Impact of radiofrequency ablation for patients with varicose veins on the budget of the German statutory health insurance system

Objectives: In contrast to other countries, surgery still represents the common invasive treatment for varicose veins in Germany. However, radiofrequency ablation, e.g. ClosureFast, becomes more and more popular in other countries due to potential better results and reduced side effects. This treatment option may cause less follow-up costs and is a more convenient procedure for patients, which could justify an introduction in the statutory benefits catalogue. Therefore, we aim at calculating the budget impact of a general reimbursement of ClosureFast in Germany. Methods: To assess the budget impact of including ClosureFast in the German statutory benefits catalogue, we developed a multi-cohort Markov model and compared the costs of a “World with ClosureFast” with a “World without ClosureFast” over a time horizon of five years. To address the uncertainty of input parameters, we conducted three different types of sensitivity analysis (one-way, scenario, probabilistic). Results: In the Base Case scenario, the introduction of the ClosureFast system for the treatment of varicose veins saves costs of about 19.1 Mio. € over a time horizon of five years in Germany. However, the results scatter in the sensitivity analyses due to limited evidence of some key input parameters. Conclusions: Results of the budget impact analysis indicate that a general reimbursement of ClosureFast has the potential to be cost-saving in the German Statutory Health Insurance.

Some aspects of implementing Regulatory Impact Analysis in Brazil

In an increasingly complex society, regulatory polices emerge as an important tool in public management. Nevertheless, regulation per se is no longer enough, and the agenda for a regulatory reform is increasing. Following this context, Brazil has implemented Regulatory Impact Analysis (RIA) in its regulatory agencies. Thus, Brazilian specificities have to be considered and, in this regard, a systematic approach provides a significant contribution. This article aims to address some critical reflections about which policy-makers should ask themselves before joining the implementation of a RIA system in the Brazilian context. Through a long-term perspective, the implementation of RIA must be seen as part of a permanent change in the administrative culture, understanding that RIA should be used as a further resource in the decision-making process, rather than a final solution.

Budget impact from the incorporation of positron emission tomography – computed tomography for staging lung cancers

OBJECTIVE To estimate the budget impact from the incorporation of positron emission tomography (PET) in mediastinal and distant staging of non-small cell lung cancer.METHODS The estimates were calculated by the epidemiological method for years 2014 to 2018. Nation-wide data were used about the incidence; data on distribution of the disease´s prevalence and on the technologies’ accuracy were from the literature; data regarding involved costs were taken from a micro-costing study and from Brazilian Unified Health System (SUS) database. Two strategies for using PET were analyzed: the offer to all newly-diagnosed patients, and the restricted offer to the ones who had negative results in previous computed tomography (CT) exams. Univariate and extreme scenarios sensitivity analyses were conducted to evaluate the influence from sources of uncertainties in the parameters used.RESULTS The incorporation of PET-CT in SUS would imply the need for additional resources of 158.1 BRL (98.2 USD) million for the restricted offer and 202.7 BRL (125.9 USD) million for the inclusive offer in five years, with a difference of 44.6 BRL (27.7 USD) million between the two offer strategies within that period. In absolute terms, the total budget impact from its incorporation in SUS, in five years, would be 555 BRL (345 USD) and 600 BRL (372.8 USD) million, respectively. The costs from the PET-CT procedure were the most influential parameter in the results. In the most optimistic scenario, the additional budget impact would be reduced to 86.9 BRL (54 USD) and 103.8 BRL (64.5 USD) million, considering PET-CT for negative CT and PET-CT for all, respectively.CONCLUSIONS The incorporation of PET in the clinical staging of non-small cell lung cancer seems to be financially feasible considering the high budget of the Brazilian Ministry of Health. The potential reduction in the number of unnecessary surgeries may cause the available resources to be more efficiently allocated.

