Cost-effective Resource Allocation Research Articles

Risk of African swine fever introduction into the European Union through transport-associated routes: returning trucks and waste from international ships and planes

BackgroundThe uncontrolled presence of African swine fever (ASF) in Russian Federation (RF) poses a serious risk to the whole European Union (EU) pig industry. Although trade of pigs and their products is banned since the official notification in June 2007, the potential introduction of ASF virus (ASFV) may occur by other routes, which are very frequent in ASF, and more difficult to control, such as contaminated waste or infected vehicles. This study was intended to estimate the risk of ASFV introduction into the EU through three types of transport routes: returning trucks, waste from international ships and waste from international planes, which will be referred here as transport-associated routes (TAR). Since no detailed and official information was available for these routes, a semi-quantitative model based on the weighted combination of risk factors was developed to estimate the risk of ASFV introduction by TAR. Relative weights for combination of different risk factors as well as validation of the model results were obtained by an expert opinion elicitation.ResultsModel results indicate that the relative risk for ASFV introduction through TAR in most of the EU countries (16) is low, although some countries, specifically Poland and Lithuania, concentrate high levels of risk, the returning trucks route being the analyzed TAR that currently poses the highest risk for ASFV introduction into the EU. The spatial distribution of the risk of ASFV introduction varies importantly between the analyzed introduction routes. Results also highlight the need to increase the awareness and precautions for ASF prevention, particularly ensuring truck disinfection, to minimize the potential risk of entrance into the EU.ConclusionsThis study presents the first assessment of ASF introduction into the EU through TAR. The innovative model developed here could be used in data scarce situations for estimating the relative risk associated to each EU country. This simple methodology provides a rapid and easy to interpret results on risk that may be used for a target and cost-effective allocation of resources to prevent disease introduction.

Providing High-Value, Cost-Conscious Care

The Accreditation Council for Graduate MedicalEducation’s system-based practice competency, discussed in Wein-berger’s article (1), is more than teaching quality improvement andbeing a team player. “...Residents must be able to utilize resourceswithin the system to provide excellent patient care by...demon-strating cost effective resource allocation and prescribing patternsthat uphold quality...”(2).

A comprehensive review of predictive and prognostic composite factors implicated in the heterogeneity of treatment response and outcome across disease areas

To assess and present the current body of evidence regarding composite measures associated with differential treatment response or outcome as a result of patient heterogeneity and to evaluate their consistency across disease areas. A comprehensive review of the literature from the last 10 years was performed using three databases (PubMed, Embase and Cochrane). All articles that met the inclusion/exclusion criteria were selected, abstracted and assessed using the NICE level-of-evidence criteria. Forty-nine studies were identified in the data abstraction. Approximately one-third focused on existing composite measures, and the rest investigated emerging composite factors. The majority of studies targeted patients with cancer, cardiovascular disease or psychological disorders. As a whole, the composite measures were found to be disease-specific, but some composite elements, including age, gender, comorbidities and health status, showed consistency across disease areas. To complement these findings, common individual factors found in five previous independent disease-specific literature assessments were also summarised, including age, gender, treatment adherence and satisfaction, healthcare resource utilisation and health status. Composite measures can play an important role in characterising heterogeneity of treatment response and outcome in patients suffering from various medical conditions. These measures can help clinicians to better distinguish between patients with high likelihood to respond well to treatment and patients with minimal chances of positive therapeutic outcomes. Herein, the individual factors identified can be used to develop novel predictive or prognostic composite measures that can be applicable across disease areas. Reflecting these cross-disease measures in clinical and public health decisions has the distinctive appeal to enable targeted treatment for patients suffering from multiple medical conditions, which may ultimately yield significant gains in individual outcomes, population health and cost-effective resource allocation.

