Cost-effective Use Of Resources Research Articles

REVIEW: AN EXPERIMENTAL STUDY ON EFFECT OF NANO MATERIALS ON STRENGTH OF CONCRETE AND PLANE STRESS ANALYSIS USING ANSYS SOFTWARE

These days, making efficient and cost-effective use of resources has taken precedence. The main ingredient in concrete, cement has been under criticism in recent years for the quantity of CO2 released during production. Although cement has better mechanical properties, it hasn't been able to live up to the expectations in terms of durability. Owing to cement's shortcomings, scientists started looking into additives that would enhance concrete's qualities while also making it stronger and lighter. Fly ash, silica fume, and other micro particles were added to cementitious materials to improve their compactness, strength, and durability. These additives were also selected because they are eco-friendly by products of industrial waste that may be handled ethically. Fly ash has significant disadvantages because it is not good for initial strength increase and setting time. Because silica fume affects cementitious material performance, researchers have recently become interested in combining it with ceramic waste and rice husk ash. A more effective way to utilize rice husk ash, a by-product of rice cultivation, would be to replace 10% to 15% of cement. Studies have shown improvements in the durability performance of recycled ceramic waste concrete and rice husk ash concrete. There are issues since the RHA production process is quite time-consuming. With the discovery of nano-particles (NP) smaller than 100 nm, researchers have advanced the field of nanotechnology to new levels. The mechanical properties of many materials, including polymers and cementitious materials, can be enhanced by NP. NP is also helpful in the fields of food, engineering, and medicine. This led researchers to investigate the effects of nano-silica (NS) on concrete in further detail. Nano materials can improve the compressive strength and ductility of concrete. In this project an effort will be made to increase the compressive strength of concrete using Nano materials and waste product like GGBS. Also plane stress analysis of concrete cubes and cylinders is to be done using Ansys Software to find deformation, principal stresses and shear stresses. Keywords: Nano –Silica, Nano Titanium dioxide, Ansys, GGBS, Compressive strength

Informing optimal treatment (tx) sequences for platinum-eligible patients with locally advanced or metastatic urothelial carcinoma (la/mUC) in the United States: Results of a clinical simulation modeling exercise.

e13514 Background: Platinum-based chemotherapy (PBT) followed by avelumab (AVE) as first-line (1L) maintenance for patients with nonprogressive disease (PBT ± AVE) is the standard of care in la/mUC. This study compared the overall survival (OS) and cost-effectiveness of the tx sequence of PBT ± AVE followed by enfortumab vedotin (EV) or other therapies, including immuno-oncology (IO), in second line (2L; ie, PBT + 2L EV/IO or PBT + AVE + 2L EV/IO) vs 1L EV + pembrolizumab (PEM) for PBT-eligible patients (PBTp) from a US commercial payer perspective. Methods: A partitioned survival model compared outcomes with PBT ± AVE and EV + PEM among PBTp. Inputs included progression-free survival and OS, time to tx discontinuation, adverse event (AE) incidence, and health utilities and costs. Efficacy inputs were sourced and extrapolated from patient data in JAVELIN Bladder 100 (data cut: Jun 4, 2021), AVENANCE real-world study (1), and published data (EV-302 trial). Safety data were sourced from US prescribing information. Drug, subsequent tx, disease management, and AE management costs (2023 USD) were calculated. The optimal tx sequencing scenario assumed 80% of patients starting PBT were eligible to receive AVE (2023 Flatiron data cut; (2)), 70% of patients progressing on PBT ± AVE would start 2L, and 70% of those would be eligible for EV. Outcomes included life-years (LYs), quality-adjusted LYs (QALYs), costs, and incremental cost-effectiveness ratio (ICER). Scenarios and probabilistic sensitivity analyses (PSAs) were conducted to assess uncertainty. Results: LY, QALY, costs, and ICER modeling outcomes are shown in the Table. Use of EV in 2L after PBT ± AVE is associated with 0.76 lower QALYs, but given the large cost saving, it represents a cost-effective use of resources at the $150,000/QALY willingness to pay (WTP) threshold. PSAs showed that PBT ± AVE is likely to be more cost-effective over a broad and relevant WTP threshold range ($0-500,000/QALY). Results were sensitive to drug acquisition costs and eligibility to receive AVE and 2L EV. Conclusions: Based on this simulation exercise, the use of 2L EV after PBT ± AVE achieves considerable survival benefit at substantially lower costs vs 1L EV + PEM in PBTp with la/mUC. Given the shift toward value-based care in oncology, such analyses are becoming increasingly relevant to guide clinical decision-making. There is a need to assess tx alternatives that balance healthcare costs while optimizing outcomes in patients with la/mUC. 1. Barthélémy et al, J Clin Oncol 2024;42[suppl 4]: Abstract 561. 2. Moon et al, J Clin Oncol 2023;41[suppl 16]: Abstract 4567. [Table: see text]

