Additional Expenditure Research Articles

When to Preprocess? Keeping Information Fresh for Computing-Enable Internet of Things

Age of information (AoI), a notion that measures the information freshness, is an essential performance measure for time-critical applications in Internet of Things (IoT). With the surge of computing resources at the IoT devices, it is possible to preprocess the information packets that contain the status update before sending them to the destination so as to alleviate the transmission burden. However, the additional time and energy expenditure induced by computing also make the optimal updating a non-trivial problem. In this paper, we consider a time-critical IoT system, where the IoT device is capable of preprocessing the status update before the transmission. Particularly, we aim to jointly design the preprocessing and transmission so that the weighted sum of the average AoI of the destination and the energy consumption of the IoT device is minimized. Due to the heterogeneity in transmission and computation capacities, the durations of distinct actions of the IoT device are non-uniform. Therefore, we formulate the status updating problem as an infinite horizon average cost semi-Markov decision process (SMDP) and then transform it into a discrete-time Markov decision process. We demonstrate that the optimal policy is of threshold type with respect to the AoI. Equipped with this, a structure-aware relative policy iteration algorithm is proposed to obtain the optimal policy of the SMDP. Our analysis shows that preprocessing is more beneficial in regimes of high AoIs, given it can reduce the time required for updates. We further prove the switching structure of the optimal policy in a special scenario, where the status updates are transmitted over a reliable channel, and derive the optimal threshold. Finally, simulation results demonstrate the efficacy of preprocessing and show that the proposed policy outperforms two baseline policies.

How Responsive is Mortality to Locally Administered Healthcare Expenditure? Estimates for England for 2014/15.

Research using local English data from 2003 to 2012 suggests that a 1% increase in healthcare expenditure causes a 0.78% reduction in mortality, and that it costs the NHS £10,000 to generate an additional quality-adjusted life year (QALY). In 2013, the existing 151 local health authorities (Primary Care Trusts) were abolished and replaced with 212 Clinical Commissioning Groups (CCGs). CCGs retained responsibility for secondary care and pharmaceuticals, but responsibility for primary care and specialised commissioning returned to central administrators. The aim was to extend and apply existing methods to more recent data using a new geography and expenditure base, while improving covariate selection and examining the responsiveness of mortality to expenditure across the mortality distribution. Instrumental variable regression is used to quantify the relationship between mortality and local expenditure. Backward selection and regularised regression are used to identify parsimonious specifications. These results are combined with information about survival and morbidity disease burden to calculate the marginal cost per QALY. Unconditional quantile regression (UQR) is used to examine the response of mortality to expenditure across the mortality distribution. Backward selection and regularised regression both suggest that the marginal cost per QALY in 2014/15 was about £7000 for locally commissioned services. The UQR results suggest that additional expenditure generates larger health benefits in high-mortality areas and that, if anything, the average size of this heterogeneous response is larger than the response at the mean. The new healthcare geography and expenditure base can be used to update estimates of the health opportunity costs associated with additional expenditure. The variation in the mortality response across the mortality distribution suggests that the use of the response at the mean will, if anything, underestimate the health opportunity costs associated with a national policy or nationally mandated guidance on the use of new technologies. The health opportunity costs of such policies are likely to be greater (lower) in areas of higher (lower) mortality, increasing health inequalities.

School Spending and Student Outcomes: Evidence from Revenue Limit Elections in Wisconsin

This study examines the impacts of two distinct types of school spending on student outcomes. State-imposed revenue limits cap the total amount of revenue that a school district in Wisconsin can raise unless the district holds a referendum asking voters to exceed the cap. Importantly, Wisconsin law requires districts to hold separate referenda for operational and capital expenditures, which allows for estimating their independent effects. Leveraging close elections in a dynamic regression discontinuity framework, I find that increases in operational spending have substantial positive effects on test scores, dropout rates, and postsecondary enrollment, but additional capital expenditures have little impact. (JEL D72, H75, I21, I22, I28)

Behaviour modification intervention for patients with chronic kidney disease could provide a mid- to long-term reduction in public health care expenditure: budget impact analysis.

