Estimates Of Benefits Research Articles

Cumulative 6-Year Risk of Screen-Detected Ductal Carcinoma In Situ by Screening Frequency

Detection of ductal carcinoma in situ (DCIS) by mammography screening is a controversial outcome with potential benefits and harms. The association of mammography screening interval and woman's risk factors with the likelihood of DCIS detection after multiple screening rounds is poorly understood. To develop a 6-year risk prediction model for screen-detected DCIS according to mammography screening interval and women's risk factors. This Breast Cancer Surveillance Consortium cohort study assessed women aged 40 to 74 years undergoing mammography screening (digital mammography or digital breast tomosynthesis) from January 1, 2005, to December 31, 2020, at breast imaging facilities within 6 geographically diverse registries of the consortium. Data were analyzed between February and June 2022. Screening interval (annual, biennial, or triennial), age, menopausal status, race and ethnicity, family history of breast cancer, benign breast biopsy history, breast density, body mass index, age at first birth, and false-positive mammography history. Screen-detected DCIS defined as a DCIS diagnosis within 12 months after a positive screening mammography result, with no concurrent invasive disease. A total of 916 931 women (median [IQR] age at baseline, 54 [46-62] years; 12% Asian, 9% Black, 5% Hispanic/Latina, 69% White, 2% other or multiple races, and 4% missing) met the eligibility criteria, with 3757 screen-detected DCIS diagnoses. Screening round-specific risk estimates from multivariable logistic regression were well calibrated (expected-observed ratio, 1.00; 95% CI, 0.97-1.03) with a cross-validated area under the receiver operating characteristic curve of 0.639 (95% CI, 0.630-0.648). Cumulative 6-year risk of screen-detected DCIS estimated from screening round-specific risk estimates, accounting for competing risks of death and invasive cancer, varied widely by all included risk factors. Cumulative 6-year screen-detected DCIS risk increased with age and shorter screening interval. Among women aged 40 to 49 years, the mean 6-year screen-detected DCIS risk was 0.30% (IQR, 0.21%-0.37%) for annual screening, 0.21% (IQR, 0.14%-0.26%) for biennial screening, and 0.17% (IQR, 0.12%-0.22%) for triennial screening. Among women aged 70 to 74 years, the mean cumulative risks were 0.58% (IQR, 0.41%-0.69%) after 6 annual screens, 0.40% (IQR, 0.28%-0.48%) for 3 biennial screens, and 0.33% (IQR, 0.23%-0.39%) after 2 triennial screens. In this cohort study, 6-year screen-detected DCIS risk was higher with annual screening compared with biennial or triennial screening intervals. Estimates from the prediction model, along with risk estimates of other screening benefits and harms, could help inform policy makers' discussions of screening strategies.

Estimation of the economic benefits for the public health system related to salt reduction in Costa Rica.

to estimate the economic benefits for the public health system related to salt reduction in Costa Rica for the year 2018. estimation of the economic benefits for the public healthcare costs and productivity losses associated to reducing the per capita salt consumption of Costa Ricans to 5g/day, including the estimation of the Years of Life Productive Lost and of the direct costs on consultations, hospitalizations, and medications for the Costa Rica Social Security System. The total annual costs of hospitalization, consultations, and medications attributable to excessive salt intake in the population older than 15 years of age for the year 2018, were estimated at USD $15.1 million. The highest were in hospitalizations (53%), followed by consultations and medications (32% and 15%, respectively). NCDs caused by excessive salt intake represent important economic losses for the country, not only in terms of direct health costs, but also indirect due to the increase in years of potential life lost due to premature deaths because of CVD, which causes significant losses of human capital and, therefore, to the economy and the development of Costa Rica.

