61 versus COC and PROG, respectively, after 6 months-5 years. Apart from cost savings and gains in SFM, quality-adjusted life months (QALM) are also favourable to LNG-IUS in all scenarios, with a range of gains between 1 and 2 QALM compared to COC and PROG. CONCLUSIONS: The results indicate that first-line use of the LNG-IUS is the dominant therapeutic option (less costly and more effective) in comparison with first-line use of COC or PROG for the treatment of DUB in Spain. LNG-IUS as first line is also the option that provides greatest health-related quality of life to patients.

Teknologiaohjelma DENSY -Hajautetun energiantuotannon tulevaisuusskenaariot ja vaikutukset liiketoimintamalleihin

Tutkimuksen tavoitteena oli selvittää miten hajautettu energiantuotanto ja siihen liittyvä liiketoiminta tulee muuttumaan tulevaisuudessaja mitä mahdollisuuksia se voisi tarjota suomalaiselle osaamiselle. Työssä käydään läpi lyhyesti hajautetun energiantuotannon teknologian nykytilaa ja tehdään teknis-taloudellista vertailua eri tuotantoteknologioiden välillä. Tämän jälkeenon muodostettu asiantuntijoiden ja aktoreiden kanssa liiketoimin-taympäristöskenaarioita, jotka kuvaavat tulevaisuuden muutossuuntia hajautetun energian-tuotannon liiketoiminnassa. Skenaarioistunnoissa löydettiin muutosta ajavat voimat ja pohdittiin niiden vaikutusta alan kehitykseen. Työn tuloksena määriteltiin skenaarioiden kehitystä vahvimmin ohjaaviksi tekijöiksi infrastruktuurin kehittyneisyys ja toisaalta myös yhteiskunnan ohjaustoimet. Niiden pohjalta luotiin lopulliset neljä skenaariota ja niille kaikille liiketoimintakuvaukset. Skenaarioiden avulla suomalaisen toimijan näkökulmasta arvioitiin houkuttelevimmiksi markkina-alueiksi EU-15, Venäjä, Intia ja Kiina. Moninaisista liiketoimintaa estävistä te-kijöistä huolimatta markkinoilta löytyi suuri potentiaali hajautetun energiantuotannon jär-jestelmille. Potentiaalisimmiksi teknologioiksi suomalaisten yritysten kannalta nähtiin puolestaan diesel- ja kaasumoottorit, tuulivoima, pienvesivoima sekä bioenergia. Yhdessä markkina- ja teknologiatutkimuksien sekä skenaariotyön avulla luotiin uusia liiketoimin-takonseptikuvauksia tulevaisuuden hajautetun energiantuotannon markkinoille suomalai-sen toimijan näkökulmasta.

Economic evaluation of the levonorgestrel-releasing intrauterine system for the treatment of dysfunctional uterine bleeding in Spain

To compare the cost and effectiveness of the levonorgestrel-releasing intrauterine system (LNG-IUS) versus combined oral contraception (COC) and progestogens (PROG) in first-line treatment of dysfunctional uterine bleeding (DUB) in Spain. STUDY DESIGN: A cost-effectiveness and cost-utility analysis of LNG-IUS, COC and PROG was carried out using a Markov model based on clinical data from the literature and expert opinion. The population studied were women with a previous diagnosis of idiopathic heavy menstrual bleeding. The analysis was performed from the National Health System perspective, discounting both costs and future effects at 3%. In addition, a sensitivity analysis (univariate and probabilistic) was conducted. RESULTS: The results show that the greater efficacy of LNG-IUS translates into a gain of 1.92 and 3.89 symptom-free months (SFM) after six months of treatment versus COC and PROG, respectively (which represents an increase of 33% and 60% of symptom-free time). Regarding costs, LNG-IUS produces savings of 174.2-309.95 and 230.54-577.61 versus COC and PROG, respectively, after 6 months-5 years. Apart from cost savings and gains in SFM, quality-adjusted life months (QALM) are also favourable to LNG-IUS in all scenarios, with a range of gains between 1 and 2 QALM compared to COC and PROG. CONCLUSIONS: The results indicate that first-line use of the LNG-IUS is the dominant therapeutic option (less costly and more effective) in comparison with first-line use of COC or PROG for the treatment of DUB in Spain. LNG-IUS as first line is also the option that provides greatest health-related quality of life to patients.

Assessing e-procurement System for Improving the Purchasing Operations

Diplomityön tavoitteena oli luoda suunnitelma elektronisen hankintatoimen aloittamiseksi, analysoimalla nykyisiä ostoprosesseja ja konsernin laajuista elektronista hankintajärjestelmää. Työ pohjautuu yritysten väliseen elektroniseen kauppaan, elektroniseen hankintatoimeen ja systeemisuunnitteluun liittyvään kirjallisuuteen. Työssä tehdyn suunnitelman tarkoituksena on auttaa Siemens Oy:tä siirtymään uuteen elektroniseen ostotoimintaan. Elektroniselle ostotoiminnalle suunniteltiin tavoitteet ja näitä vastaavat vaatimukset. Elektronisen hankintajärjestelmän analysointi perustuu kirjallisuudessa esitettyihin järjestelmän elinkaari-mallin vaiheisiin. Analysoinnin tarkoituksena oli saada selville järjestelmän soveltuvuus Siemens Oy: n liiketoimintaympäristöön, prosesseihin ja vaatimuksiin. Elektronisen hankintatoiminnan etuja ovat liiketoiminta prosessien johtamisen parantuminen, kustannusten väheneminen sekä taloudellisen suorituskyvyn lisääntyminen. Elektronisen hankintatoiminnan aloittaminen vaatii kuitenkin huolellista suunnittelua. Työssä tehdyt suunnitelmat ja analysoinnit auttavat arvioidessa järjestelmän sopivuutta Siemens Oy: n vaatimuksiin. Oikean ja toimivan järjestelmän valinta ei kuitenkaan takaa elektronisesta hankintatoiminnasta hyötymistä. Tärkeimpiä jatkotoimenpiteitä onkin suorittaa kustannus/hyöty analyysi ja arvioida toimittajien halukkuutta ja kykyjä osallistua markkinapaikkaan.