A recent cost-effectiveness analysis (CEA) study evaluated the widespread diffusion of behaviour modification intervention for patients with chronic kidney disease (CKD). Incorporating this behaviour modification intervention, comprising educational sessions on nutrition/lifestyle and support for regular patient visits, to the current CKD guideline-based practice was found to be cost-effective. This study aimed to examine the affordability of this efficient new practice under the hypothesis that the behaviour modification intervention would be initiated by general physicians (GPs). A budget impact analysis was conducted by defining the target population as patients aged 40-74years with stage-3-5 CKD based on the prevalence of definitive CKD in the Japanese general population. Costs expended by social insurers without discount were counted as budgets. We estimated the annual budget impact for 15years by running our CEA model, assuming that it would be good for the span. We estimated the number of patients with end-stage kidney disease (ESKD) to decrease by 4,496 in the fifteenth year of the new practice using our CEA model. Compared to that in the current practice, the budget impact as total additional expenditure of the new practice was estimated to be negative by the tenth year in the base case. The widespread diffusion of behaviour modification intervention would contain public health care expenditure over the mid-to-long term, resulting from a reduction in progression to ESKD. We suggest that providing sufficient economic incentives to GPs and strengthening recommendations in CKD guidelines would realise effective GP-initiated interventions.

Strengthening Taiwan’s Green Building Certification System from Aspects of Productivity and Energy Costs to Provide a Healthier Workplace

This study estimates the relationship between poor indoor environmental quality (IEQ) and the increasing labor costs in green buildings in Taiwan. Specifically, poor performance of IEQ including HVAC, lighting, and indoor air quality, influences the health and well-being of occupants and leads to worse productivity, ultimately causing increased personnel cost. In Taiwan’s green building certification (GBC) system, the energy-savings category is mandatory while the IEQ category is only optional. It means that certified building cases may not reach the expected level in IEQ. Thus, this study reviews the thermal environment, indoor air quality (IAQ), and illumination performances of IEQ-certified and non-IEQ-certified buildings in 20 green buildings. Building energy and IEQ simulations were conducted to analyze the relationships between indoor comfort, energy cost, and personnel cost in green buildings. The results show that IEQ-certified green buildings averagely perform better than non-IEQ-certified ones in the aspects of IEQ and building costs. Besides, 3 of 13 non-IEQ-certified green buildings undertake extremely high additional expenditure for the poor IEQ. The results correspond to some previous findings that green-certified buildings do not necessarily guarantee good building performance. This study further inspects the pros and cons of Taiwan’s GBC system and proposes recommendations against its insufficient IEQ evaluation category. As the trade-off of energy-saving benefits with health and well-being in green buildings has always been a concern, this study aims to stimulate more quantitative research and promote a more comprehensive green building certification system in Taiwan.

Psychological distress and associated additional medical expenditures in adolescent and young adult cancer survivors.

Adolescent and young adult (AYA) cancer survivors experience psychological distress often because of cancer and its treatment. However, no prior studies have evaluated the additional medical expenditures and health care utilization associated with psychological distress in AYA cancer survivors. AYA cancer survivors and a comparison matched group of adults with no history of cancer were identified from 2011-2016 Medical Expenditure Panel Survey data. Medical expenditures and health care utilization were evaluated with multivariable regression models. AYA cancer survivors were more likely to have psychological distress (11.5% of 1757) than adults with no history of cancer (5.8% of 5227). The prevalence of psychological distress was found to be high many years after the diagnosis, with 11.2% reporting distress ≥20 years after their cancer diagnosis. AYA cancer survivors with psychological distress were more likely to smoke and have chronic conditions and were less likely to exercise regularly in comparison with AYAs with no history of psychological distress. AYA cancer survivors with psychological distress had additional annual medical expenses ($4415; 95% CI, $993-$9690), office visits (2.80; 95% CI, 0.23-6.15), and use of prescription medications/medication renewals (11.58; 95% CI, 5.70-19.47) in comparison with AYA cancer survivors without psychological distress. Additional annual medical expenses of psychological distress were $2600 higher in AYA cancer survivors than adults without a history of cancer ($1802; 95% CI, $440-$3791). These results highlight the substantial economic burden associated with psychological distress in AYA cancer survivors. This research could inform survivorship care plans and interventions addressing the psychological needs of AYA cancer survivors.