Opening Pousada da Serra da Estrela in Covilhã: A two-way impact analysis - interacting with private agents

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Opening Pousada da Serra da Estrela in Covilhã: A two-way impact analysis - Interacting with public agents

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Social tariffs for water and waste services in mainland Portugal: An impact analysis

This paper proposes to quantify the effect of social tariffs (ST) in the Portuguese water and waste sector (WWS). It calculates the amount of subsidy implicit in ST schemes, characterising the existing tariffs in 2011 and producing a synthetic tariff scene where the regulator’s recommendation is respected. This is the first time such an exercise is undertaken and it is very relevant in a context of deep economic crisis. Results suggest that there are fewer beneficiaries than what income eligibility criteria would imply and that putting the regulator’s recommendation in practice would considerably raise subsidy amounts, potentially leading to a severe increase in non-subsidised user tariffs to allow for break-even.

Regulatory Impact Analysis (RIA) Public Health (Sunbeds) Bill 2013

There has been a growing body of evidence over recent years, that the use of sunbeds, especially by children, should be restricted because of the associated increased risk of skin cancer and other health problems. Regulatory Impact Analysis (RIA) of the Public Health (Sunbeds) Bill 2013

Issue review : fiscal year 2011 Judicial Branch budget impact.

This issue review analyzes recent activity related to the Judicial Branch budget. The Judicial Branch budget is 3 percent of the total state general fund budget and consists of 95 percent personnel costs and 5 percent non-personnel costs. As of August 31, 2010, 29 clerks-of-court offices are operating on a part-time basis with reduced public hours. The remaining 70 offices are closed for two hours a day, two days a week. From February 2009 through June 2010, there were 15 court closure days.

El Niño 2015/2016: impact analysis of past El Niños

This is a DfID (Department for International Development) commissioned report on the impact of historical El Niño events on low- and middle-income countries across Africa and elsewhere. The report identifies El Niño events in the past 35 years and highlights regions and countries vulnerable to their impacts. The impacts on rainfall and temperature are broken down by season and country as the El Niño develops, peaks and decays and are represented in at-a-glance Impact Tables. The Impact Tables also include an extensive review of literature (e.g., peer-reviewed, grey literature and media reports) to identify potential socio-economic impacts in vulnerable sectors such as water, infrastructure, energy and health. The risk of such impacts are graded as high, medium or potential depending on the meteorological signal and the robustness of evidence available.

El Niño 2015/2016 impact analysis, monthly outlook November 2015

During the summer and autumn 2015, El Niño conditions in the east and central Pacific have strengthened, disrupting weather patterns throughout the tropics and into the mid-latitudes. For example, rainfall during this summer’s Indian monsoon was approximately 15% below normal. The continued strong El Niño conditions have the potential to trigger damaging impacts (e.g., droughts, famines, floods), particularly in less-developed tropical countries, which would require a swift and effective humanitarian response to mitigate damage to life and property (e.g., health, migration, infrastructure). This analysis uses key climatic variables (temperature, soil moisture and precipitation) as measures to monitor the ongoing risk of these potentially damaging impacts. The previous 2015-2016 El Niño Impact Analysis was based on observations over the past 35 years and produced Impact Tables showing the likelihood and severity of the impacts on temperature and rainfall by season. The current report is an extension of this work providing information from seasonal forecast models to give a more detailed monthly outlook of the potential near-term impacts of the current El Niño conditions by region. This information has been added to the Impact Tables in the form of a monthly outlook column. This monthly outlook is an indication of the average likely conditions for that month and region and is not a definite prediction of weather impacts.