Deployment of Cooperative Intelligent Transport System infrastructure along highways: A bottom-up societal benefit analysis for Flanders

The arrival of specific telecommunication technologies has enabled road users and traffic managers to use shared information to coordinate their actions. Cooperative Intelligent Transport Systems (C-ITS) aim to improve road safety, reduce environmental impacts and congestion, and optimize transport efficiency. For this reason, the European Commission and its Member States are explicitly looking forward to connected vehicles to help reach major societal goals in terms of traffic safety (Vision Zero) and traffic emissions (Green Deal). As the necessary roadside infrastructure requires substantial investments from road authorities, societal benefit estimation of C-ITS on these domains is essential within efficient public budget allocation. Therefore, this paper investigates to what extent the societal benefits of roadside unit (RSU) investments in Flanders contribute to obtaining the societal goals, for the upcoming 15 years. It is shown that the contribution of C-ITS with regard to societal goals is rather limited. Adoption of C-ITS in passenger cars is found to be the major limiting factor for benefits.

Phytochemistry and Polypharmacological Potential of Colebrookea oppositifolia Smith.

Colebrookea oppositifolia Smith. is a valuable traditional therapeutic plant belonging to the family Lamiaceae. It is a dense and wool-like shrub that is mostly found in subtropical regions of some countries of Asia, such as China and India. It has been widely used for the mitigation of nervous system disorders like epilepsy. The active constituents of the plant have exhibited antioxidant, anti-microbial, and antifungal properties, which are considered due to the presence of polyphenols and flavonoids as chief chemical constituents. Flavonoids like quercetin, landenein, chrysin, and 5, 6, 7-trimethoxy flavones cause protein denaturation of the microbial cell wall. To comprehend and assemble the fragmented pieces of evidence presented on the traditional uses, botany, phytochemistry, and pharmacology of the plant to reconnoiter its therapeutic perspective and forthcoming research opportunities. The available information on Colebrookea oppositifolia has been established by electronically searching peer-reviewed literature from PubMed, Google Scholar, Springer, Scopus, Web of Science, and Science Direct over the earlier few years. The plant has been greatly used for the preparation of many herbal medicines which are used for treating traumatic injuries, fever, rheumatoid arthritis, headache, and gastric problems. From the aerial parts of the plant, a phenylethanoid glycoside named acteoside has been isolated and evaluated for its therapeutic potential viz. immunomodulatory, neuroprotective, hepatoprotective, analgesic, anti-tumour, antispasmodic, antioxidant, antibacterial, free radical scavenger, and improving sexual function. Acteoside showed neuroprotective activities against Aβ-peptide, which is neurotoxic and causes apoptosis. The petroleum ether extract of the plant leaves offers many active compounds like sitosterol, n-triacontane, hydroxydotriacontyl ferulate, acetyl alcohol, and 3,7,4,2-tetramethoxyflavones which have shown hepatoprotective potential. The plant should be evaluated further for the estimation of some other health benefits. The consequences of restricted pharmacological screening and reported phytomolecules of Colebrookea oppositifolia Smith. advocate that there is still an exigent requisite for in-depth pharmacological studies of the plant.

The risk of radiation-induced neurocognitive impairment and the impact of sparing the hippocampus during pediatric proton cranial irradiation

Background and purpose Hippocampus is a central component for neurocognitive function and memory. We investigated the predicted risk of neurocognitive impairment of craniospinal irradiation (CSI) and the deliverability and effects of hippocampal sparing. The risk estimates were derived from published NTCP models. Specifically, we leveraged the estimated benefit of reduced neurocognitive impairment with the risk of reduced tumor control. Material and methods For this dose planning study, a total of 504 hippocampal sparing intensity modulated proton therapy (HS-IMPT) plans were generated for 24 pediatric patients whom had previously received CSI. Plans were evaluated with respect to target coverage and homogeneity index to target volumes, maximum and mean dose to OARs. Paired t-tests were used to compare hippocampal mean doses and normal tissue complication probability estimates. Results The median mean dose to the hippocampus could be reduced from 31.3 GyRBE to 7.3 GyRBE (p < .001), though 20% of these plans were not considered clinically acceptable as they failed one or more acceptance criterion. Reducing the median mean hippocampus dose to 10.6 GyRBE was possible with all plans considered as clinically acceptable treatment plans. By sparing the hippocampus to the lowest dose level, the risk estimation of neurocognitive impairment could be reduced from 89.6%, 62.1% and 51.1% to 41.0% (p < .001), 20.1% (p < .001) and 29.9% (p < .001) for task efficiency, organization and memory, respectively. Estimated tumor control probability was not adversely affected by HS-IMPT, ranging from 78.5 to 80.5% for all plans. Conclusions We present estimates of potential clinical benefit in terms of neurocognitive impairment and demonstrate the possibility of considerably reducing neurocognitive adverse effects, minimally compromising target coverage locally using HS-IMPT.