Consumption tax and productive government expenditure in DSGE model

Our article presents a dynamic stochastic general equilibrium (DSGE) model to derive effects of a consumption tax rate increase. In the DSGE model, money and inflation are examined to elucidate the transitional path of policy. Results of a consumption tax rate increase are intuitive: GDP declines because of lower aggregate consumption. With a consumption tax rate increase, we consider the productive government expenditure model. In the standard DSGE model, the production function comprises inputs of capital stock and labor. Policy can change the capital stock and labor inputs to alter the production level. However, the production level can be changed by other policies. For instance, increased public investment in infrastructure by government can change the production level. After setting the DSGE model with productive government expenditure, we attempt derivation of a result. We consider the case in which additional productive government expenditure is financed by a consumption tax. In this case, compared with the case of a consumption tax increase without productive government expenditure, GDP increases even if the consumption tax rate is raised. An increase in productive government expenditure increases marginal labor productivity, thereby raising the wage rate. Consequently, by virtue of a raised wage rate, consumption can increase even if the consumption tax negatively affects aggregate consumption.

Primary Ureteroscopy for Diagnosing and Treating Acute Urolithiasis During the COVID-19 Pandemic

Purpose: The purpose of this study was to investigate the management of acute urolithiasis during index admission by primary ureteroscopy (P-URS) during coronavirus disease-2019 (COVID-19) pandemic. With the rise in prevalence of urolithiasis, the focus has shifted to manage patients presenting with acute ureteric colic during their first admission rather than using temporary measures such as emergency stenting (ES) or nephrostomies which are followed by deferred ureteroscopic procedures Deferred Ureteroscopy (D-URS). We compared the results of ES with P-URS procedures in terms of quality and cost benefits during COVID-19 pandemic. Materials and Methods: Data were collected prospectively from April 2020 to March 2021 for all emergency urolithiasis procedures performed including ES and P-URS. The quality assessment was based in relation to patient factors including the number of procedures per patient, number of days spent at hospital, number of days off work, and expertise of person operating. Cost analysis included theater expenses, hospital stay charges, and loss of working days. Results: This study revealed that the average stay of patients on index admission who had an ES was 1.35 days compared to 1.78 days in patients who underwent P-URS. Patients who had ES had to undergo D-URS and spent another average of 1.5 days in the hospital. Overall, additional expenditure in patients who did not undergo primary ureterorenoscopy was on an average in the range of £1800 (excluding loss of work for patients, who needed to return for multiple procedures). Conclusion: We conclude that the approach of P-URS and management of stones in index admission is very effective in both improving quality of patients (during the COVID-19 pandemic) and bringing down cost expenditure effectively.

Research on civil engineering management and engineering cost control

In order to improve the level of civil engineering construction and reduce the cost of construction expenditures, research on civil engineering management and engineering cost control methods is carried out. Comprehensively consider the risk factors that may increase the additional expenditures of the construction of the construction site, and manage the sub-items of the basic cost of civil engineering in a targeted manner; control the cost of the civil engineering project in each construction stage according to the three steps before, during and after the event expenditure. Choose a real project as the experimental project, and control the project construction expenditure with reference to the designed control method. After practice, it is proved that this method can realize the control of the actual expenditure of the expenditure cost project during the construction process to ensure that the project is in the existing High-quality completion within the scope of funds.