El Niño 2015/2016 impact analysis, monthly outlook December 2015

During the summer and autumn 2015, El Niño conditions in the east and central Pacific have strengthened, disrupting weather patterns throughout the tropics and into the mid-latitudes. For example, rainfall during this summer’s Indian monsoon was approximately 15% below normal. The continued strong El Niño conditions have the potential to trigger damaging impacts (e.g. droughts, famines, floods), particularly in less-developed tropical countries, which would require a swift and effective humanitarian response to mitigate damage to life and property (e.g. health, migration, infrastructure). This analysis uses key climatic variables (temperature, soil moisture and precipitation) as measures to monitor the ongoing risk of these potentially damaging impacts. The previous 2015-2016 El Niño Impact Analysis was based on observations over the past 35 years and produced Impact Tables showing the likelihood and severity of the impacts on temperature and rainfall by season. The current report is an extension of this work providing information from observations and seasonal forecast models to give a more detailed outlook of the potential near-term impacts of the current El Niño conditions by region. This information has been added to the Impact Tables in the form of an ‘Observations and Outlook’ row. This consists of observational information for the past seasons of JJA 2015 and SON 2015, a detailed monthly outlook from 5 modeling centres for Dec 2015 and then longer-term seasonal forecast information from 2 modeling centres for the future seasons of JF 2016 and MAM 2016. The seasonal outlook information is an indication of the average likely conditions for that coming month (or season) and region and is not a definite prediction of weather impacts.

El Niño 2015/2016 impact analysis, monthly outlook January 2016

During the summer and autumn of 2015, El Niño conditions in the east and central Pacific have strengthened, disrupting weather patterns throughout the tropics and into the mid-latitudes. For example, rainfall during this summer’s Indian monsoon was approximately 15% below normal. The continued strong El Niño conditions have the potential to trigger damaging impacts (e.g., droughts, famines, floods), particularly in less-developed tropical countries, which would require a swift and effective humanitarian response to mitigate damage to life and property (e.g., health, migration, infrastructure). This analysis uses key climatic variables (temperature, soil moisture and precipitation) as measures to monitor the ongoing risk of these potentially damaging impacts. The previous 2015-2016 El Niño Impact Analysis was based on observations over the past 35 years and produced Impact Tables showing the likelihood and severity of the impacts on temperature and rainfall by season. The current report is an extension of this work providing information from observations and seasonal forecast models to give a more detailed outlook of the potential near-term impacts of the current El Niño conditions by region. This information has been added to the Impact Tables in the form of an ‘Observations and Outlook’ row. This consists of observational information for the past seasons of JJA 2015, SON 2015 and Dec 2015, a detailed monthly outlook from 4 modeling centres for Jan 2016 and then longer-term seasonal forecast information from 2 modeling centres for the future seasons of Feb 2016, MAM 2016 and Jun 2016. The seasonal outlook information is an indication of the average likely conditions for that coming month (or season) and region and is not a definite prediction of weather impacts.

El Niño 2015/2016 impact analysis, monthly outlook February 2016

During the summer and autumn of 2015, El Niño conditions in the east and central Pacific strengthened, disrupting weather patterns throughout the tropics and into the mid-latitudes. For example, rainfall during the summer’s Indian monsoon was approximately 15% below normal. The continued strong El Niño conditions have the potential to trigger damaging impacts (e.g., droughts, famines, floods), particularly in less-developed tropical countries, which would require a swift and effective humanitarian response to mitigate damage to life and property (e.g., health, migration, infrastructure). This analysis uses key climatic variables (temperature, soil moisture and precipitation) as measures to monitor the ongoing risk of these potentially damaging impacts. The previous 2015-2016 El Niño Impact Analysis was based on observations over the past 35 years and produced Impact Tables showing the likelihood and severity of the impacts on temperature and rainfall by season. The current report is an extension of this work, providing information from observations and seasonal forecast models to give a more detailed outlook of the potential near-term impacts of the current El Niño conditions by region. This information has been added to the Impact Tables in the form of an ‘Observations and Outlook’ row. This consists of observational information for the past seasons of JJA 2015, SON 2015 and DJ 2015/2016, a detailed monthly outlook from 5 modeling centres for Feb 2016 and then longer-term seasonal forecast information from 2 modeling centres for the future seasons of MAM 2016 and JJ 2016. The seasonal outlook information is an indication of the average likely conditions for that coming month (or season) and region and is not a definite prediction of weather impacts. This report has been produced by University of Reading for Evidence on Demand with the assistance of the UK Department for International Development (DFID) contracted through the Climate, Environment, Infrastructure and Livelihoods Professional Evidence and Applied Knowledge Services (CEIL PEAKS) programme, jointly managed by DAI (which incorporates HTSPE Limited) and IMC Worldwide Limited.