Modelling the Clinical and Economic Impacts of Foundation-Funded versus Staff-Driven Quality Improvement Mental Health Strategies

BACKGROUND Employing a valid and reliable clinical measurement system established in 2002 within our regional Child and Adolescent, Addictions, Mental Health, and Psychiatry Program, we have been able to measure the effect of the general service system, a novel pre-admission initial family group session to orient families to treatment, and an acute at home care service deigned to divert admissions from emergency to in-home support rather than inpatient admission. Additionally, the modelled clinical effect and economic impact of two community programs; one school-based mental health literacy program and one primary care physician training and education program focusing on the management of children's mental health problems. In this paper, we present an established clinical measurement system combined with standardized cost evaluation strategy to assess the respective cost/benefit impacts of four service innovations. METHODS The clinical measurement system has been described in detail, as has its role in measuring the impact of community-level training on the quality of referrals. Our financial department developed standardized per diem cost references for levels of care within our system. The cost references permitted comparison of groups that were exposed and unexposed to the system innovations before and after the initiation of service and community innovations. The school-based mental health literacy program was a regional implementation of a national program (https://mentalhealthliteracy.org/). The primary care physician education was an internationally develop program from the United States (https://thereachinstitute.org). The other two projects were accomplished on a somewhat smaller local scale and at lower overall cost. The pre-admission initial family group session was a bottom-up, staff-designed and developed quality improvement project. The acute at home project, while funded by the children’s hospital foundation as were the two national and international projects. the acute at home project was a top-down director-designed project with one manager and a coordinator. RESULTS The four innovations were evaluated employing the same model. In each case the clinical space created by each innovation was measured in terms of the cost saved comparing the same outcomes (re-admission rates and lengths of stay) over comparable time intervals between and within pre/post exposed and unexposed groups, whilst controlling for clinical effects of exposure and time. The clinical measurement system helped determine group effects to ensure that the target groups were comparable within each initiative’s exposed and unexposed groups and were appropriately distinct between initiatives (eg, appropriate clinical groups were served by each initiative). While four projects were different and served somewhat different patient groups, the pre-admission initial family group session was the most cost effective. The physician training program was both effective and cost neutral. The school-based mental health literacy program was the least evaluable due to the direction of implementation and tended to increase referrals rather than create clinical space for more affected youth, as might be expected. The acute at home project successfully diverted less suicidal patients away from inpatient readmission over the evaluation period. DISCUSSION The main implications for mental health policy derives from linking standardized cost and clinical measurement models permitting economic evaluation of system and community level innovations. Pre and post clinical and cost measurements within and between exposed and unexposed groups for each innovation or project permitted estimation of benefits and cost. CONCLUSIONS The projects varied in focus together with the evaluability of each project, yet this provided important information for health system innovation and renewal within the context of fiscal constraint. The ranking of the projects in terms of their overall benefits and costs may guide decision-making where maximum return on investment makes the most sense.

Individualised Estimation of Quality-adjusted Survival Benefit and Cost-effectiveness of Proton Beam Therapy in Intermediate-stage Hodgkin Lymphoma