ANALISIS MULTIPLIER EFFECT DAN PEMBANGUNAN BERKELANJUTAN PUSAT INFORMASI WISATA

The existence of the Toba Caldera National Geopark Information Center is an indicator of the seriousness of the government in tapping the potential of Lake Toba with the World-recognized National Geopark approach. Therefore, it is very interesting to explore the impact of the Toba Caldera National Geopark Information Center, especially for the surrounding community. On the one hand, the existence of the Toba Caldera National Geopark Information Center as one of the tourist information centers is a question of whether it is really needed, considering that tourists can now access digital information. Therefore this study seeks to see how the Toba Caldera National Geopark Information Center applies the principle of sustainable development to maintain its existence. This research method is a combination of the quantitative Keynesian Income Multiplier method and interview techniques with the sustainable tourism development approach of the United Nations World Tourism Organization (UNWTO) by combining practical principles. The results obtained show that economically, the Toba Caldera National Geopark Information Center has an encouraging impact on the number 1: 1.26, meaning that for each additional tourist expenditure of IDR 10,000, local income will increase by IDR 12,600. On the other hand, the Toba Caldera National Geopark Information Center has attempted to apply the principles of sustainable tourism development in view of the dimensions of business quality, social sustainability and environmental balance recommended by UNWTO, but improvements are needed for aspects of tourism facilities and activities.

ZADUŽENOST U VRIJEME PANDEMIJE COVID-19 – SLUČAJ BOSNE I HERCEGOVINE

The COVID-19 pandemic is a global unprecedented event since the Spanish flu pandemic in 1918. The IMF addressed this pandemic-caused economic fallout as the worst crisis since the Great Depression. Entire continents are in lockdowns just with essential services and activities. Unlike the global financial crisis that derived from a financial sector, this pandemic-caused crisis is shock in real economy, both on the demand and supply side. During previous crisis, especially during global financial crisis, most governments responded with austerity measures and fiscal consolidation. This time it is different. Governments worldwide approved additional expenditures, tax cuts, government bond issuance and borrowing in order to mitigate economic consequences of the looming crisis. One of the pandemic’s result is dramatic increase of indebtedness that could affect efficiency of fiscal and monetary responses created before to fight against crisis. This sudden and strong COVID-10 shock especially effects developing countries and emerging markets, but also advanced countries with already limited fiscal space. The COVID-19 pandemic-caused crisis evoked again fear of debt crisis and expanded a number of countries with indebtedness problems. Bosnia and Herzegovina as developing country with complex state structure and its own macroeconomic, political, institutional problems is not spared of negative effects of the pandemic. In order to save economy when recovery from the previous crisis is still in swing, Bosnia and Herzegovina did emergency measures to support economy. Increase of government spending in addition to reduced tax revenues have created the need for budget rebalance and additional borrowing. The aim of this work is to show macroeconomic situation and problems in the EU countries, countries in the region and especially in Bosnia and Herzegovina before the pandemic as well as current problems, their reactions to COVID-19 pandemic and necessary financial support that could cause increase of indebtedness.

CONFIDENCE LEVEL OF A MOTION FEEDBACK SYSTEM FOR ANALYZING EXERCISE TRAINING EFFICACY

The increase in aged population is a global trend. Inculcating healthy behaviors such as regular exercises in the elderly has a significant impact on the financial and medical burden globally. Moreover, air pollution and the outbreak of the coronavirus disease 19 (COVID-19) pose a serious threat to public health. In order to improve the health conditions of the population, this study developed a motion feedback system named MoveV that can be used for several indoor training exercises. This system provides instant motion feedback by synchronizing exercise training videos on the website using a motion analysis algorithm that is applicable on smartphones, and a cloud database platform is used to record health behaviors. Feature extraction is performed based on force intensity, motion velocity, and exercise direction. The resultant accuracy of the motion feedback system was tested by a motion science expert and presented as the confidence level. For perfect movement, a confidence level of up to 90.5% was achieved, indicating that the MoveV system was able to record users’ exercise frequency and distinguish whether the user was performing well in the exercise movements. The proposed system is convenient and does not incur additional expenditure by purchasing any new device. Furthermore, it provides visual and voice feedback, companionship, and exercise motivation to the users, all of which are important factors when using online exercise platforms.

