The use of cost per life year gained as a measurement of cost-effectiveness in Spain: a systematic review of recent publications

The objective of this study was to evaluate the methodological characteristics of cost-effectiveness evaluations carried out in Spain, since 1990, which include LYG as an outcome to measure the incremental cost-effectiveness ratio. METHODS: A systematic review of published studies was conducted describing their characteristics and methodological quality. We analyse the cost per LYG results in relation with a commonly accepted Spanish cost-effectiveness threshold and the possible relation with the cost per quality adjusted life year (QALY) gained when they both were calculated for the same economic evaluation. RESULTS: A total of 62 economic evaluations fulfilled the selection criteria, 24 of them including the cost per QALY gained result as well. The methodological quality of the studies was good (55%) or very good (26%). A total of 124 cost per LYG results were obtained with a mean ratio of 49,529 and a median of 11,490 (standard deviation of 183,080). Since 2003, a commonly accepted Spanish threshold has been referenced by 66% of studies. A significant correlation was found between the cost per LYG and cost per QALY gained results (0.89 Spearman-Rho, 0.91 Pearson). CONCLUSIONS: There is an increasing interest for economic health care evaluations in Spain, and the quality of the studies is also improving. Although a commonly accepted threshold exists, further information is needed for decision-making as well as to identify the relationship between the costs per LYG and per QALY gained.

Development of a population-based cost-effectiveness model of chronic graft versus host disease in Spain

Chronic graft-versus-host disease (cGvHD) is the leading cause of late nonrelapse mortality (transplant-related mortality) after hematopoietic stem cell transplant. Given that there are a wide range of treatment options for cGvHD, assessment of the associated costs and efficacy can help clinicians and health care providers allocate health care resources more efficiently. OBJECTIVE: The purpose of this study was to assess the cost-effectiveness of extracorporeal photopheresis (ECP) compared with rituximab (Rmb) and with imatinib (Imt) in patients with cGvHD at 5 years from the perspective of the Spanish National Health System. METHODS: The model assessed the incremental cost-effectiveness/utility ratio of ECP versus Rmb or Imt for 1000 hypothetical patients by using microsimulation cost-effectiveness techniques. Model probabilities were obtained from the literature. Treatment pathways and adverse events were evaluated taking clinical opinion and published reports into consideration. Local data on costs (2010 Euros) and health care resources utilization were validated by the clinical authors. Probabilistic sensitivity analyses were used to assess the robustness of the model. RESULTS: The greater efficacy of ECP resulted in a gain of 0.011 to 0.024 quality-adjusted life-year in the first year and 0.062 to 0.094 at year 5 compared with Rmb or Imt. The results showed that the higher acquisition cost of ECP versus Imt was compensated for at 9 months by greater efficacy; this higher cost was partially compensated for ( 517) by year 5 versus Rmb. After 9 months, ECP was dominant (cheaper and more effective) compared with Imt. The incremental cost-effectiveness ratio of ECP versus Rmb was 29,646 per life-year gained and 24,442 per quality-adjusted life-year gained at year 2.5. Probabilistic sensitivity analysis confirmed the results. The main study limitation was that to assess relative treatment effects, only small studies were available for indirect comparison. CONCLUSION: ECP as a third-line therapy for cGvHD is a more cost-effective strategy than Rmb or Imt.

Cost-effectiveness analysis of cardiac resynchronization therapy in patients with NYHA I and NYHA II heart failure in Spain

Objectives: The aim of the study was to combine clinical results from the European Cohort of the REVERSE study and costs associated with the addition of cardiac resynchronization therapy (CRT) to optimal medical therapy (OMT) in patients with mild symptomatic (NYHA I-II) or asymptomatic left ventricular dysfunction and markers of cardiac dyssynchrony in Spain. Methods: A Markov model was developed with CRT + OMT (CRT-ON) versus OMT only (CRT-OFF) based on a retrospective cost-effectiveness analysis. Raw data was derived from literature and expert opinion, reflecting clinical and economic consequences of patient"s management in Spain. Time horizon was 10 years. Both costs (euro 2010) and effects were discounted at 3 percent per annum. Results: CRT-ON showed higher total costs than CRT-OFF; however, CRT reduced the length of hospitalization in ICU by 94 percent (0.006 versus 0.091 days) and general ward in by 34 percent (0.705 versus 1.076 days). Surviving CRT-ON patients (88.2 percent versus 77.5 percent) remained in better functional class longer, and they achieved an improvement of 0.9 life years (LYGs) and 0.77 years quality-adjusted life years (QALYs). CRT-ON proved to be cost-effective after 6 years, except for the 7th year due to battery depletion. At 10 years, the results were 18,431 per LYG and 21,500 per QALY gained. Probabilistic sensitivity analysis showed CRT-ON was cost-effective in 75.4 percent of the cases at 10 years. Conclusions: The use of CRT added to OMT represents an efficient use of resources in patients suffering from heart failure in NYHA functional classes I and II.