AimsRadiotherapy for Hodgkin lymphoma leads to the irradiation of organs at risk (OAR), which may confer excess risks of late effects. Comparative dosimetry studies show that proton beam therapy (PBT) may reduce OAR irradiation compared with photon radiotherapy, but PBT is more expensive and treatment capacity is limited. The purpose of this study is to inform the appropriateness of PBT for intermediate-stage Hodgkin lymphoma (ISHL). Materials and methodsA microsimulation model simulating the course of ISHL, background mortality and late effects was used to estimate comparative quality-adjusted life years (QALYs) lived and healthcare costs after consolidative pencil beam scanning PBT or volumetric modulated arc therapy (VMAT), both in deep-inspiration breath-hold. Outcomes were compared for 606 illustrative patients covering a spectrum of clinical presentations, varying by two age strata (20 and 40 years), both sexes, three smoking statuses (never, former and current) and 61 pairs of OAR radiation doses from a comparative planning study. Both undiscounted and discounted outcomes at 3.5% yearly discount were estimated. The maximum excess cost of PBT that might be considered cost-effective by the UK's National Institute for Health and Care Excellence was calculated. ResultsOAR doses, smoking status and discount rate had large impacts on QALYs gained with PBT. Current smokers benefited the most, averaging 0.605 undiscounted QALYs (range –0.341 to 2.171) and 0.146 discounted QALYs (range –0.067 to 0.686), whereas never smokers benefited the least, averaging 0.074 undiscounted QALYs (range –0.196 to 0.491) and 0.017 discounted QALYs (range –0.030 to 0.086). For the gain in discounted QALYs to be considered cost-effective, PBT would have to cost at most £4812 more than VMAT for current smokers and £645 more for never smokers. This is below preliminary National Health Service cost estimates of PBT over photon radiotherapy. ConclusionIn a UK setting, PBT for ISHL may not be considered cost-effective. However, the degree of unquantifiable uncertainty is substantial.

Collaborative Watershed Modeling as Stakeholder Engagement Tool for Science-Based Water Policy Assessment in São Paulo, Brazil

This study describes a collaborative modeling process deployed at the Cantareira Water Supply System (CWSS) in São Paulo City Metropolitan Area, Brazil. The CWSS faces challenges for meeting the increasing water demand, while land-use and climate change and their combined effect on its water cycle and balance have created a complex water resources management problem. Through a stakeholder engagement process—involving scientists and policymakers, the water utility company, and state administration—environmental simulation models were developed to elicit and represent multiple environmental, economic, and policy perspectives, developing a mutual language to communicate and establish common goals of water resources management. Study outputs include estimation of biophysical and economic benefits associated with prioritized native vegetation restoration activities in the source watersheds. These outputs are deployed in support of landscape planning and the decision process integrating multiple stakeholder perspectives in São Paulo state administration, the water utility company, and municipalities.

Prediction of Gold associated Mineral worth: An application of mathematically driven artificial neural network technique

The elemental composition of other associate minerals existing with gold is a significant asset that defines the amount of additional economic contribution that can be obtained from the gold tailings. The elemental composition is a needed factor in increasing the economic value of gold run-off and getting a clear estimation for the quantity of value-added elements in each tonne of gold sand scooped during the separation process. In this study, the artificial neural network (ANN) modeling technique was used to develop an economic worth prediction model for 10 gold-associated minerals. The developed models have a 1:7:10 architecture and were trained using the ANN Bayesian regularization training algorithm. According to the root mean square error values, the results revealed that the predicted values of the associated minerals are closer to the measured values. Also, the developed model prediction performance was found to be appropriate for the estimation of gold-associated mineral economic benefits based on the high coefficient of determination and variance account. The model performance evaluation results show that the developed ANN models are suitable for economic estimation of gold-associated mineral worth.

Effects of graphical presentation of benefits on cognitive judgments induced by affect heuristic: Focusing on the acceptance of genetically modified foods

Genetically modified (GM) foods have been assumed to be seen through intuitive and affective routes (i.e., affect heuristics) rather than analytical and deliberative routes. We examined the impact of the graphical presentation of benefits derived from GM or conventionally bred foods on the acceptance of these varieties. In the two experiments (n = 266 for study 1 and n = 402 for study 2), no differences emerged in the estimation of farmers' benefits resulting from the introduction of improved varieties by the type of improvement. However, there were statistically significant differences in the magnitude of risk and the degree of acceptance of the improved varieties. Therefore, despite presenting identical benefits as a graphical figure, GM foods were consistently evaluated as providing higher risk and were less frequently accepted than conventionally bred foods. These results suggest that while the graphical presentation of benefits may promote comprehension of some advantages of the introduction of GM varieties, this may not lead to acceptance from the consumer's point of view. Based on the current findings, as well as previous studies on trust in risk managers, we discuss the specific factors that might promote acceptance of GM products.