Trade-offs in the design of cost-effective habitat networks when conservation costs are variable in space and time

The consideration of economic costs can dramatically influence the cost-effective allocation of resources spent on the conservation of biodiversity. In the face of ecological and economic data scarcity, simple rules are needed for the design of cost-effective habitat networks. A conceptual semi-analytical ecological-economic model is developed that is based on metapopulation theory and takes into account that the costs of conservation may be spatially heterogeneous and changing in time. The model is used to study trade-offs between amount, spatial connectivity and temporal continuity of habitat. The cost-effective levels of habitat connectivity and continuity are determined as functions of species attributes and economic parameters like the distribution of conservation costs. The results are relevant for the design of cost-effective conservation instruments.

Comprehensive bioeconomic modelling of multiple harmful non-indigenous species

Harmful non-indigenous species (NIS) introductions lead to loss of biodiversity and serious economic impacts. Government agencies have to decide on the allocation of limited resources to manage the risk posed by multiple NIS. Bioeconomic modelling has focused on single species and little is known about the optimal management of multiple NIS using a common budget. A comprehensive bioeconomic model that considers the exclusion, detection and control of multiple NIS spreading by stratified dispersal and presenting Allee effects was developed and applied to manage the simultaneous risk posed by Colorado beetle, the bacterium causing potato ring rot and western corn rootworm in the UK. A genetic algorithm was used to study the optimal management under uncertainty. Optimal control methods were used to interpret and verify the genetic algorithm solutions. The results show that government agencies should allocate less exclusion and more control resources to NIS characterised by Allee effects, low rate of satellite colonies generation and that present low propagule pressure. The prioritisation of NIS representative of potential NIS assemblages increases management efficiency. The adoption of management measures based on the risk analysis of a single NIS might not correspond to the optimal allocation of resources when other NIS share a common limited budget. Comprehensive bioeconomic modelling of multiple NIS where Allee effects and stratified dispersal are considered leads to a more cost-effective allocation of limited resources for the management of NIS invasions.

Promoting Multifunctionality of Agriculture: An Economic Analysis of New Approaches in Germany

In the early and mid-1990s, a number of policies to support the multifunctionality of agriculture, e.g., agri-environmental schemes (AESs), started to be implemented in Europe. Based on experiences with their implementation, new approaches have since been developed to advance these policies, and other new opportunities have arisen to further strengthen the multifunctionality of agriculture. Here we present three innovative approaches for supporting agricultural multifunctionality in Germany: participatory and local approaches for developing AESs, voluntary co-operative agreements (CAs) between farmers and water suppliers, and the combination of the impact mitigation principle with environmentally friendly farming. We evaluate these new policies in terms of their ability to improve the cost-effective provision of environmental benefits. We do this by applying a framework that encompasses an analysis of the cost-effective allocation of resources for producing environmental benefits and of the implementation and decision-making costs. Our analysis suggests that for locally developed AESs and CAs, there is a trade-off between more cost-effective resource allocation and better monitoring, on the one hand, and higher decision-making costs, on the other. When combining the impact mitigation principle with farming, we expect to find savings in terms of production, decision-making and implementation costs.

The ecological importance of species and the Noah's Ark problem

Abstract Using the Noah's Ark problem – the problem of efficiently allocating limited funds to conserve biodiversity – the standard economic approach to endangered species conservation constructs a human-centered biodiversity by favoring species directly valuable to humans. I analyze this approach and draw on the functional ecology literature to offer an alternative emphasizing the role species play in their ecosystems. The aim is to create a working ecosystem on the Ark rather than a collection of charismatic and distinct species. To do so, I construct a new measure of a species' ecological importance and an ecological objective appropriate for cost-effective resource allocation. The ecological approach fundamentally changes the notion of species-value from a direct value based on a species' appearance or taxonomic difference to an indirect value based on a species' ecological role in its ecosystem. In the process, ‘populations’ of species become the fundamental unit of biodiversity rather than ‘species’, and abiotic processes also possess value. When compared to the economic approach, the ecological approach prioritizes different species for the Ark and achieves superior economic outcomes in all but the mythical Noah's Ark scenario where interactions are non-existent. The analysis challenges the approach of US endangered species legislation and I call for a reformulation based on endangered ecological interactions.