Abstract PO1-01-10: Comparison of the cost-effectiveness of multigene assays for HR+/HER2- node-negative early-stage breast cancer in the US

Abstract Background Traditional clinico-pathologic features, such as tumor grade and size, age, and menopausal status, may provide incomplete prognostic information, and have limited ability to predict chemotherapy benefit for patients with hormone-receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2)-, axillary lymph node-negative (N0) early-stage breast cancer, leading to both under- and over-treatment with adjuvant chemotherapy. Multigene expression profile tests have been used in clinical practice to complement clinico-pathologic information to optimize treatment decisions. To date, the Oncotype DX Breast Recurrence ScoreÒ test is the only multigene assay with the ability to predict chemotherapy benefit validated by evidence from randomized clinical trials and supported by NCCN and ASCO guidelines. Other commercially available assays in the US include MammaPrintÒ, EndoPredictÒ and Prosigna RORÒ, which offer prognostic information beyond traditional clinico-pathologic features to improve treatment decisions. The relative cost-effectiveness of the four multigene assays compared to using clinico-pathologic risk alone to guide chemotherapy decisions was assessed from a societal perspective in the US. Methods A cost-effectiveness model built in Microsoft Excel estimated the cost-effectiveness of the Oncotype DXÒ test, MammaPrint, EndoPredict and Prosigna ROR compared to using clinical-pathological risk alone over a lifetime horizon. The model structure consisted of a decision-tree portion informed using published studies for the distribution of distant recurrence risk categories as defined by each test (low, intermediate, and high risk for the Oncotype DX test and Prosigna ROR, low and high risk for MammaPrint and EndoPredict). Decision impact studies and clinical expert opinion informed the proportion of patients allocated to adjuvant chemotherapy conditional on test result category. A Markov discrete health state model then simulated the future risk of distant recurrence, and long-term adverse effects of chemotherapy: acute myeloid leukemia (AML), and congestive heart failure (CHF), and aggregated the costs and outcomes of treatment decisions over a patient’s lifetime. The probability of distant recurrence of breast cancer conditional on test result category was derived from the most up-to-date studies assessing the performance of tests: TAILORx for the Oncotype DX test, MINDACT for MammaPrint, and TransATAC for EndoPredict and Prosigna ROR. Costs were estimated from a US societal perspective in 2020 US dollars (including Medicare healthcare costs, lost productivity and patient out-of-pocket chemotherapy costs from literature), and outcomes were expressed in terms of life-years, quality-adjusted life-years (QALYs), and net monetary benefit (NMB). The cost-effectiveness of each multigene assay compared to using clinico-pathologic risk alone was presented using the incremental cost-effectiveness ratio (ICER). Results Using the Oncotype DX test resulted in the largest lifetime cost savings (-$13,395) and generated the largest QALY gain (0.25) out of the four multigene assays included in the model, when compared to using clinico-pathologic risk alone (Table 1). All four multigene assays represented a cost-effective use of resources from a societal perspective (based on the accepted willingness-to-pay threshold of $100,000 per QALY gained), with a low net lifetime cost or net cost savings with positive QALY gain. Conclusion These results support the use of multigene assays to guide treatment decisions in node-negative HR+/HER2- early-stage breast cancer to improve treatment outcomes, and also result in substantial net cost savings from a societal perspective. The prediction of chemotherapy benefit using the Oncotype DX test resulted in substantially higher cost savings and improved breast cancer outcomes. Citation Format: Vladislav Berdunov, Gebra Cuyun Carter, Christy Russell, Sara Campbell, Jennifer Racz, Yara Abdou. Comparison of the cost-effectiveness of multigene assays for HR+/HER2- node-negative early-stage breast cancer in the US [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-01-10.

Exploring the Cost-Utility of a Biomarker Predicting Persistent Severe Acute Kidney Injury: The Case of C-C Motif Chemokine Ligand 14 (CCL14).

