Reducing the global burden of depression : population level analysis of intervention cost-effectiveness in 14 world regions

International evidence on the cost and effects of interventions for reducing the global burden of depression remain scarce. Aims: To estimate the population-level cost-effectiveness of evidence-based depression interventions and their contribution towards reducing current burden. Method: Primary-care-based depression interventions were modelled at the level of whole populations in 14 epidemiological subregions of the world. Total population-level costs (in international dollars or I$) and effectiveness (disability adjusted life years (DALYs) averted) were combined to form average and incremental cost-effectiveness ratios. Results: Evaluated interventions have the potential to reduce the current burden of depression by 10–30%. Pharmacotherapy with older antidepressant drugs, with or without proactive collaborative care, are currently more cost-effective strategies than those using newer antidepressants, particularly in lower-income subregions. Conclusions: Even in resource-poor regions, each DALYaverted by efficient depression treatments in primary care costs less than 1 year of average per capita income, making such interventions a cost-effective use of health resources. However, current levels of burden can only be reduced significantlyif there is a substantialincrease substantial increase intreatment coverage.

Correcting for bias when estimating the cost of hospital-acquired infection : an analysis of lower respiratory tract infections in non-surgical patients

Hospital acquired infections (HAI) are costly but many are avoidable. Evaluating prevention programmes requires data on their costs and benefits. Estimating the actual costs of HAI (a measure of the cost savings due to prevention) is difficult as HAI changes cost by extending patient length of stay, yet, length of stay is a major risk factor for HAI. This endogeneity bias can confound attempts to measure accurately the cost of HAI. We propose a two-stage instrumental variables estimation strategy that explicitly controls for the endogeneity between risk of HAI and length of stay. We find that a 10% reduction in ex ante risk of HAI results in an expected savings of £693 ($US 984).

Knowledge Sharing within IT Projects

Even though today’s corporations recognize that they need to understand modern project management techniques (Schwalbe, 2002, p2), many researchers continue to provide evidence of poor IT project success. With Kotnour, (2000) finding that project performance is positively associated with project knowledge, a better understanding of how to effectively manage knowledge in IT projects should have considerable practical significance for increasing the chances of project success. Using a combined qualitative/quantitative method of data collection in multiple case studies spanning four continents, and comprising a variety of organizational types, the focus of this current research centered on the question of why individuals working within IT project teams might be motivated towards, or inhibited from, sharing their knowledge and experience in their activities, procedures, and processes. The research concluded with the development of a new theoretical model of knowledge sharing behavior, ‘The Alignment Model of Motivational Focus’. This model suggests that an individual’s propensity to share knowledge and experience is a function of perceived personal benefits and costs associated with the activity, balanced against the individual’s alignment to a group of ‘institutional’ factors. These factors are identified as alignments to the project team, to the organization, and dependent on the circumstances, to either the professional discipline or community of practice, to which the individual belongs.