A cost-effective resource allocation and management scheme for content networks supporting IPTV services

This study presents a cost-effective resource allocation approach, which takes the storage and bandwidth costs into consideration, for the proposed content network. The designed content network for supporting IPTV services is composed of several peer service areas, and all video servers are classified into two types – Type 1 and Type 2. Type 1 video servers only store the contents with high hit rates, while Type 2 video servers store other contents with lower hit rates. A novel scheme that allocates contents and video servers based on the hit rate distribution is proposed. The allocation strategy aims at minimizing the cost of the proposed content network. Numerical results show that the optimal resource allocation is strongly related to the hit rate distribution of contents, but is not sensitive to the content size distribution. Additionally, compared with the fully replicated storage method, the proposed allocation scheme can save a considerable percentage of storage space and reduce the total cost of the content network. Based on these findings, we believe that implementing the proposed resource allocation and management scheme will be of benefit to content network operators, especially to infrastructure-based IPTV operators, for reducing the operating expenses.

Using publicly available information to create exposure and risk-based ranking of chemicals used in the workplace and consumer products

Mandates that require the estimation of exposure and human health risk posed by large numbers of chemicals present regulatory managers with a significant challenge. Although these issues have been around for some time, the estimation of human exposure to chemicals from use of products in the workplace and by the consumer has been generally hindered by the lack of good tools. Logically and in the interest of cost-effective resource allocation and regulation one would typically and naturally first attempt to rank-order or prioritize the chemicals according to the human exposure potential that each might pose. We have developed an approach and systematic modeling construct that accomplishes this critical task by providing a quantitative estimate of human exposure for as many as several hundred chemicals initially; however, it could ultimately do this for any number of regulated chemicals starting only with the identity (Chemical Abstract Service number) for each chemical under consideration. These exposure estimates can then be readily linked to toxicological benchmarks for each item to estimate and rank the human health risk for the chemicals under consideration in a "worst things first" listing. This modeling construct, entitled Complex Exposure Tool (ComET) was developed by The LifeLine Group as a proof of concept under the sponsorship of Health Canada. ComET considers multiple routes of exposure, multiple subpopulations and different possible durations of exposure. A beta-version of ComET was issued and demonstrated in which users can change the assumptions in the model and see the impacts of these changes and the quality of information as they relate to the predicted exposure potential. We have advanced the operational elements of ComET into a tool entitled the Chemical Exposure Priority Setting Tool (CEPST) designed to provide quantitative estimation of the exposure potential of large groups of chemicals with little data and possibly multiple exposure scenarios. A basic feature of this tool is the utilization of an internally consistent approach and assumptions that are completely transparent. It uses publicly available information as critical input and is specifically designed to be continually reviewed, refined, expanded and updated using scientific peer review and stakeholder input.

An optimization-model-based interactive decision support system for regional energy management systems planning under uncertainty

In this study, an interactive decision support system (UREM-IDSS) has been developed based on an inexact optimization model (UREM, University of Regina Energy Model) to aid decision makers in planning energy management systems. Optimization modeling, scenario development, user interaction, policy analysis and visual display are seamlessly integrated into the UREM-IDSS. Uncertainties in energy-related parameters are effectively addressed through the interval linear programming (ILP) approach, improving the robustness of the UREM-IDSS for real-world applications. Thus, it can be used as an efficient tool for analyzing and visualizing impacts of energy and environmental policies, regional/community sustainable development strategies, emission reduction measures and climate change in an interactive, flexible and dynamic context. The Region of Waterloo has been selected to demonstrate the applicability and capability of the UREM-IDSS. A variety of scenarios (including a reference case) have been identified based on different energy management policies and sustainable development strategies for in-depth analysis of interactions existing among energy, socio-economy, and environment in the Region. Useful solutions for the planning of energy management systems have been generated, reflecting complex tradeoffs among energy-related, environmental and economic considerations. Results indicate that the UREM-IDSS can be successfully used for evaluating and analyzing not only the effects of an individual policy scenario, but also the variations between different scenarios compared with a reference case. Also, the UREM-IDSS can help tackle dynamic and interactive characteristics of the energy management system in the Region of Waterloo, and can address issues concerning cost-effective allocation of energy resources and services. Thus, it can be used by decision makers as an effective technique in examining and visualizing impacts of energy and environmental policies, regional/community development strategies, emission reduction measures, and climate change within an integrated and dynamic framework.