Cost-effectiveness of Tenofovir / Emtricitabine / Efavirenz versus Zidovudine / Lamivudine / Efavirenz as fist-line regimens for the treatment of HIV-infected patients in low-income settings

The Highly Active Antiretroviral Therapy (HAART) is the combination of at least three antiretroviral compounds. The combination purpose is to reduce the likelihood of drug resistance. However in the long-term the resistance to the first-line combination occurs and leads to treatment failure. Thus, a second-line and even a third-line regimen are recommended in the long run. [...] [P. 5] The two treatment alternatives under comparison: Tenofovir (300 mg) CO-formulated with Emtricitabine (200 mg) and Efavirenz (600 mg) currently known under the brand name Atripla (R) was introduced in July 2006 in the United States market. The excellent safety profile and ease of use make this combination a perfect first-line regimen in low-income settings. Therefore, this treatment option was recommended in WHO 2006 reviewed guidelines. Unfortunately, Tenofovir and Emtricitabine compounds are still costly and not yet widely available. For a matter of simplification this regimen is referred in this report as "the recent" therapy. Initially, we had in mind to consider the most frequently used first-line regimen in low-income countries (Stavudine / Larnivudme / Nevirapine) as a comparator for this economic evaluation. Unfortunately, according to the literature review results (see Annex 3); there was no data available comparing head to head the effectiveness of this regimen with the recent one. Instead, we selected a less frequently but commonly used first-line regimen in low-income countries as a comparator: Zidovudine, Lamivudine, Efavirenz. This combination has extensive experience in durability, safety and toxicity and seems to be an optimal choice for a first-line regimen according to the clinical trial group 384 team. Furthermore, Zidovudine, one of the compounds of this combination is now recommended as one of the preferred NNRTI [Non Nucleoside Reverse Transcriptase Inhibitors] options to be considered by countries instead of Stavudine (the most used NNRTI in limited-income countries). As this combination has been included in the WHO guidelines as a first-line therapy since 2003 when WHO launched the "3 by 5" scaling-up initiative, this combination of drugs is referred in this report as the "old" therapy. Objectives: The primary objective of this economic evaluation is to compare the two first-line HAARTs introduced above, in a low-income setting context. Both of these combinations are recommended by the 2006 WHO guidelines as potential first-line regimens. The secondary objective is to provide a simplified and comprehensible cost-effectiveness modeling tool in order to help policy makers, in resource-limited settings, make decisions about which first-line HAART to fund using the scarce resources available. [P. 6-7]

Solitary pulmonary nodule and 18F-FDG PET/CT. Part 2: accuracy, cost-effectiveness, and current recommendations

Abstract A solitary pulmonary nodule is a common, often incidental, radiographic finding. The investigation and differential diagnosis of solitary pulmonary nodules remain complex, because there are overlaps between the characteristics of benign and malignant processes. There are currently many strategies for evaluating solitary pulmonary nodules. The main objective is to identify benign lesions, in order to avoid exposing patients to the risks of invasive methods, and to detect cases of lung cancer accurately, in order to avoid delaying potentially curative treatment. The focus of this study was to review the evaluation of solitary pulmonary nodules, to discuss the current role of 18F-fluorodeoxyglucose positron-emission tomography, addressing its accuracy and cost-effectiveness, and to detail the current recommendations for the examination in this scenario.