Cost-effectiveness of Internet Interventions Compared With Treatment as Usual for People With Mental Disorders: Systematic Review and Meta-analysis of Randomized Controlled Trials.

The economic costs of mental disorders for society are huge. Internet-based interventions are often coined as cost-effective alternatives to usual care, but the evidence is mixed. The aim was to review the literature on the cost-effectiveness of internet interventions for mental disorders compared with usual care and to provide an estimate of the monetary benefits of such interventions compared with usual care. A systematic review and meta-analysis of randomized controlled trials was conducted, which included participants with symptoms of mental disorders; investigated a telephone- or internet-based intervention; included a control condition in the form of treatment as usual, psychological placebo, waiting list control, or bibliotherapy; reported outcomes on both quality of life and costs; and included articles published in English. Electronic databases such as PubMed (including MEDLINE), Embase, Emcare, PsycINFO, Web of Science, and the Cochrane Library were used. Data on risk of bias, quality of the economic evaluation, quality-adjusted life years, and costs were extracted from the included studies, and the incremental net benefit was calculated and pooled. The search yielded 6226 abstracts, and 37 studies with 14,946 participants were included. The quality of economic evaluations of the included studies was rated as moderate, and the risk of bias was high. A random-effects approach was maintained. Analyses suggested internet interventions were slightly more effective than usual care in terms of quality-adjusted life years gain (Hedges g=0.052, 95% CI 0.010-0.094; P=.02) and equally expensive (Hedges g=0.002, 95% CI -0.080 to 0.84; P=.96). The pooled incremental net benefit was US $255 (95% CI US $91 to US $419; P=.002), favoring internet interventions over usual care. The perspective of the economic evaluation and targeted mental disorder moderated the results. The findings indicate that the cost-effectiveness of internet interventions for mental disorders compared with a care-as-usual approach is likely, but generalizability to new studies is poor given the substantial heterogeneity. This is the first study in the field of mental health to pool cost-effectiveness outcomes in an aggregate data meta-analysis. PROSPERO CRD42019141659; https://tinyurl.com/3cu99b34.

Individualized Net Benefit estimation and meta-analysis using generalized pairwise comparisons in N-of-1 trials.

The Net Benefit (Δ) is a measure of the benefit-risk balance in clinical trials, based on generalized pairwise comparisons (GPC) using several prioritized outcomes and thresholds of clinical relevance. We extended Δ to N-of-1 trials, with a focus on patient-level and population-level Δ. We developed a Δ estimator at the individual level as an extension of the stratum-specific Δ, and at the population-level as an extension of the stratified Δ. We performed a simulation study mimicking PROFIL, a series of 38 N-of-1 trials testing sildenafil in Raynaud's phenomenon, to assess the power for such an analysis with realistic data. We then reanalyzed PROFIL using GPC. This reanalysis was finally interpreted in the context of the main analysis of PROFIL which used Bayesian individual probabilities of efficacy. Simulations under the null showed good size of the test for both individual and population levels. The test lacked power when being simulated from the true PROFIL data, even when increasing the number of repetitions up to 140 days per patient. PROFIL individual-level estimated Δ were well correlated with the probabilities of efficacy from the Bayesian analysis while showing similarly wide confidence intervals. Population-level estimated Δ was not significantly different from zero, consistently with the previous Bayesian analysis. GPC can be used to estimate individual Δ which can then be aggregated in a meta-analytic way in N-of-1 trials. GPC ability to easily incorporate patient preferences allow for more personalized treatment evaluation, while needing much less computing time than Bayesian modeling.