Development of an optimization model for energy systems planning in the Region of Waterloo

In this study, a large-scale dynamic optimization model (University of Regina Energy Model, UREM) has been developed for supporting long-term energy systems planning in the Region of Waterloo. The model can describe energy management systems as networks of a series of energy flows, transferring extracted/imported energy resources to end users through a variety of conversion and transmission technologies over a number of periods. It can successfully incorporate optimization models, scenario development and policy analysis within a general framework. Complexities in energy management systems can be systematically reflected; thus, the applicability of the modeling process can be highly enhanced. Four scenarios (including a reference case) are considered based on different energy management policies and sustainable development strategies for in-depth analysis of interactions existing among energy, socio-economy and environment in the Region. Useful solutions for the planning of energy management systems have been generated, reflecting trade-offs among energy-related, environmental and economic considerations. They are helpful for supporting (a) adjustment or justification of the existing allocation patterns of energy resources and services, (b) allocations of renewable energy resources, (c) formulation of local policies regarding energy consumption, economic development and energy structure, and (d) analysis of interactions among economic cost, system efficiency, emission mitigation and energy-supply security. Results also indicate that UREM can help tackle dynamic and interactive characteristics of the energy management system in the Region of Waterloo and can address issues concerning cost-effective allocation of energy resources and services. Thus, it can be used by decision makers as an effective technique in examining and visualizing impacts of energy and environmental policies, regional/community development strategies and emission reduction measures within an integrated and dynamic framework. Copyright © 2008 John Wiley & Sons, Ltd.

A revenue-rewarding scheme of providing incentive for cooperative proxy caching for media streaming systems

Network entities cooperating together can improve system performance of media streaming. In this paper, we address the “ incentive issue ” of a cooperative proxy caching system and how to motivate each proxy to provide cache space to the system. To encourage proxies to participate, we propose a “ revenue-rewarding scheme ” to credit the cooperative proxies according to the resources they contribute. A game-theoretic model is used to analyze the interactions among proxies under the revenue-rewarding scheme. We propose two cooperative game settings that lead to optimal situations. In particular, (1) We propose a distributed incentive framework for peers to participate in resource contribution for media streaming; (2) Proxies are encouraged to cooperate under the revenue-rewarding scheme; (3) Profit and social welfare are maximized in these cooperative games; and (4) Cost-effective resource allocation is achieved in these cooperative games. Large scale simulation is carried out to validate and verify the merits of our proposed incentive schemes.

Service needs of residents in community‐based long‐term care facilities in northern Taiwan

The purpose of this study was to quantify the service needs of residents in community-based long-term care (LTC) facilities and to determine their predictors. Disabled older family members in Taiwan are often eventually sent to community-based LTC facilities. Many service needs of these residents are likely to go unmet. A cross-sectional survey was used. This involved purposive sampling of 132 residents from 10 LTC facilities in Taipei City. A previously developed LTC service need assessment scale was used to collect information about the residents' needs in terms of five kinds of LTC services, namely health education, skilled nursing services, referral services, activities of daily living (ADL) assistance and instrumental activities of daily living assistance. The mean age of residents was 75.2 years. The average period of institutionalization was 21.93 months. Overall, 70% of the residents had either complete or partial ADL function dependency. Among the specific ADL function dependencies of the residents, inability to take a bath was the most common. The most significant predictors of service needs were health status, age, number of children, number of medical diagnoses and whether the stay is self-choice. These combined variables explained between 25.5% and 41.6% of the variance of the need for LTC services. The findings of this study show that age, health status, number of children, number of medical diagnoses and whether the stay is self-choice are significant determinants of residents' needs in terms of LTC. Assessment of the extent to which facilities meet the residents' needs is the first step in providing the most cost-effective allocation of scarce resources. It is suggested that, if reimbursement by the National Health Insurance system of physician visits, including psychiatric visits, to LTC facilities were allowed, this would improve quality of care.