Ohjelmakauden 1995 - 1999 yritystukien vaikuttavuus Etelä-Karjalassa

TE-keskusten toimenkuvaan ei ole kuulunut systemaattisesti selvittää hankkeen päätyttyä tuen vaikutuksia. Vaikuttavuusarviointi on ollut lähinnä hankkeen aloitusajankohdan tietojen keräämistä yrityksiltä. Ensimmäisen ohjelmakauden 1995 - 1999 yritystukien vaikuttavuutta ei ole tutkittu Etelä-Karjalassa jälkikäteisarvioinnilla. Tutkimus selvitti, mitä yhteiskunnallisia ja yrityskohtaisia vaikutuksia TE-keskuksen yritystuilla on ollut 3-5 vuoden jälkeen viimeisestä tukirahan maksatuksesta. Vaikuttavuutta mitattiin laaditulla kyselylomakkeella. Lisäksi tutkimustuloksia verrattiin TE-keskuksen etukäteisarviointituloksiin tukien vaikutuksista. Tutkimustulokset painottuvat eri vaikuttavuustekijöihin kuin TE-keskuksen tuloksissa. Kysely osoitti suurimmiksi tukien vaikutuksiksi yrityksen kilpailukyvyn muutoksen, muun rahoituksen helpomman saannin ja hankkeen nopeamman toteuttamisen. Muut merkittävimmät vaikutukset olivat yritysten tuotteiden ja palveluiden laadun sekä teknologiatason parantaminen ja tuotantomenetelmien kehittäminen. Yritystuilla on myös muita vaikutuksia, mutta ne jäävät alueella pieniksi. Vuoden 2003 lopussa yritystukea saaneista 366 yrityksestä vain 49 % oli toiminnassa olevaa ja 51 % todennäköisesti toimintansa lopettanutta. Tuilla luotiin vain 184 uutta työpaikkaa Etelä-Karjalaan. Keskimäärin syntyi yksi uusi työpaikka yritystä kohden, joka maksoi 38 200 euroa. Tehty arviointi osoittaa tukien vaikuttavuuden jäävän pienemmäksi kuin TE-keskuksen etukäteisarvioinnissa.

Improving the effectiveness of supply chain development work – an expert role perspective

This study focuses to the intersection of three sets of activities in a company: expert work, development work and supply chain management, SCM. Experts and expert work represent a set of individuals whose efficiency and impact this study is intended to improve, while development work defines the set of organizational activities to focus on. SCM as an expertise area acts as the platform on which this study is built. The study has two aims. Firstly, it aims to derive a model helping an SCM expert to increase the effectiveness of expert work in development tasks by understanding the encountered organizational situations and processes better, reflecting his/her past and future actions to organizational processes and selecting and adjusting the processes and contents of his/her work accordingly. Secondly, it aims to develop applicable approaches and methods to understand, evaluate and manage the organizational processes and situations in development work. The integrative model on approaches and methods to improve the effectiveness of development processes is split to two aggregate dimensions: technical performance of the developed solution and consumption of resources of the development process. Six potential approaches and methods aiming at helping in the management of organizational dimensions are presented in enclosed publications. The approaches focus on three subtasks of development work: decision making, implementation and change, and knowledge accumulation. The approaches and methods have been tested in case studies representing typical development processes in the area of supply chain management. As a result, four suggestions are presented. Firstly, SCM experts are advised to consider the SCM development work to be consisting of development processes. Secondly, inside these processes they should identify and evaluate the risk of difficult decision-making related to organizational factors. Thirdly, they are prompted for an active role in implementation and change, supporting the implementation through whole process. Finally, the development should be seen in a holistic view, taking into account the stage of knowledge and organizational issues related to it, and adopt a knowledge development strategy.

Hitsaustuotannon tehostaminen robotisoinnin avulla

Tuotannon tehostaminen ja tätä kautta saavutettava lisäkapasiteetti ja yksikkökustannusten aleneminen ovat seikkoja, joita täytyy jatkuvasti miettiä, jotta yrityksen kilpailukyky markkinoilla pysyy hyvänä ja liiketoiminta kannattavana. Keinoja tuotannon tehostamiseen on useita, mutta tässä työssä on keskitytty hitsaavan yrityksen hitsaustuotannon kehittämiseen ja keinoina on käytetty lähinnä hitsauksen ja leikkauksen robotisointia. Myös tehokkaampien hitsausprosessien hyödyntämistä on käsitelty teoreettisella tasolla. Työn teoriaosuudessa on pyritty käsittelemään robotisointia kokonaisvaltaisesti hankintapäätökseen vaikuttavista tekijöistä aina robotin käyttöönottoon ja robotin toiminnan tehostamiseen asti. Robotisoinnilla saavutettavia hyötyjä ja robotisoinnin aiheuttamia vaatimuksia on käyty läpi, ja myös robotisoinnin taloudellisen kannattavuuden arviointikeinoja on esitelty. Työn käytännön osuudessa on käsitelty robotisointia GaV Group Oy:n tuotannon kannalta. Tuotteiden robotisoitua hitsattavuutta on arvioitu, ja robotisoituun hitsaukseen sekä tekniseltä että vuosivolyymiltään sopivia tuotteita on esitelty ja robotille kertyviä vuosittaisia käyttötunteja arvioitu. Näiden seikkojen pohjalta on arvioitu myös robotti-investoinnin kannattavuutta. Työn viimeisenä vaiheena on määritetty yrityksen tarpeisiin parhaiten sopivan robottisolun sisältö ja konkreettinen sijainti tehtaassa.

Do innovation and human capital explain the productivity gap between small and large firms?