Approximately 24% of hospitalized stage 2-3 acute kidney injury (AKI) patients will develop persistent severe AKI (PS-AKI), defined as KDIGO stage 3 AKI lasting ≥3 days or with death in ≤3 days or stage 2 or 3 AKI with dialysis in ≤3 days, leading to worse outcomes and higher costs. There is currently no consensus on an intervention that effectively reverts the course of AKI and prevents PS-AKI in the population with stage 2-3 AKI. This study explores the cost-utility of biomarkers predicting PS-AKI, under the assumption that such intervention exists by comparing C-C motif chemokine ligand 14 (CCL14) to hospital standard of care (SOC) alone. The analysis combined a 90-day decision tree using CCL14 operating characteristics to predict PS-AKI and clinical outcomes in 66-year-old patients, and a Markov cohort estimating lifetime costs and quality-adjusted life years (QALYs). Cost and QALYs from admission, 30-day readmission, intensive care, dialysis, and death were compared. Clinical and cost inputs were informed by a large retrospective cohort of US hospitals in the PINC AI Healthcare Database. Inputs and assumptions were challenged in deterministic and probabilistic sensitivity analyses. Two-way analyses were used to explore the efficacy and costs of an intervention preventing PS-AKI. Depending on selected costs and early intervention efficacy, CCL14-directed care led to lower costs and more QALYs (dominating) or was cost-effective at the $50,000/QALY threshold. Assuming the intervention would avoid 10% of PS-AKI complications in AKI stage 2-3 patients identified as true positive resulted in 0.066 additional QALYs and $486 reduced costs. Results were robust to substantial parameter variation. The analysis suggests that in the presence of an efficacious intervention preventing PS-AKI, identifying people at risk using CCL14 in addition to SOC is likely to represent a cost-effective use of resources.

Using Machine Learning to Improve Physical Activity: A Systematic Review

Abstract Background Many diseases that threaten public health can be prevented with policies to improve physical activity. To improve physical activity, the implementation of individual interventions at the societal level remains limited. At this point, technological devices as mobile phones, which provide access to all individuals, enable widespread implementation of public health interventions and the cost-effective use of resources. In recent years, Machine Learning has been used in various areas of health promotion, including improving physical activity. This systematic review was conducted to examine the effect of machine learning on health outcomes related to physical activity. Methods Studies on this topic from 2013 to 2023 have been accessed by five database searches. The methodological quality of the studies was assessed using the Critical Appraisal Checklists for experimental and quasi-experimental studies, developed by the Joanna Briggs Institute. This study was conducted by following the Preferred Reporting System for Systematic Reviews and Meta-Analyses. Results This systematic review included thirteen studies with a total sample size of 2945 individual. In the study, it was found that using machine learning algorithms can help to detect physical actvivity level and intensity, increase the daily step count, predict adherence to the physical activity goal, develop physical activity skills, increase the duration of daily cycling time, accessing accurate and real-time data on physical activity, personalize physical activity recommendations and identify the types of gaits. Conclusions Machine learning can be used to improve physical activity by providing more personalized and effective recommendations, using real-time feedback, and gamifying physical activity to increase motivation and adherence. Machine learning holds promise in the field of health promotion and has the potential to improve physical activity for individuals and communities. Key messages • Machine learning approaches are effective methods in determining and improving the level of physical activity on a public scale. • In terms of public health initiatives, using machine learning to improve physical activity is a cost-effective and efficient approach.

Cardiometabolic effect of sodium and glucosa cotransporter inhibitors type 2

Introduction: Type 2 diabetes mellitus has emerged as a leading cause of premature death and a growing threat to the healthcare system due to the high costs of medical care in the context of cardiovascular complications. Methods: We conducted a systematic electronic search of clinical trials published from 2015 to January 2023 in PubMed, Scopus, Web of Science and ScieLO databases, which evaluated the efficacy and safety of the use of type 2 sodium-glucose cotransporter inhibitors in patients with type 2 diabetes mellitus and established cardiovascular disease on routine treatment and their cost-effectiveness.Results: Significantly lower rates of acute myocardial infarction, stroke, cardiovascular death and hospitalization due to heart failure were observed when the study drugs were added to standard therapy. In addition, it was evidenced that the reduction in cardiovascular clinical events manages to offset the cost of type 2 sodium-glucose cotransporter inhibitors resulting in a cost-effective use of resources at the health care level.Conclusions: As the transition to a new evidence-based era of managing patients with type 2 diabetes mellitus and cardiovascular disease progresses, it is imperative that new therapies are developed that not only improve glycemic control, but also improve cardiovascular outcomes, because these events represent the major cause of mortality in this population.

