Which screening strategy using BMD measurements would be most cost effective for hip fracture prevention in elderly women? A decision analysis based on a Markov model.

INTRODUCTION: Hip fractures are responsible for excessive mortality, decreasing the 5-year survival rate by about 20%. From an economic perspective, they represent a major source of expense, with direct costs in hospitalization, rehabilitation, and institutionalization. The incidence rate sharply increases after the age of 70, but it can be reduced in women aged 70-80 years by therapeutic interventions. Recent analyses suggest that the most efficient strategy is to implement such interventions in women at the age of 70 years. As several guidelines recommend bone mineral density (BMD) screening of postmenopausal women with clinical risk factors, our objective was to assess the cost-effectiveness of two screening strategies applied to elderly women aged 70 years and older. METHODS: A cost-effectiveness analysis was performed using decision-tree analysis and a Markov model. Two alternative strategies, one measuring BMD of all women, and one measuring BMD only of those having at least one risk factor, were compared with the reference strategy "no screening". Cost-effectiveness ratios were measured as cost per year gained without hip fracture. Most probabilities were based on data observed in EPIDOS, SEMOF and OFELY cohorts. RESULTS: In this model, which is mostly based on observed data, the strategy "screen all" was more cost effective than "screen women at risk." For one woman screened at the age of 70 and followed for 10 years, the incremental (additional) cost-effectiveness ratio of these two strategies compared with the reference was 4,235 euros and 8,290 euros, respectively. CONCLUSION: The results of this model, under the assumptions described in the paper, suggest that in women aged 70-80 years, screening all women with dual-energy X-ray absorptiometry (DXA) would be more effective than no screening or screening only women with at least one risk factor. Cost-effectiveness studies based on decision-analysis trees maybe useful tools for helping decision makers, and further models based on different assumptions should be performed to improve the level of evidence on cost-effectiveness ratios of the usual screening strategies for osteoporosis.

Decision analysis of the effectiveness of lung cancer screening using autofluorescence bronchoscopy and computed tomography

Background: Lung cancer (LC) is the leading cause of cancer death in the developed world. Most cancers are associated with tobacco smoking. A primary hope for reducing lung cancer has been prevention of smoking and successful smoking cessation programs. To date, these programs have not been as successful as anticipated. Objective: The aim of the current study was to evaluate whether lung cancer screening combining low dose computed tomography with autofluorescence bronchoscopy (combined CT & AFB) is superior to CT or AFB screening alone in improving lung cancer specific survival. In addition, the extent of improvement and ideal conditions for combined CT & AFB screening were evaluated. Methods: We applied decision analysis and Monte Carlo simulation modeling using TreeAge Software to evaluate our study aims. Histology- and stage specific probabilities of lung cancer 5-year survival proportions were taken from Surveillance and Epidemiologic End Results (SEER) Registry data. Screeningassociated data was taken from the US NCI Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO), National Lung Screening Trial (NLST), and US NCI Lung Screening Study (LSS), other relevant published data and expert opinion. Results: Decision Analysis - Combined CT and AFB was the best approach at Improving 5-year survival (Overall Expected Survival (OES) in the entire screened population was 0.9863) and in lung cancer patients only (Lung Cancer Specific Expected Survival (LOSES) was 0.3256). Combined screening was slightly better than CT screening alone (OES = 0.9859; LCSES = 0.2966), and substantially better than AFB screening alone (OES = 0.9842; LCSES = 0.2124), which was considerably better than no screening (OES = 0.9829; LCSES = 0.1445). Monte Carlo simulation modeling revealed that expected survival in the screened population and lung cancer patients is highest when screened using CT and combined CT and AFB. CT alone and combined screening was substantially better than AFB screening alone or no screening. For LCSES, combined CT and AFB screening is significantly better than CT alone (0.3126 vs. 0.2938, p< 0.0001). Conclusions: Overall, these analyses suggest that combined CT and AFB is slightly better than CT alone at improving lung cancer survival, and both approaches are substantially better than AFB screening alone or no screening.