Micro-epidemiology of Plasmodium falciparum malaria: Is there any difference in transmission risk between neighbouring villages?

BackgroundMalaria control strategies are designed as a solution for either the whole region or the whole country and are assumed to suit every setting. There is a need to shift from this assumption because transmission may be different from one local setting to another. The aim of this study was to assess the risk of clinical malaria given the village of residence among under-five children in rural north-western Burkina Faso.Methods867 children (6–59 months) were randomly selected from four sites. Interviewers visited the children weekly at home over a one-year period and tested them for fever. Children with fever were tested for malaria parasites. An episode of clinical malaria was defined as fever (axillary temperature ≥ 37.5°C) + parasites density ≥ 5,000 parasites/μl. Logistic regression was used to assess the risk of clinical malaria among children at a given site of residence.ResultsChildren accumulated 758 person years (PYs). Overall, 597 episodes of clinical malaria were observed, giving an incidence rate of 0.79 per PY. The risk of clinical malaria varied amongst the four sites. Taking one village as reference the odds ratio for the other three sites ranged from 0.66; 95%CI: 0.44–0.98 to 1.49; 95%CI: 1.10–2.01.ConclusionMalaria control strategies should be designed to fit the local context. The heterogeneity of transmission should be assessed at the district level to allow cost-effective resource allocation that gives priority to locations with high risk. Functional routine health information systems could provide the necessary data for context specific risk assessment.

Effects of socioeconomic and geographic variations on survival for adult glioma in England and Wales

Background To investigate the effects of SES and geographic variations on survival for adult patients with glioma, we analyzed data from 30 489 patients from the Cancer Registry in England and Wales. Methods Median survival and CSRs for 8 variables (age, sex, morphology, World Health Organization [WHO] grade, tumor site, SES, geographic regions, and periods of diagnosis) are calculated using the Kaplan-Meier method. Distributions among different variables are compared using χ 2 test. Cox regressions are performed for estimating HRs to death. Results The median survival and the 1-, 5-, and 10-year CSR in this population are 0.42 years, 29.1%, 12.0%, and 7.7%, respectively. There is a gradient in SES from the south to the north ( χ 2 test, P < .001) and a gradual increment in higher SES from the early to the recent period ( χ 2 test, P < .001). Mono- and multivariate analyses reveal that all the 8 variables influenced the survival ( P < .05). Age (HR, 1.04 per year from 15 years, P < .001), WHO grade (1.21 per grade from grade I, P < .001), and morphology (HR from 1.23 to 1.89, compared with ependymoma, P < .05) are the most influential factors. However, there are also independent effects from SES (HR, 1.03 per quintile of deprivation, P < .001) and geographic regions (HR, 1.10 for outside southern England; P < .001) on the survival. Conclusions Although age and tumor characteristics (morphology, WHO grade, tumor site) are well-known prognostic factors, SES and geographic variations also play a slight but significant role, and for more cost-effective allocation of health resources, alleviation on these 2 modifiable factors should be considered.

Chronic kidney disease in African American and Mexican American populations

Chronic kidney disease in African American and Mexican American populations. AbstractAfrican Americans and Mexican Americans suffer from disproportionately high rates of end-stage renal disease in comparison with whites from the United States. An improved understanding of both classic and novel chronic kidney disease risk factors among racial/ethnic minorities may help to facilitate improved prevention, screening, and early intervention strategies for all patients at risk for chronic kidney disease—not only in the United States, but on a global level. The economic implications are equally important to inform health policy recommendations and ensure cost-effective allocation of limited resources.