Empirical evidence is compelling that large firms are more productive than small firms. The hypothesis in this paper is that the productivity differences between small and large firms are associated with two of the main determinants of a firm’s performance: the human and technological capital that firms incorporate. We suggest that the contribution of these factors in explaining the productivity-size gap might not only be due to the fact that large firms make a more extensive use of them, but also because large firms obtain higher returns from their investment in human and technological capital. The evidence we obtain for a comprehensive sample of Spanish manufacturing firms (1990-2002) supports this hypothesis, which has important implications for the effectiveness of policies designed to improve productivity in SMEs by stimulating innovation and the use of more skilled workers.

Does human capital stimulate investment in physical capital? Evidence from a cost system framework

The direct effect of human capital on economic growth has been widely analysed in the economic literature. This paper, however, focuses on its indirect effect as a stimulus for private investment in physical capital. The methodological framework used is the duality theory, estimating a cost system aggregated with human capital. Empirical evidence is given for Spain for the period 1980-2000. We provide evidence on the indirect effect of human capital in making private capital investment more attractive. Among the main explanations for this process, we observe that higher worker skill levels enable higher returns to be extracted from investment in physical capital.

Robottihitsauksen kokonaisvaltainen tehostaminen

Diplomityö on osa KaskiTec 2010 projektia. Työn tavoitteena oli tehostaa Lametal Oy:n hitsausrobotin käyttöä. Tehostamisella pyrittiin robotin käyttöasteen ja tuottavuuden kohottamiseen ja sitä kautta parantamaan investoinnin kannattavuutta. Työ on jaettu teoriaosaan ja soveltavaan osaan. Teoriaosassa käsitellään yleisesti robottihitsausta ja hitsauksen tuottavuutta. Lähdeaineistona on käytetty alan kirjallisuutta. Soveltavassa osassa käsitellään työn käytännön osuutta yrityksessä. Työn alkuvaiheessa kartoitettiin yrityksen lähtötilanne, selvitettiin pahimmat ongelmakohdat ja etsittiin ongelmiin parannuskeinoja. Tutkimusmenetelminä yrityksessä käytettiin havainnointia, henkilöhaastatteluita sekä tilastollisia ja laskennallisia menetelmiä. Seurattavaksi valittiin tuottavuuden tunnuslukuja, joiden perusteella voitiin arvioida tehostamistoimenpiteiden vaikutuksia. Yrityksessä kartoitettujen ongelmien perusteella ryhdyttiin nostamaan robotin käyttöastetta, kehittämään tuotannonohjausta, robotin materiaalivirtoja ja layoutia. Käyttöastetta nostettiin viemällä robotille uusia hitsattavia tuotteita. Työssä selvitettiin yrityksessä jo olemassa oleva tuotannonohjausjärjestelmän soveltuvuus hitsausrobotin ohjaukseen. Materiaalivirtojen sujuvuutta ja layoutia kehitettiin yhdessä muiden KaskiTec- projektin osapuolten kanssa.

The effects of social networks on work-team effectiveness

This is a study of team social networks, their antecedents and outcomes. In focusing attention on the structural configuration of the team this research contributes to a new wave of thinking concerning group social capital. The research site was a random sample of Finnish work organisations. The data consisted of 499 employees in 76 teams representing 48 different organisations. A systematic literature review and quantitative methods were used in conducting the research: the former primarily to establish the current theoretical position on the relationships among the variables and the latter to test these relationships. Social network analysis was the primary method used in identifying the social-network relations among the work-team members. The first and key contribution of this study is that it relates the structuralnetwork properties of work teams to behavioural outcomes, attitudinal outcomes and, ultimately, team performance. Moreover, it shows that addressing attitudinal outcomes is also important in terms of team performance; attitudinal outcomes (team identity) mediated the relationship between the team’s performance and its social network. The second contribution is that it examines the possible antecedents of the social structure. It is thus one response to Salancik’s (1995) call for a network theory in that it explains why certain network characteristics exist. Itdemonstrates that irrespective of whether or not a team is heterogeneous in terms of age or gender, educational diversity may protect it from centralisation. However, heterogeneity in terms of gender turned out to have a negative impact on density. Thirdly, given the observation that the benefits of (team) networks are typically theorised and modelled without reference to the nature of the relationships comprising the structure, the study directly tested whether team knowledge mediated the effects of instrumental and expressive network relationships on team performance. Furthermore, with its focus on expressive networks that link the workplace to a more informal world, which have been rather neglected in previous research, it enhances knowledge of teams andnetworks. The results indicate that knowledge sharing fully mediates the influence of complementarities between dense and fragmented instrumental network relationships, thus providing empirical validation of the implicit understanding that networks transfer knowledge. Fourthly, the study findings suggest that an optimal configuration of the work-team social-network structure combines both bridging and bonding social relationships.