Potential Benefits of Remote Working on Urban Mobility and Related Environmental Impacts: Results from a Case Study in Italy

Remote working is increasingly seen as an effective model in several countries in the last decade, mainly thanks to the development of information and communication technologies in support of common daily working tasks. The emergence of the COVID-19 pandemic has represented a pivotal moment for the adoption of remote working in multiple sectors, with positive effects on the environmental impacts caused by the daily commuting of workers. However, due to the fact that pandemic-induced remote working has represented a major forced experiment on a global scale, and that it has often been imposed rather than chosen by employees, workers’ well-being has not always been ensured. This research work presents an analysis of a wide survey of remote workers in public administrations in four different provinces in Italy, with the aim of assessing the main characteristics of the users and the related environmental benefits. Survey data refer to remote workers before COVID-19, thus representing workers who have freely chosen to work from home for different reasons. The results of this work represent a useful tool with which to support the definition of new remote work strategies that could help policy makers reduce a part of the systematic mobility demand. We have also calculated average energy and emission savings to provide useful indicators for a preliminary estimation of the potential environmental benefits of remote working. Considering the entire sample of respondents, workers who would have commuted at least partially by car have saved on average 6 kg of CO2 per day thanks to remote working (with an average round-trip commuting distance of approximately 35 km). The current results will be supplemented by the results of a new survey underway, aimed at evaluating the differences of remote working experiences during the emergency response to COVID-19.

Consumer surplus estimation comparisons on a Korea highway network master plan

In the cost–benefit analysis of transportation investment, although the benefit estimation method due to the effect of travel time saving has been widely used, several limitations with the method have been pointed out in a number of studies. As an alternative, a logsum-based benefit calculation has been widely adopted, with most of the research focused on urban transportation. Therefore, it is rarely applied to interregional transportation. In this study, we applied a logsum-based approach to the calculation of benefits for expressway road projects in Korea's long-term transportation plan. To calculate the logsum, this study used input data from both the mode choice and destination choice models, finding that an analysis of the feasibility of inter-regional road investment was possible. Various studies have calculated the benefits based on one of the two models. The two methods have similar formulas; however, varying results were derived due to differences in the application of formulas for parameter estimation and benefit estimation. In conclusion, the proposed methods are expected to enable a more comprehensive evaluation of the transport system. Looking at more detailed research results, the logsum based on the mode choice model had great benefits in the Seoul metropolitan area where demand was high; however, the logsum of the destination-based model showed a large difference in distribution of benefits evenly by various metropolitan areas. On the other hand, it was found that the traditional reduction of travel time was much less by region than the logsum methods, but the effect was large in the metropolitan area. From the perspective of the theoretical and practical consumer surplus analysis, we suggest open discussions regarding which method to choose when calculating benefits from the mode choice logsum model, the destination logsum model and travel time savings method.

Свойства средней временной выгоды для вероятностных моделей эксплуатируемых популяций

A model of a homogeneous population given in the absence of exploitation by a differential equation x ̇=g(x) is considered. At each moment of time τ_k=kd, where d&gt;0, k=1,2,..., some random share of the resource ω_k ∈ [0,1] is extracted from this population. We assume that it is possible to stop the harvesting if its share turns out to be greater than a certain value u∈[0,1): then the share of the extracted resource will be l_k=l(ω_k,u)=min(ω_k,u), k=1,2,.... The average time benefit from resource extraction is investigated, it is equal to the lower limit of the arithmetic amount of the resource obtained in n extractions as n→∞. It is shown that the properties of this characteristic are associated with the presence of a positive fixed point of the difference equation X_(k+1) = φ(d,(1-u)X_k), k=1,2,..., where φ(t,x) is a solution of the equation x ̇=g(x) satisfying the initial condition φ(0,x)=x. The conditions for the existence of the limit and the estimates of the average time benefit performed with probability one are obtained. The results of the work are illustrated by examples of exploited homogeneous populations depending on random parameters.

The association of postoperative radiotherapy with survival in resected N2 non-small cell lung cancer.