Méthode pour l’établissement d’une liste de médicaments remboursables dans le cadre du nouveau programme d’assurance-médicaments en Côte d’Ivoire

Contexte général La Côte d'Ivoire est un pays de l’Afrique de l’Ouest qui a décidé, depuis 2001, d'étendre la couverture des prestations de santé à toute sa population. En effet, cette réforme du système de santé avait pour but de fournir, à chaque ivoirien, une couverture médicale et pharmaceutique. Toutefois, la mise en œuvre de cette réforme était difficile car, contrairement aux pays développés, les pays en développement ont un secteur « informel » échappant à la législation du travail et occupant une place importante. En conséquence, il a été recommandé qu’il y ait deux caisses d'assurance santé, une pour le secteur formel (fonctionnaires) et l'autre pour le secteur informel. Ces caisses auraient légitimité en ce qui a trait aux décisions de remboursement de médicaments. D’ores-et-déjà, il existe une mutuelle de santé appelée la Mutuelle Générale des Fonctionnaires et Agents de l'État de Côte d'Ivoire (MUGEFCI), chargée de couvrir les frais médicaux et pharmaceutiques des fonctionnaires et agents de l’Etat. Celle-ci connaît, depuis quelques années, des contraintes budgétaires. De plus, le processus actuel de remboursement des médicaments, dans cette organisation, ne prend pas en considération les valeurs implicites liées aux critères d'inscription au formulaire. Pour toutes ces raisons, la MUGEFCI souhaite se doter d’une nouvelle liste de médicaments remboursables, qui comprendrait des médicaments sécuritaires avec un impact majeur sur la santé (service médical rendu), à un coût raisonnable. Dans le cadre de cette recherche, nous avons développé une méthode de sélection des médicaments pour des fins de remboursement, dans un contexte de pays à faibles revenus. Cette approche a ensuite été appliquée dans le cadre de l’élaboration d’une nouvelle liste de médicaments remboursables pour la MUGEFCI. Méthode La méthode de sélection des médicaments remboursables, développée dans le cadre de cette recherche, est basée sur l'Analyse de Décision Multicritère (ADM). Elle s’articule autour de quatre étapes: (1) l'identification et la pondération des critères pertinents d'inscription des médicaments au formulaire (combinant revue de la littérature et recherche qualitative, suivies par la réalisation d’une expérience de choix discrets); (2) la détermination d'un ensemble de traitements qui sont éligibles à un remboursement prioritaire; (3) l’attribution de scores aux traitements selon leurs performances sur les niveaux de variation de chaque critère, et (4) le classement des traitements par ordre de priorité de remboursement (classement des traitements selon un score global, obtenu après avoir additionné les scores pondérés des traitements). Après avoir défini la liste des médicaments remboursables en priorité, une analyse d’impact budgétaire a été réalisée. Celle-ci a été effectuée afin de déterminer le coût par patient lié à l'utilisation des médicaments figurant sur la liste, selon la perspective de la MUGEFCI. L’horizon temporel était de 1 an et l'analyse portait sur tous les traitements admissibles à un remboursement prioritaire par la MUGEFCI. En ce qui concerne la population cible, elle était composée de personnes assurées par la MUGEFCI et ayant un diagnostic positif de maladie prioritaire en 2008. Les coûts considérés incluaient ceux des consultations médicales, des tests de laboratoire et des médicaments. Le coût par patient, résultant de l'utilisation des médicaments figurant sur la liste, a ensuite été comparé à la part des dépenses par habitant (per capita) allouée à la santé en Côte d’Ivoire. Cette comparaison a été effectuée pour déterminer un seuil en deçà duquel la nouvelle liste des médicaments remboursables en priorité était abordable pour la MUGEFCI. Résultats Selon les résultats de l’expérience de choix discrets, réalisée auprès de professionnels de la santé en Côte d'Ivoire, le rapport coût-efficacité et la sévérité de la maladie sont les critères les plus importants pour le remboursement prioritaire des médicaments. Cela se traduit par une préférence générale pour les antipaludiques, les traitements pour l'asthme et les antibiotiques indiqués pour les infections urinaires. En outre, les résultats de l’analyse d’impact budgétaire suggèrent que le coût par patient lié à l'utilisation des médicaments figurant sur la liste varierait entre 40 et 160 dollars américains. Etant donné que la part des dépenses par habitant allouées à la santé en Côte d’Ivoire est de 66 dollars américains, l’on pourrait conclure que la nouvelle liste de médicaments remboursables serait abordable lorsque l'impact économique réel de l’utilisation des médicaments par patient est en deçà de ces 66 dollars américains. Au delà de ce seuil, la MUGEFCI devra sélectionner les médicaments remboursables en fonction de leur rang ainsi que le coût par patient associé à l’utilisation des médicaments. Plus précisément, cette sélection commencera à partir des traitements dans le haut de la liste de médicaments prioritaires et prendra fin lorsque les 66 dollars américains seront épuisés. Conclusion Cette étude fait la démonstration de ce qu’il est possible d'utiliser l’analyse de décision multicritère pour développer un formulaire pour les pays à faibles revenus, la Côte d’Ivoire en l’occurrence. L'application de cette méthode est un pas en avant vers la transparence dans l'élaboration des politiques de santé dans les pays en développement.

