Eliciting 10% of semi-natural habitats on farmland for biodiversity: Recommendations for cost-effective policy

Alcohol is one of the most important risk factors for burden of disease, particularly in high-income countries such as Canada. The purpose of this article was to estimate the number of hospitalizations, hospital days, and the resulting costs attributable to alcohol for Canada in 2002. Exposure distribution was taken from the Canadian Addiction Survey and corrected for per capita consumption from production and sales. For chronic disease, risk relations were taken from the published literature and combined with exposure to calculate age- and gender-specific alcohol-attributable fractions. For injury, alcohol-attributable fractions were taken directly from available statistics. Data on the most responsible diagnosis, length of stay for hospitalizations, and costs were obtained from the national Canadian databases. For Canada in 2002, there were 195,970 alcohol-related diagnoses among acute care hospitalizations, 2,058 alcohol-attributable psychiatric hospitalizations, and 183,589 alcohol-attributable admissions to specialized treatment centers. These accounted for 1,246,945 hospital days in acute care facilities, 54,114 hospital days in psychiatric hospitals, and 3,018,688 hospital days in specialized treatment centers (inpatient and outpatient). The main causes of alcohol-attributable morbidity were neuropsychiatric conditions, cardiovascular disease, and unintentional injuries. In total, Can. $2.29 billion were spent on alcohol-related health care. Alcohol poses a heavy burden of disease as well as a financial strain on Canadian society. However, there are evidence-based effective and cost-effective policy and legislative interventions as well as measures to better enforce these laws.

On the 3 September 2016, China officially ratified the Paris agreement as the main global producer of carbon emissions. A key of China’s commitment is to reduce its carbon intensity by 60–65% between 2005 and 2030. An improved understanding of the inequality of carbon intensity at national-, inter-regional-, and intra-regional scale is a prerequisite for the development of a more cost-effective carbon intensity reduction policy. In this study, we used the Dagum Gini coefficient and its subgroup decomposition method to quantify China’s inequality of carbon intensity between 2000 and 2014 based on available and updated data. The results show: (i) The Gini coefficient indicates a rising inequality of the carbon intensity at both national and sub-national scale, suggesting accelerated inequality of carbon intensity at national-, inter-regional, and intra-regional-scale. (ii) The Gini coefficient indicates a rising trend of intra-regional carbon intensity in Central and Western China, while the trend declines for Eastern China. (iii) The Gini coefficient indicates rising carbon intensity between Eastern and Central China, Western and Eastern China, and Central and Western China. (iv) Transvariation intensity occupies a leading role in the increasing national-level carbon intensity Gini coefficient. Ultimately, several policy recommendations are provided.

The undertreatment of pain in older adults who reside in long-term care (LTC) facilities has been well documented, leading to clinical guideline development and professional educational programs designed to foster better pain assessment and management in this population. Despite these efforts, little improvement has occurred, and we postulate that focused attention to public policy and cost implications of systemic change is required to create positive pain-related outcomes. Our goal was to outline feasible and cost-effective clinical and public policy recommendations designed to address the undermanagement of pain in LTC facilities. We arranged a 2-day consensus meeting of prominent United States and Canadian pain and public policy experts. An initial document describing the problem of pain undermanagement in LTC was developed and circulated prior to the meeting. Participants were also asked to respond to a list of relevant questions before arriving. Following formal presentations of a variety of proposals and extensive discussion among clinicians and policy experts, a set of recommendations was developed. We outline key elements of a transformational model of pain management in LTC for the United States and Canada. Consistent with previously formulated clinical guidelines but with attention to readily implementable public policy change in both countries, this transformational model of LTC has important implications for LTC managers and policy makers as well as major quality of life implications for LTC residents.

IntroductionIn 2012, the Advisory Committee on Immunization Practices (ACIP) revised recommendations for adult pneumococcal vaccination to include a sequential regimen of 13-valent pneumococcal conjugate vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) for certain high-risk adults with immunocompromising conditions. This study, from a payer perspective, examined: (1) the cost-effectiveness of the new 2012 ACIP vaccine policy recommendation relative to the 1997 ACIP recommendation; (2) the cost-effectiveness of potential future pneumococcal vaccination policies; and (3) key assumptions that influence study results.MethodsA static cohort model that incorporated costs, health outcomes, and quality-adjusted life-year (QALY) losses associated with invasive pneumococcal disease and non-bacteremic pneumococcal pneumonia (NBPP) was developed to evaluate seven pneumococcal vaccination strategies for a 50-year-old adult cohort over a 50-year period using incremental cost-effectiveness ratios (ICERs).ResultsFor objective 1, the 2012 ACIP recommendation is the more economically efficient strategy (ICER was $25,841 per QALY gained vs. no vaccination). For objective 2, the most efficient vaccination policy would be to maintain the 2012 recommendation for PPSV23 for healthy and immunocompetent adults with comorbidities, and to modify the recommendation for adults with immunocompromising conditions by replacing PPSV23 with a sequential regimen of PCV13 and PPSV23 at age 65 (ICER was $23,416 per QALY gained vs. no vaccination). For objective 3, cost-effectiveness ratios for alternative pneumococcal vaccine policies were highly influenced by assumptions used for vaccine effectiveness against NBPP and accounting for the herd protection effects of pediatric PCV13 vaccination on adult pneumococcal disease.ConclusionModifying the 2012 recommendation to include an additional dose of PCV13 at age 65, followed by PPSV23, for adults with immunocompromising conditions appears to be a cost-effective vaccine policy. Given the uncertainty in the available data and the absence of key influential data, comprehensive sensitivity analyses should be conducted by policy-makers when evaluating new adult pneumococcal vaccine strategies.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-014-0115-y) contains supplementary material, which is available to authorized users.