Socioeconomic relevance of selected treatment strategies in patients with chronic heart failure

More than 2.8% of the population in the USA suffer from chronic heart failure, a condition that primarily afflicts people above the age of 60 years, and results in major expenses for social and health care of affected patients, their caregivers and families. The mainstay of treatment is drug therapy, complemented by comprehensive rehabilitation, invasive procedures, palliative treatment and monitoring. While sufficient health economic evidence exists on the cost–effectiveness of certain standard drugs, such as angiotensin converting enzyme inhibitors or β-blockers, little or no information exists on the cost effectivty of diuretics or aldosterone antagonists. Recently, introduced treatment strategies such as ventricular assistance devices or telemonitoring have yet to be evaluated for their cost–effectiveness in terms of risk of hospitalization, life expectancy and quality of life. With respect to the aging population and the drastically increasing costs of healthcare for heart failure patients, the goal is a more conscious and cost-effective resource allocation. This can help reduce the incidence of over and under treatment, diminish side effects and consequently improve symptoms, quality of life and life expectancy in the affected population. Further clinical trials and health economic analyses are necessary to optimize recommendations for healthcare of patients with chronic heart failure.

Closing the gap between internal medicine training and practice: Recommendations from recent graduates

Closing the gap between internal medicine training and practice: Recommendations from recent graduates

Role of Microalbuminuria in the Assessment of Cardiovascular Risk in Essential Hypertension

Accurate cardiovascular risk evaluation is a prerequisite for devising cost-effective therapeutic strategies in patients with essential hypertension. In fact, the knowledge of concomitant risk factors, diabetes, target organ damage, or associated clinical conditions may be useful when deciding both treatment and BP goals. Thorough evaluation of target organ damage is the key to sensitive assessment of global risk, but cost-effective allocation of economic resources should also be taken into consideration. Thanks to its low cost and widespread availability, the search for microalbuminuria is a first-line tool for identifying hypertensive patients who are at higher cardiovascular risk.

The impact of echography on evaluation and management of posterior segment disorders

Purpose To investigate the impact on patient management of posterior segment echographic evaluation at an academic institution. Design Retrospective, noncomparative, consecutive case series. Methods Records were reviewed of all patients evaluated for the first time with ocular echography for posterior segment evaluation at Bascom Palmer Eye Institute between September 2000 and August 2001. Patients with prior posterior segment echography, intraocular tumors, or suspected optic nerve or orbital disease were excluded. An “impactful” echographic evaluation was defined as an evaluation that confirmed the diagnosis and management plan. A “pivotal” evaluation was defined as an evaluation that either (1) made or subclassified the diagnosis or (2) established or changed the management plan or both. Main outcome measures include proportions of impactful and pivotal echographic evaluations and factors associated with pivotal evaluations. Results The study included 154 eyes of 143 patients. The requesting physician was a retina fellowship-trained faculty member in 55 cases (36%), a nonretina faculty member in 22 (14%), a fellow in 9 (6%), and a resident in 68 (44%). Reasons for obtaining echography included evaluation for retinal tear or detachment in 83 eyes (54%), evaluation for posterior segment disease (for example, before cataract extraction) in 40 (26%), evaluation for endophthalmitis in 10 (7%), evaluation for intraocular foreign body in 8 (5%), characterization of choroidal detachment in 4 (2%), and other in 9 (6%). Echography confirmed the suspected diagnosis and pre-echography management plan in 128 eyes (83%). Echography made or subclassified the diagnosis in 20 eyes (13%) and established or changed the management plan in 12 eyes (8%). Accounting for definitional overlaps, echography was pivotal in 22 eyes (14%). Significant predictors of a pivotal evaluation or an evaluation that affected the management plan include a retina faculty member as the requesting physician ( P = .003), lack of a management plan before echography ( P < .001), and certain reasons for obtaining echography (for example, to rule out retinal tear or detachment and to rule out intraocular foreign body; P = .032). The final clinical or pathologic diagnosis confirmed the echographic diagnosis in 148 eyes (96%). Conclusions Posterior segment echography may be a very useful diagnostic tool. Its value may be optimized in certain subsets of patients. Considerations such as these may contribute to more cost-effective allocation of resources.