The current staging system for completely resected pathologic N2 non-small cell lung cancer (NSCLC) treated with chemotherapy is not suitable for distinguishing those patients most likely to benefit from postoperative radiotherapy (PORT). This study aimed to construct a survival prediction model that will enable individualized prediction of the net survival benefit of PORT in patients with completely resected N2 NSCLC treated with chemotherapy. A total of 3,094 cases from between 2002 and 2014 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Patient characteristics were included as covariates, and their association with overall survival (OS) with and without PORT was assessed. Data from 602 patients from China were included for external validation. Age, sex, the number of examined/positive lymph nodes, tumor size, the extent of surgery, and visceral pleural invasion (VPI) were significantly associated with OS (P<0.05). Two nomograms were developed based on clinical variables to estimate individuals' net survival difference attributable to PORT. The calibration curve showed excellent agreement between the OS predicted by the prediction model and that actually observed. In the training cohort, the C-index for OS was 0.619 [95% confidence interval (CI): 0.598-0.641] in the PORT group and 0.627 (95% CI: 0.605-0.648) in the non-PORT group. Results showed that PORT could improve OS [hazard ratio (HR): 0.861; P=0.044] for patients with a positive PORT net survival difference. Our practical survival prediction model can be used to make an individualized estimate of the net survival benefit of PORT for patients with completely resected N2 NSCLC who have been treated with chemotherapy.

Clinical effectiveness and cost-effectiveness of emergency surgery for adult emergency hospital admissions with common acute gastrointestinal conditions: the ESORT study

Background Evidence is required on the clinical effectiveness and cost-effectiveness of emergency surgery compared with non-emergency surgery strategies (including medical management, non-surgical procedures and elective surgery) for patients admitted to hospital with common acute gastrointestinal conditions. Objectives We aimed to evaluate the relative (1) clinical effectiveness of two strategies (i.e. emergency surgery vs. non-emergency surgery strategies) for five common acute conditions presenting as emergency admissions; (2) cost-effectiveness for five common acute conditions presenting as emergency admissions; and (3) clinical effectiveness and cost-effectiveness of the alternative strategies for specific patient subgroups. Methods The records of adults admitted as emergencies with acute appendicitis, cholelithiasis, diverticular disease, abdominal wall hernia or intestinal obstruction to 175 acute hospitals in England between 1 April 2010 and 31 December 2019 were extracted from Hospital Episode Statistics and linked to mortality data from the Office for National Statistics. Eligibility was determined using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, diagnosis codes, which were agreed by clinical panel consensus. Patients having emergency surgery were identified from Office of Population Censuses and Surveys procedure codes. The study addressed the potential for unmeasured confounding with an instrumental variable design. The instrumental variable was each hospital’s propensity to use emergency surgery compared with non-emergency surgery strategies. The primary outcome was the ‘number of days alive and out of hospital’ at 90 days. We reported the relative effectiveness of the alternative strategies overall, and for prespecified subgroups (i.e. age, number of comorbidities and frailty level). The cost-effectiveness analyses used resource use and mortality from the linked data to derive estimates of incremental costs, quality-adjusted life-years and incremental net monetary benefits at 1 year. Results Cohort sizes were as follows: 268,144 admissions with appendicitis, 240,977 admissions with cholelithiasis, 138,869 admissions with diverticular disease, 106,432 admissions with a hernia and 133,073 admissions with an intestinal obstruction. Overall, at 1 year, the average number of days alive and out of hospitals at 90 days, costs and quality-adjusted life-years were similar following either strategy, after adjusting for confounding. For each of the five conditions, overall, the 95% confidence intervals (CIs) around the incremental net monetary benefit estimates all included zero. For patients with severe frailty, emergency surgery led to a reduced number of days alive and out of hospital and was not cost-effective compared with non-emergency surgery, with incremental net monetary benefit estimates of –£18,727 (95% CI –£23,900 to –£13,600) for appendicitis, –£7700 (95% CI –£13,000 to –£2370) for cholelithiasis, –£9230 (95% CI –£24,300 to £5860) for diverticular disease, –£16,600 (95% CI –£21,100 to –£12,000) for hernias and –£19,300 (95% CI –£25,600 to –£13,000) for intestinal obstructions. For patients who were ‘fit’, emergency surgery was relatively cost-effective, with estimated incremental net monetary benefit estimates of £5180 (95% CI £684 to £9680) for diverticular disease, £2040 (95% CI £996 to £3090) for hernias, £7850 (95% CI £5020 to £10,700) for intestinal obstructions, £369 (95% CI –£728 to £1460) for appendicitis and £718 (95% CI £294 to £1140) for cholelithiasis. Public and patient involvement translation workshop participants emphasised that these findings should be made widely available to inform future decisions about surgery. Limitations The instrumental variable approach did not eliminate the risk of confounding, and the acute hospital perspective excluded costs to other providers. Conclusions Neither strategy was more cost-effective overall. For patients with severe frailty, non-emergency surgery strategies were relatively cost-effective. For patients who were fit, emergency surgery was more cost-effective. Future work For patients with multiple long-term conditions, further research is required to assess the benefits and costs of emergency surgery. Study registration This study is registered as reviewregistry784. Funding This project was funded by the National Institute for Health and Care Research (IHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 1. See the NIHR Journals Library website for further project information.