Cost-Effectiveness of Newborn Screening for Spinal Muscular Atrophy in England.

We sought to evaluate the cost-effectiveness of newborn screening (NBS) versus no NBS for 5q spinal muscular atrophy (SMA) in England. A cost-utility analysis using a combination of decision tree and Markov model structures was developed to estimate the lifetime health effects and costs of NBS for SMA, compared with no NBS, from the perspective of the National Health Service (NHS) in England. A decision tree was designed to capture NBS outcomes, and Markov modeling was used to project long-term health outcomes and costs for each patient group following diagnosis. Model inputs were based on existing literature, local data, and expert opinion. Sensitivity and scenario analyses were conducted to assess the robustness of the model and the validity of the results. The introduction of NBS for SMA in England is estimated to identify approximately 56 (96% of cases) infants with SMA per year. Base-case results indicate that NBS is dominant (less costly and more effective) than a scenario without NBS, with a yearly cohort of newborns accruing incremental savings of £62,191,531 and an estimated gain in quality-adjusted life-years of 529years over their lifetime. Deterministic and probabilistic sensitivity analyses demonstrated the robustness of the base-case results. NBS improves health outcomes for patients with SMA and is less costly compared with no screening; therefore, it is a cost-effective use of resources from the perspective of the NHS in England.

THE NEED TO REFORM THE MANAGEMENT SYSTEM OF HIGHER EDUCATION INSTITUTIONS AND IMPLEMENT NEW PRINCIPLES TO IT

When we covered the topic "The need to reform the management system of higher education institutions and introduce new principles to it" in the article, we presented the need and important principles of developing and updating the management system of higher education institutions. These principles can be: Orientation to central goals: The importance of orientation to central goals is shown in the management system of higher education institutions. The management system should include support for goal setting, instructional design, student achievement of goals, and performance evaluation. Discussion and management transparency: In the reform of the management system, it is necessary to follow the principles of discussion and management transparency[1]. Effective and mutual cooperation between the administration, teachers, students and parents, establishment of high-level relations between governing bodies and organizations is important. Establishing a broad framework of management: In reforming the management system of higher education institutions, the principle of establishing a broad framework of management is important. This is to support changing and innovative methods of strategic management, monitor learning processes, enable efficient and cost-effective use of resources, ensure quality, improve the quality of education and learn to adopt innovations. contains z.

P120 What's driving this disease activity score? A support framework to aid your decision

Abstract Background/Aims NICE now enables patients with a DAS of > 3.1 to < 5.2 to be treated with advanced drug therapies. To ensure correct and cost-effective use of resources it is essential that we identify a moderate DAS that is driven by inflammatory joint disease as opposed to a differential diagnosis. A reference-based tool entitled “DAS drivers: A nursing decision-making algorithm“ was designed to support nurses in their clinical decision making around appropriate treatment for moderate disease. Clinical trials suggest that advanced therapy provides similar benefits for people with moderate disease as well as those with severe disease. After a pragmatic review of existing evidence. NICE guidance was introduced in 2021 to include patients with a moderate RA DAS (>3.1 - < 5.2) to be eligible for advanced therapies. This is a positive step to improving access to advanced treatment options for patients and will help stem the burden of disability associated with RA. The algorithm presented was initially developed to support nurses identify and navigate around management plans for patients with moderate RA disease and would be freely available for all of rheumatology community to use in their daily practice. It is recognised in the BSR report ‘Specialist Nursing in Rheumatology - The State of Play’ that there is a need for succession planning and an increase in appropriately skilled rheumatology nursing workforce. The authors are experienced, longstanding members of the rheumatology workforce and thus are sharing knowledge and experience with the next generation of nurses to allow for continued quality of patient care as part of the succession planning program that rheumatology services now face. The algorithm aims to address these challenges by supporting the identification of patients with active inflammation in moderate RA therefore ensuring that appropriate patients are given access to valuable limited resources within the NHS. Methods Round-table discussions between three advanced rheumatology nurse leaders (the authors) with a cumulative and varied rheumatology experience of 70+ years, lead to the development of an algorithm specifically around identifying active inflammation in moderate RA. The authors drew on relevant publications and clinical experience to develop the algorithm and refine over a 12-month period. The intention of the algorithm is to make it user friendly and support standardised decision making in a clinical setting for all nurses working within rheumatology, irrespective of experience. Results The algorithm provides a structured approach and promotes ideas to consider when assessing and treatment patients with rheumatoid arthritis. Conclusion To endorse and disseminate the algorithm as an education tool and develop a publication. An audit on the use of the algorithm amongst nurses in clinical practice with a pilot audit with nurses who have attended educational events delivered by the authors. Disclosure B. Rhys-Dillion: Honoraria; B.R.D. has received honoraria from Galapagos. A. Kent: Honoraria; A.K. has received honoraria from Galapagos, Roche, Pfizer, Gilead, BMS, Amgen, Chugai-Pharma, Sanofi Aventis and UCB Pharma. J. Painter: Honoraria; J.P. has received honoraria from Galapagos, Pfizer, Novartis and Roche/Chugai-Pharma.