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Deconstruction plan assessment using multi-criteria decision-making methods

The purpose of this paper is to present two multi-criteria decision-making models, including an Analytic Hierarchy Process (AHP) model and an Analytic Network Process (ANP) model for the assessment of deconstruction plans and to make a comparison between the two models with an experimental case study. Deconstruction planning is under pressure to reduce operation costs, adverse environmental impacts and duration, in the meanwhile to improve productivity and safety in accordance with structure characteristics, site conditions and past experiences. To achieve these targets in deconstruction projects, there is an impending need to develop a formal procedure for contractors to select a most appropriate deconstruction plan. Because numbers of factors influence the selection of deconstruction techniques, engineers definitely need effective tools to conduct the selection process. In this regard, multi-criteria decision-making methods such as AHP have been adopted to effectively support deconstruction technique selection in previous researches. in which it has been proved that AHP method can help decision-makers to make informed decisions on deconstruction technique selection based on a sound technical framework. In this paper, the authors present the application and comparison of two decision-making models including the AHP model and the ANP model for deconstruction plan assessment. The paper concludes that both AHP and ANP are viable and capable tools for deconstruction plan assessment under the same set of evaluation criteria. However, although the ANP can measure relationship among selection criteria and their sub-criteria, which is normally ignored in the AHP, the authors also indicate that whether the ANP model can provide a more accurate result should be examined in further research.

A fuzzy multi-criteria decision approach for enhanced auto-tracking of seismic events

The main activity carried out by the geophysicist when interpreting seismic data, in terms of both importance and time spent is tracking (or picking) seismic events. in practice, this activity turns out to be rather challenging, particularly when the targeted event is interrupted by discontinuities such as geological faults or exhibits lateral changes in seismic character. In recent years, several automated schemes, known as auto-trackers, have been developed to assist the interpreter in this tedious and time-consuming task. The automatic tracking tool available in modem interpretation software packages often employs artificial neural networks (ANN's) to identify seismic picks belonging to target events through a pattern recognition process. The ability of ANNs to track horizons across discontinuities largely depends on how reliably data patterns characterise these horizons. While seismic attributes are commonly used to characterise amplitude peaks forming a seismic horizon, some researchers in the field claim that inherent seismic information is lost in the attribute extraction process and advocate instead the use of raw data (amplitude samples). This paper investigates the performance of ANNs using either characterisation methods, and demonstrates how the complementarity of both seismic attributes and raw data can be exploited in conjunction with other geological information in a fuzzy inference system (FIS) to achieve an enhanced auto-tracking performance.

Economic development and growth in West Africa: a multiple case study analysis of sovereign wealth funds’ investments and performance