Study on cost benefit estimation of enterprise environmental management based on multiple linear regression

Study on cost benefit estimation of enterprise environmental management based on multiple linear regression

Social cost-benefit analysis of the improving of urban recreation facilities: The case of Iskenderun-Arsuz-Payas urban area

Facilities for public recreation are having an increasing impact on physical and social life. The overvaluation of urban lands raises economic concerns in rapidly expanding cities. Therefore, in this study, it is aimed to reveal the social costs and benefits of the development of recreational facilities in the urban area of Iskenderun-Arsuz-Payas. Although public recreation facilities are a broad concept, these facilities are limited to active open-green spaces and cultural areas in the research, based on the current conditions and concepts in the development legislation. In the social benefit estimation, the present and future use values of recreation areas were taken as the basis, and for this purpose, a survey was conducted with 309 households. Within the scope of the survey, the monetary values spent for participation in recreational activities and the monetary values willing to pay (WTP) for the development of areas were questioned. Initial facility costs were taken into account in cost calculations. The total benefit was calculated as 1.956.310.884 TL, the total cost was 418.414.364 TL, and the social benefit-cost ratio was calculated as 1:4.67. The results show that the users will bear the cost of the benefit they will gain from an urban environment with qualified recreational areas. It is thought that the results of the study will shed light on the professional disciplines that play an active role in the planning of public open-green spaces and cultural spaces and the decision-makers in local governments.

Impact of early detection on cancer curability: A modified Delphi panel study.

Expert consensus on the potential benefits of early cancer detection does not exist for most cancer types. We convened 10 practicing oncologists using a RAND/UCLA modified Delphi panel to evaluate which of 20 solid tumors, representing >40 American Joint Committee on Cancer (AJCC)-identified cancer types and 80% of total cancer incidence, would receive potential clinical benefits from early detection. Pre-meeting, experts estimated how long cancers take to progress and rated the current curability and benefit (improvement in curability) of an annual hypothetical multi-cancer screening blood test. Post-meeting, experts rerated all questions. Cancers had varying estimates of the potential benefit of early cancer detection depending on estimates of their curability and progression by stage. Cancers rated as progressing quickly and being curable in earlier stages (stomach, esophagus, lung, urothelial tract, melanoma, ovary, sarcoma, bladder, cervix, breast, colon/rectum, kidney, uterus, anus, head and neck) were estimated to be most likely to benefit from a hypothetical screening blood test. Cancer types rated as progressing quickly but having comparatively lower cure rates in earlier stages (liver/intrahepatic bile duct, gallbladder, pancreas) were estimated to have medium likelihood of benefit from a hypothetical screening blood test. Cancer types rated as progressing more slowly and having higher curability regardless of stage (prostate, thyroid) were estimated to have limited likelihood of benefit from a hypothetical screening blood test. The panel concluded most solid tumors have a likelihood of benefit from early detection. Even among difficult-to-treat cancers (e.g., pancreas, liver/intrahepatic bile duct, gallbladder), early-stage detection was believed to be beneficial. Based on the panel consensus, broad coverage of cancers by screening blood tests would deliver the greatest potential benefits to patients.