BackgroundWorld Health Organisation recommends routine Human Papilloma Virus (HPV) vaccination for girls when its cost-effectiveness in the country or region has been duly considered. We therefore aimed to evaluate cost-effectiveness of HPV vaccination in Nigeria using pragmatic parameter estimates for cost and programme coverage, i.e. realistically achievable in the studied context.MethodsA microsimulation frame-work was used. The natural history for cervical cancer disease was remodelled from a previous Nigerian model-based study. Costing was based on health providers’ perspective. Disability adjusted life years attributable to cervical cancer mortality served as benefit estimate. Suitable policy option was obtained by calculating the incremental costs-effectiveness ratio. Probabilistic sensitivity analysis was used to assess parameter uncertainty. One-way sensitivity analysis was used to explore the robustness of the policy recommendation to key parameters alteration. Expected value of perfect information (EVPI) was calculated to determine the expected opportunity cost associated with choosing the optimal scenario or strategy at the maximum cost-effectiveness threshold.ResultsCombination of the current scenario of opportunistic screening and national HPV vaccination programme (CS + NV) was the only cost-effective and robust policy option. However, CS + NV scenario was only cost-effective so far the unit cost of HPV vaccine did not exceed $5. EVPI analysis showed that it may be worthwhile to conduct additional research to inform the decision to adopt CS + NV.ConclusionsNational HPV vaccination combined with opportunist cervical cancer screening is cost-effective in Nigeria. However, adoption of this strategy should depend on its relative efficiency when compared to other competing new vaccines and health interventions.

The international character of today’s most pressing environmental problems has become a key challenge for environmental policy making. As regulation by a supranational authority is not a realistic option at present, policymakers have to rely on decentralized approaches to the management of international environmental resources. This study combines two core dimensions of international environmental policy: the traditional search for cost-effective policy instruments and the creation of incentives for voluntary cooperation among sovereign nations. The analysis offers some clear-cut policy recommendations for the design of environmental treaties and for the further development of existing international institutions to protect the global environment.

Value of schizophrenia treatment I: The patient journey

The international character of today’s most pressing environmental problems has become a key challenge for environmental policy making. As regulation by a supranational authority is not a realistic option at present, policymakers have to rely on decentralized approaches to the management of international environmental resources. This study combines two core dimensions of international environmental policy: the traditional search for cost-effective policy instruments and the creation of incentives for voluntary cooperation among sovereign nations. The analysis offers some clear-cut policy recommendations for the design of environmental treaties and for the further development of existing international institutions to protect the global environment.

The international character of today’s most pressing environmental problems has become a key challenge for environmental policy making. As regulation by a supranational authority is not a realistic option at present, policymakers have to rely on decentralized approaches to the management of international environmental resources. This study combines two core dimensions of international environmental policy: the traditional search for cost-effective policy instruments and the creation of incentives for voluntary cooperation among sovereign nations. The analysis offers some clear-cut policy recommendations for the design of environmental treaties and for the further development of existing international institutions to protect the global environment.

The international character of today's most pressing environmental problems has become a key challenge for environmental policy making. As regulation by a supranational authority is not a realistic option at present, policymakers have to rely on decentralized approaches to the management of international environmental resources. This study combines two core dimensions of international environmental policy: the traditional search for cost-effective policy instruments and the creation of incentives for voluntary cooperation among sovereign nations. The analysis offers some clear-cut policy recommendations for the design of environmental treaties and for the further development of existing international institutions to protect the global environment.

The international character of today’s most pressing environmental problems has become a key challenge for environmental policy making. As regulation by a supranational authority is not a realistic option at present, policymakers have to rely on decentralized approaches to the management of international environmental resources. This study combines two core dimensions of international environmental policy: the traditional search for cost-effective policy instruments and the creation of incentives for voluntary cooperation among sovereign nations. The analysis offers some clear-cut policy recommendations for the design of environmental treaties and for the further development of existing international institutions to protect the global environment.

The international character of today’s most pressing environmental problems has become a key challenge for environmental policy making. As regulation by a supranational authority is not a realistic option at present, policymakers have to rely on decentralized approaches to the management of international environmental resources. This study combines two core dimensions of international environmental policy: the traditional search for cost-effective policy instruments and the creation of incentives for voluntary cooperation among sovereign nations. The analysis offers some clear-cut policy recommendations for the design of environmental treaties and for the further development of existing international institutions to protect the global environment.

The international character of today's most pressing environmental problems has become a key challenge for environmental policy making. As regulation by a supranational authority is not a realistic option at present, policymakers have to rely on decentralized approaches to the management of international environmental resources. This study combines two core dimensions of international environmental policy: the traditional search for cost-effective policy instruments and the creation of incentives for voluntary cooperation among sovereign nations. The analysis offers some clear-cut policy recommendations for the design of environmental treaties and for the further development of existing international institutions to protect the global environment.

The international character of today’s most pressing environmental problems has become a key challenge for environmental policy making. As regulation by a supranational authority is not a realistic option at present, policymakers have to rely on decentralized approaches to the management of international environmental resources. This study combines two core dimensions of international environmental policy: the traditional search for cost-effective policy instruments and the creation of incentives for voluntary cooperation among sovereign nations. The analysis offers some clear-cut policy recommendations for the design of environmental treaties and for the further development of existing international institutions to protect the global environment.