SICI-GISE/SICOA Consensus document: Clinical follow-up of patients after acute coronary syndrome or percutaneous coronary intervention

In the last decades, advances in percutaneous coronary intervention (PCI) strategies have significantly reduced the risk of procedural complications and in-hospital mortality of patients with acute coronary syndromes (ACS), thus increasing the population of stable post-ACS patients. This novel epidemiological scenario emphasizes the importance of implementing secondary preventive and follow-up strategies. The follow-up of patients after ACS or elective PCI should be based on common pathways and on the close collaboration between hospital cardiologists and primary care physicians. However, the follow-up strategies of these patients are still poorly standardized. This SICI-GISE/SICOA consensus document was conceived as a proposal for the long-term management of post-ACS or post-PCI patients based on their individual residual risk of cardiovascular adverse events. We defined five patient risk classes and five follow-up strategies including medical visits and examinations according to a specific time schedule. We also provided a short guidance for the selection of the appropriate imaging technique for the assessment of left ventricular ejection fraction and of non-invasive anatomical or functional tests for the detection of obstructive coronary artery disease. Physical and pharmacological stress echocardiography was identified as the first-line imaging technique in most of cases, while cardiovascular magnetic resonance should be preferred when an accurate evaluation of left ventricular ejection fraction is needed. The standardization of the follow-up pathways of patients with a history of ACS or elective PCI, shared between hospital doctors and primary care physicians, could result in a more cost-effective use of resources and potentially improve patient's long-term outcome.

Degradation Model Applied to the Plasterwork of the Palace of Pedro I (Royal Alcazar of Seville)

This study proposes a model to evaluate the overall degradation condition of historical plasterworks in three different locations inside the Royal Alcazar of Seville, Spain. A Severity of Degradation Index (Sw) is proposed to establish a priority of intervention while also improving the durability and conservation of plasterworks with exceptional heritage features. The Sw is a numerical index that considers the area affected by the different anomalies, their severity, and the relative importance of each anomaly on the overall conservation condition of the plasterworks, while also considering its influence on the overall performance of the plasterworks and its propensity to generate new anomalies. Visual inspections and non-destructive tests (NDT) were adopted to evaluate the conservation condition of the plasterworks of the Palace of Pedro I, which revealed that cracking and metal fixing elements represent the most common and severe anomalies detected. The method proposed allows for a more rational and cost-effective use of resources in the conservation of patrimonial-built heritage.

Estimating the Cost of 3 Risk Prediction Strategies for Potential Use in the United Kingdom National Breast Screening Program.

Economic evaluations have suggested that risk-stratified breast cancer screening may be cost-effective but have used assumptions to estimate the cost of risk prediction. The aim of this study was to identify and quantify the resource use and associated costs required to introduce a breast cancer risk-stratification approach into the English national breast screening program. A micro-costing study, conducted alongside a cohort-based prospective trial (BC-PREDICT), identified the resource use and cost per individual (£; 2021 price year) of providing a risk-stratification strategy at a woman's first mammography. Costs were calculated for 3 risk-stratification approaches: Tyrer-Cuzick survey, Tyrer-Cuzick with Volpara breast-density measurement, and Tyrer-Cuzick with Volpara breast-density measurement and testing for 142 single nucleotide polymorphisms (SNP). Costs were determined for the intervention as implemented in the trial and in the health service. The cost of providing the risk-stratification strategy was calculated to be £16.45 for the Tyrer-Cuzick survey approach, £21.82 for the Tyrer-Cuzick with Volpara breast-density measurement, and £102.22 for the Tyrer-Cuzick with Volpara breast-density measurement and SNP testing. This study did not use formal expert elicitation methods to synthesize estimates. The costs of risk prediction using a survey and breast density measurement were low, but adding SNP testing substantially increases costs. Implementation issues present in the trial may also significantly increase the cost of risk prediction. This is the first study to robustly estimate the cost of risk-stratification for breast cancer screening. The cost of risk prediction using questionnaires and automated breast density measurement was low, but full economic evaluations including accurate costs are required to provide evidence of the cost-effectiveness of risk-stratified breast cancer screening. Economic evaluations have suggested that risk-stratified breast cancer screening may be a cost-effective use of resources in the United Kingdom.Current estimates of the cost of risk stratification are based on pragmatic assumptions.This study provides estimates of the cost of risk stratification using 3 strategies and when these strategies are implemented perfectly and imperfectly in the health system.The cost of risk stratification is relatively low unless single nucleotide polymorphisms are included in the strategy.