Physiological and biochemical mechanisms of the hen’s body recovery from dermanyssosis associated with deacarization

The purpose of the research is to study the efficacy of the insectoacaricide "5% D-cyphenotrine emulsion" against infestation of birds with Dermanyssus gallinae (dermanyssosis) after the deacarization of the poultry building and to characterize physiological and biochemical mechanisms of the recovery of Hy-Line hens after removed parasites.Materials and methods. A parasitological examination of the poultry farm found D. gallinae in one of the poultry buildings. Given positive results of the drug efficacy against the poultry red mite, we analyzed the morpho-physiological and physiological and biochemical parameters of the hen’s blood before and 10 and 20 days after the treatments. Changes in the ethological status of birds were recorded. We used 0.005% aqueous emulsion of "5% D-cyphenothrin emulsion" for treatment. To obtain it, the drug was diluted with water at a ratio of 1:1000 immediately before use.Results and discussion. After double treatment with "5% D-cyphenotrine emulsion" of the shop with hens from the test group, no live poultry red mite was found. Within 20 days after the disease reduction, representatives of this group showed high concentrations of cortisol which were 2.3–2.4 times (p < 0.001) higher than those of healthy hens. This indicates that the stress state of hens still remains after the parasitizing of D. gallinae. In addition, the recovery process takes a long time and with great stress for all systems of their body. This is also confirmed by a high level of lipid peroxidation. At the same time, high intensity of gluconeogenesis and, as a result, deterioration of lipid and protein metabolism were recorded in the hens in question. The positive results indicate an increasing need for additional energy expenditures which are paramount for the effective and well-timed implementation of adaptation mechanisms. It should be noted here that the values of all the above-mentioned indicators tend to normalize by the end of the study period. The changes noted in the blood of birds indicate the restoration of a number of body systems. The poultry red mite as an emergency factor affects the morphophysiology of the blood, in particular, the level of white blood cells, which is restored by the 10th day after deacarization, which triggers regenerative and reparative processes. There were also changes in the number of cells of the immune system, an increase in hemoglobin concentration to control values and optimization of behavior in representatives of the test group which are largely related to the normalized physiological activity of the thyroid gland after the poultry building deacarization. We found a partial recovery of the hen’s body systems after the poultry building deacarization with the drug "5% D-cyphenotrine emulsion", which is due to the long-term parasitizing of D. gallinae, a stressor of extreme strength.

Optimization of Wind Sail using Computational Fluid Dynamics Simulation

The marine industry is highly dependent on oil as the fuel and the increased consumption of this fast-depleting oil recourse creates a shortage of fuel for the future as well as pollutes the environment. The pollution of water bodies also seriously affects marine life. Thus, the need for an alternate sustainable fuel source is of great importance. One such feasible alternative energy source is wind energy. The abundance, free availability and ease of conversion make it an ideal alternative to oil. Wind energy can be extracted by wind turbines or by sails. The sails convert the wind energy directly into energy for propulsion. The challenge in the conversion is the relative angle of attack of wind on the sail. The wind cannot be expected to be always in the direction of the course of the ship. When the wind is at an angle to the direction of the course, the thrust in the course director will be reduced and a component of thrust is developed on the sail which shifts the course of the ship. Bringing the ship back to the original course will create an additional expenditure of fuel. In such circumstances modification of the sail section shape from its conventional form to an optimal form helps to reduce these deficiencies. Therefore, the effort here is to numerically analyze the aerodynamic characteristics of wing-sails and to optimize their shape. The aerofoil NACA 0018 used here was chosen through a high fidelity two-dimensional computational analysis which was done earlier. The tip of the NACA 0018 was further modified by tilting it through different angles and at different chord positions forming a flap. The main objective of the study is to optimize the angle and the position of the flap relative to the chord of the aerofoil. The flapped airfoils were formed by modifying them from 10% chord length to 60% chord length. That flap angle was also varied from 0 degrees to 50 degrees in steps of 10- deg. The angle of attack on the sail was varied from 0 to 10 degrees in steps of 2 degrees. The thrust in the direction of course and the lateral thrust of each of these sail sections were estimated, tabulated and graphs were plotted. Analyzing these, an optimum shape for the sail section is derived.