Terveyskorttiprojektin kustannusvaikuttavuuden arviointi

Tämän kandidaatintyön lähtökohtana oli selvittää Helsingin kaupungin Terveysasemaosaston Terveyskorttiprojektin aikana toteutetun pilotin taloudellisuutta ja vaikuttavuutta rinnakkaispalveluna. Kirjallisuuskatsauksen tavoitteena oli selvittää millaisilla metodeilla kustannusvaikuttavuutta voidaan analysoida terveydenhuollossa. Lisäksi tavoitteena oli selvittää kyseisen projektin kustannusten suhdetta palvelun vaikuttavuuteen, eli muutoksiin asiakkaiden terveystottumuksissa. Keskeisimpiä kustannusvaikuttavuuden arviointimenetelmiä terveydenhuollossa ovat kustannusten minimointianalyysi (KMA), kustannus-hyötyanalyysi (KHA), kustannus-vaikuttavuusanalyysi (KVA) ja kustannus-utiliteettianalyysi (KUA). Käytännön päätöksenteon analyyttinen mallintaminen empirian- ja näyttöön perustuvan tiedon pohjalta osoittautui kirjallisuuskatsauksessa myös päteväksi tavaksi arvioida palveluiden vaikuttavuutta. Terveyskorttiprojektin suurimmat kustannussäästöt, verrattuna perinteiseen vastaanotto-malliin, muodostuivat verkkopalvelun seulontavaiheessa. Terveyden edistämisen osa-alueisiin painonhallinta, liikunta ja ravitsemus palvelu soveltui hyvin. Palvelun käytettävyyden kehittämishaasteiksi muodostuivat tulosten perusteella tekniset ongelmat, vuoro-vaikutuksen puute ja asiakkaan oman motivaation löytyminen.

Identification de biomarqueurs protéiques prédictifs et diagnostiques des maladies coronariennes pour une population de souche canadienne-française

Les biomarqueurs plasmatiques constituent des outils essentiels, mais rares, utilisés pour diagnostiquer les maladies, comme les maladies cardiovasculaires (MCV), et stratifier le niveau de risque associé. L’identification de nouveaux biomarqueurs plasmatiques susceptibles d’améliorer le dépistage et le suivi des MCV représente ainsi un enjeu majeur en termes d’économie et de santé publique. Le projet vise à identifier de nouveaux biomarqueurs plasmatiques prédictifs ou diagnostiques des MCV, à déterminer le profil protéomique plasmatique de patients atteints de MCV et à développer des méthodes innovantes d’analyse d’échantillon plasmatique. L’étude a été effectuée sur une large banque de plasma provenant de 1006 individus de souche Canadienne-Française recrutés à différents stades de la MCV et qui ont été suivis sur une période de 5 ans. Des séries de déplétions ont été réalisées afin de dépléter les 14 protéines majoritaires (colonne IgY14TM) de l’échantillon avant son analyse par trois approches effectuées en parallèle: 1) Une chromatographie liquide (LC) en 2 dimensions qui fractionne les protéines selon le point isoélectrique puis selon le degré d’hydrophobicité, via le système PF2D, suivie par une chromatographie liquide couplée avec une spectrométrie de masse en tandem (LC-MS/MS). 2) Une séparation classique sur gel 1D-SDS-PAGE suivie d’une LC-MS/MS; 3) Par une déplétion plus poussée du plasma avec l’utilisation en tandem avec la colonne IgY14TM d’une colonne SupermixTM permettant de dépléter également les protéines de moyenne abondance, suivie d’une séparation sur gel 1D-SDS-PAGE et d’une analyse LC-MS/MS de la portion déplétée (3a) et de la portion liée à la SupermixTM (3b). Les résultats montrent que le système PF2D permet d’identifier plusieurs profils protéiques spécifiques au groupe MCV. Sur un total de 1156 fractions (équivalent à 1172 pics protéiques pour le groupe contrôle et 926 pics pour le groupe MCV) recueillies, 15 fractions (23 pics protéiques) présentaient des différences quantitativement significatives (p<0,05) entre les 2 groupes. De plus, 6 fractions (9 pics) sont uniquement présentes dans un groupe, représentant d’autres signatures protéomiques et biomarqueurs potentiellement intéressants. Les méthodes 2, 3a et 3b ont permis l’identification de 108, 125 et 91 protéines respectivement avec des chevauchements partiels (31% entre la méthode 2 et 3a, 61% entre 2 et 3b et 19% entre 3a et 3b). Les méthodes 2 et 3 ont permis l’identification de 12 protéines qui présentaient des différences quantitatives significatives entre les 2 groupes. L’utilisation de plusieurs approches protéomiques complémentaires nous ont d’ores et déjà permis d’identifier des candidats biomarqueurs des angines instables avec récidive d’infarctus du myocarde (IM).