Durante a recente crise da dívida soberana europeia, os fundos soberanos demonstraram seu peso na esfera financeira global. Contribuíram para salvar o sistema financeiro dos países desenvolvidos, distribuindo créditos que as entidades financeiras tradicionais do Norte não podiam mais providenciar. Em 2012, os ativos totais desses fundos atingiram USD 4.620 bilhões, comparado aos USD 3.355 bilhões de antes da crise, no final de 2007 (Preqin, 2012). Sendo quase todos criados por economias em desenvolvimento ou subdesenvolvidas, os fundos soberanos podem então ser vistos como o símbolo de um recente reequilíbrio do poder a favor desses países (Santiso, 2008). Além disso, em um futuro próximo, espera-se que os fundos soberanos afastem-se dos países desenvolvidos para investir mais em países em desenvolvimento. Nesse contexto, os países africanos estão cada vez mais alvos de investimentos dos fundos (Triki & Faye, 2011). O estudo subjacente analisa dois fundos, o IFC ALAC e o Mubadala Development Company, para entender como, de acordo com as percepções dos seus gestores, os fundos soberanos podem ajudar no desenvolvimento dos países beneficiários. Mais precisamente, trata-se definir, através de um estudo de casos múltiplos, quais são os mecanismos pelos quais os fundos soberanos podem impactar o desenvolvimento da África ocidental. Os resultados sugerem que, segundo os gestores, os fundos soberanos podem desempenhar um papel significativo no desenvolvimento dos países beneficiários. Eles investem em alguns setores-chave da economia (bancos, infraestruturas etc.), criando condições favoráveis ao desenvolvimento local. Além disso, através de um efeito multiplicador, os investimentos dos fundos soberanos alavancam novos investimentos do setor privado local ou global, fortalecendo o tecido industrial e produtivo do país beneficiário. Porém, parece que as empresas beneficiárias não ajudam nas transferências de conhecimento e de tecnologia, embora sejam essenciais para o desenvolvimento econômico, e se limitam a programas de treinamento específico e de RSE. Além disso, apesar dos investimentos de fundos soberanos impulsionarem o crescimento da região, eles também podem agravar a dependência dessas economias à exportação de commodities. Finalmente, os impactos positivos dos fundos soberanos sobre a economia regional são muitas vezes reduzidos devido a conflitos políticos e barreiras estruturais exigindo reformas profundas e de longo prazo.

Criteria for analysis of the structure of electronic scientific journals

This paper is the result of the Masters dissertation studying the role and history of scientific communication, especially the changes that have occurred after the appearance of electronic communication and computer networks. This study showed that hypertext systems are increasingly being used in the scientific and academic world in the production of electronic journals; this makes it possible for the user to rapidly access information in their area. However, these systems need to be improved to help the user during search and access to information. Both printed journals migrating to electronic media, and the exclusively electronic journals should present the current quality indicators. The attempt was made to discover whether characteristics related to printed journals are being maintained in their electronic counterparts. For this, a prototype model was developed to analyze the structure of electronic scientific journals; it composes 14 criteria expressing aspects of quality for these journals. It includes elements of Website Information Architecture and those already in place in printed scientific journals in order to ensure that basic functions - archiving and dissemination - are maintained in electronic publishing. Each criterion consists of variables, which measure the maintenance of these functions both in the migrating printed journals and the exclusively electronic ones. This prototype model was used to analyze Ciência da Informação On-line and DataGramaZero - Revista de Ciência da Informação. Results indicate that this model is able to find out if the basic functions of archiving and dissemination are being maintained in electronic journals. Therefore, its implementation is justified in electronic journals. The model can help librarians, authors, and users of electronic journals to identify quality journals, and assist editors in developing their projects. The material from the study may be included in the preservice and inservice education of Information Science professionals and to support editors of scientific journals.

Análise de decisão multicritério na localização de usinas termoelétricas utilizando SIG

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Measuring the efficiency of outsourcing: An illustrative case study from the aerospace industry

Outsourcing is related to the action which an organization deals with its suppliers through a kind of business contract where a specific activity or service has been hired to be made. The outsourcing of some activities has become a common practice in the industry, nowadays. It reduces costs, significantly, in the production process and, at the same time, adds some values to the business organization. However it is necessary to measure the performance of these activities. Data Envelopment Analysis (DEA) is a non-parametric method useful to measure comparative performance. It has a wide range of applications measuring comparative efficiency. The Analytic Hierarchy Process (AHP) is a multiple criteria decision-making method that uses hierarchic structures to represent a decision problem and then develops priorities for the alternatives based on the decision-maker's judgments. This paper presents an integrated application based on DEA and AHP to evaluate the efficiency of subcontracted companies in a Brazilian aerospace factory. © 2007 Springer-Verlag London Limited.