Development of an Abbreviated Longitudinal Approach for Medical Student Learning in Perioperative Medicine: Teaching the Perioperative Surgical Home.

Leaders in anesthesiology are promoting increased involvement of anesthesiologists in perioperative medicine (POM). Academic leaders are calling for a corresponding increase in resident and medical student education in this evolving medical discipline. Formalized POM programs are new to most academic anesthesiology programs, and very little has been written about development of these programs for anesthesiology residents or medical students. We describe the creation of a longitudinal medical student clerkship in POM using established curriculum design methods with minimal capital resources. This is a descriptive account of the process of clerkship design. It includes a qualitative analysis of participants' satisfaction with the novel clerkship. Design and implementation of a new, advanced medical student clerkship in POM using no additional capital resources was successful. Medical students indicated appreciation for the unique longitudinal design. Students also demonstrated understanding of the expanding role of anesthesiology in perioperative care of patients, a primary goal of the educational process. The principles of the American Society of Anesthesiology's Perioperative Surgical Home can be taught systematically and successfully to advanced medical students with little additional expenditure of departmental resources.

Medical Care and Long-Term Care Expenditures Attributable to Alzheimer's Disease Onset: Results from the LIFE Study.

Background:Alzheimer’s disease (AD) can increase both medical care and long-term care (LTC) costs, but the latter are frequently neglected in estimates of AD’s economic burden.Objective:To elucidate the economic burden of new AD cases in Japan by estimating patient-level medical care and LTC expenditures over 3 years using a longitudinal database.Methods:The study was performed using monthly claims data from residents of 6 municipalities in Japan. We identified patients with new AD diagnoses between April 2015 and March 2016 with 3 years of follow-up data. Medical care and LTC expenditures were estimated from 1 year before onset until 3 years after onset. To quantify the additional AD-attributable expenditures, AD patients were matched with non-AD controls using propensity scores, and their differences in expenditures were calculated.Results:After propensity score matching, the AD group and non-AD group each comprised 1748 individuals for analysis (AD group: mean age±standard deviation, 81.9±7.6 years; women, 66.0%). The total additional expenditures peaked at $1398 in the first month, followed by $1192 and $1031 in the second and third months, respectively. The additional LTC expenditures increased substantially 3 months after AD onset ($227), and gradually increased thereafter. These additional LTC expenditures eventually exceeded the additional medical care expenditures in the second year after AD onset.Conclusion:Although total AD-attributable expenditures peaked just after disease onset, the impact of LTC on these expenditures rose over time. Failure to include LTC expenditures would severely underestimate the economic burden of AD.

The Impact of the First Wave of Covid 19 on Orthopaedic Surgeries in a Tertiary Care Teaching Hospital

Background: The Covid 19 was declared a global pandemic that had a sizeable impact on the health care services in the surgical field including the orthopaedic department. There was additionally a decreased accessibility to healthcare personnel and facilities reallocated to manage the Covid patients. The study was mainly conducted to find out the impact of the first wave of COVID-19 on the orthopaedic surgeries.
 Aim: The main aim of the study is to find out the alteration in the number, type of surgeries, financial implications, duration of hospital stay, delay in surgery during the first wave of the COVID-19 pandemic.
 Study Design: Retrospective crossectional study.
 Methods: All the surgeries conducted in the orthopaedic department in the year 2019 and 2020 following first peak in March including pre-op and post-op COVID cases are included in the study. The procedure conducted, date of admission, date of surgery, date of discharge, investigations done and the cost expenses are the various parameters that are taken into consideration. The results are analysed for each year and comparisons are made using statistical methods.
 Results: The comparative analysis of the data collected from the years 2019 and 2020 showed an increase in the duration of hospital stay, delay in surgery, additional expenditure, back log in the number of elective surgeries done during the Pandemic.

Financing the COVID-19 response

The COVID-19 pandemic posed immediate and unprecedented financial challenges to health service providers and health systems more broadly. Providers were faced with additional expenditures, not only because many COVD-19 patients required intensive and costly medical care but also because they had to secure necessary supplies and equipment, such as personal protective equipment (PPE), testing supplies and ventilators; reshape facilities to implement new hygiene and safety measures and reorganise patient pathways; and pay health professionals for high-risk and overtime work. At the same time, providers faced sharp falls in revenues due to reduction in volume of non-COVID-19 services, both because people postponed seeking care as well as due to facilities temporarily postponing non-essential care in order treat COVD-19 patients or reorganise provision in a safe way. These increases in the financing needs of the public sector occurred in the context of pandemic-associated economic decline and sharply falling public revenues precipitated by the (sometimes multiple) national lockdowns and general anxiety about engaging in normal daily activities. This presentation will provide an overview of strategies that countries have used to raise extra funds for the health system, adjust payment and purchasing systems to meet changing needs, and ensure health coverage. A brief overview of key metrics to assess resilience in the area of financing will also be provided.

What are the current and projected future cost and health-related quality of life implications of scaling up cognitive stimulation therapy?

Cognitive stimulation therapy (CST) is one of the few non-pharmacological interventions for people living with dementia shown to be effective and cost-effective. What are the current and future cost and health-related quality of life implications of scaling-up CST to eligible new cases of dementia in England? Data from trials were combined with microsimulation and macrosimulation modelling to project future prevalence, needs and costs. Health and social costs, unpaid care costs and quality-adjusted life years (QALYs) were compared with and without scaling-up of CST and follow-on maintenance CST (MCST). Scaling-up group CST requires year-on-year increases in expenditure (mainly on staff), but these would be partially offset by reductions in health and care costs. Unpaid care costs would increase. Scaling-up MCST would also require additional expenditure, but without generating savings elsewhere. There would be improvements in general cognitive functioning and health-related quality of life, summarised in terms of QALY gains. Cost per QALY for CST alone would increase from £12,596 in 2015 to £19,573 by 2040, which is below the threshold for cost-effectiveness used by the National Institute for Health and Care Excellence (NICE). Cost per QALY for CST and MCST combined would grow from £19,883 in 2015 to £30,906 by 2040, making it less likely to be recommended by NICE on cost-effectiveness grounds. Scaling-up CST England for people with incident dementia can improve lives in an affordable, cost-effective manner. Adding MCST also improves health-related quality of life, but the economic evidence is less compelling.

Direct participation of people with communication disabilities in research on poverty and disabilities in low and middle income countries: A critical review.

IntroductionAn estimated 1 billion people with disabilities live in low and middle income countries, a population that includes people with communication disabilities (PwCD). PwCD are a heterogenous group with a wide range of abilities who may be underrepresented in research due to the communication demands involved in research participation.MethodsA critical analysis of 145 studies from a previously published systematic review was undertaken with the aim of documenting the opportunities for direct participation of PwCD in research on poverty and disability in low- and middle- income countries.ResultsThe key finding was the high risk of underrepresentation of PwCD in research on poverty and disability in LMICs, despite low rates of explicit exclusion (n = 8; 5.5%). A total of 366 uses of data collection tools were analysed (255 unique tools). The majority of data collection tools had high communication demands (92.9%), including those measuring disability (88.6%) and those assessing poverty (100%). Only 22 studies (15.2%) specifically included PwCD. A subset of these studies (n = 14) presented disaggregated data in a way that allowed for analysis of outcomes for PwCD, suggesting a clear intersection between poverty and communication disability, with findings related to general poverty indicators, reduced access to education, low levels of employment, and additional expenditure.ConclusionsThe findings suggest a systematic underrepresentation of PwCD in research on poverty and disability with substantial implications for future policy and program planning, directly affecting the availability and provision of services and resources for this population. A failure to provide adequate opportunity for participation of PwCD in research risks leaving those with communication disabilities behind in the pursuit of global poverty eradication.