Cost-Effectiveness of Newborn Screening for Spinal Muscular Atrophy in The Netherlands

ObjectivesSpinal muscular atrophy (SMA) is a rare genetic disorder that causes progressive muscle weakness and paralysis. In its most common and severe form, the majority of untreated infants die before 2 years of age. Early detection and treatment, ideally before symptom onset, maximize survival and achievement of age-appropriate motor milestones, with potentially substantial impact on health-related quality of life. Therefore, SMA is an ideal candidate for inclusion in newborn screening (NBS) programs. We evaluated the cost-effectiveness of including SMA in the NBS program in The Netherlands. MethodsWe developed a cost-utility model to estimate lifetime health effects and costs of NBS for SMA and subsequent treatment versus a treatment pathway without NBS (ie, diagnosis and treatment after presentation with overt symptoms). Model inputs were based on literature, local data, and expert opinion. Sensitivity and scenario analyses were conducted to assess model robustness and validity of results. ResultsAfter detection of SMA by NBS in 17 patients, the number of quality-adjusted life-years gained per annual birth cohort was estimated at 320 with NBS followed by treatment compared with treatment after clinical SMA diagnosis. Total healthcare costs, including screening, diagnostics, treatment, and other healthcare resource use, were estimated to be €12 014 949 lower for patients identified by NBS. ConclusionsNBS for early identification and treatment of SMA versus later symptomatic treatment after clinical diagnosis improves health outcomes and is less costly and, therefore, is a cost-effective use of resources. Results were robust in sensitivity and scenario analyses.

Impact of Expanding Eligibility Criteria for Cochlear Implantation - Dynamic Modeling Study.

Eligibility criteria for cochlear implantation (CI) are shifting due to technological and surgical improvements. The aim of this study was to explore the impact of further expanding unilateral CI criteria in those with severe hearing loss (HL) (61-80 dBHL) in terms of number of CI recipients, costs, quality of life, and cost-effectiveness. A dynamic population-based Markov model was constructed mimicking the Dutch population in three age categories over a period of 20 years. Health states included severe HL (61-80 dBHL), profound HL (>81 dBHL), CI recipients, and no-CI recipients. Model parameters were based on published literature, (national) databases, expert opinion, and model calibration. If persons with severe HL would qualify and opt for CI similar to those with profound HL now, this would lead to a 6-7 times increase of new CI recipients and an associated increase in costs (€550million) and QALYs (54.000) over a 20-year period (incremental cost utility ratio: 10.771 euros/QALY [2.5-97.5 percentiles: 1.252-23.171]). One-way-sensitivity analysis indicated that model outcomes were most sensitive to regaining employment, utility associated with having a CI, and costs of surgery and testing. Our findings suggest that expanding eligibility for CI to persons with severe HL could be a cost-effective use of resources. Clearly, however, it would require a significant increase in diagnostic, operative, and rehabilitative capacity. Our quantitative estimates can serve as a basis for a wider societal deliberation on the question whether such an increase can and should be pursued. NA Laryngoscope, 133:924-932, 2023.

A Stakeholder Evaluation of an RN-to-BSN Academic Progression Program.

The aim of this study was to evaluate programmatic elements supporting BSN attainment by employed nurses holding associate degrees or diplomas, using a stakeholder involvement approach. Studies have associated higher percentages of baccalaureate-prepared nurses with improved clinical outcomes. Since 2013, the study organization supported an RN-to-BSN requirement with an academic progression benefit program and achieved an 80% BSN goal by 2021. The Centers for Disease Control and Prevention's Framework for Program Evaluation was used. A mixed methods approach was orchestrated by a stakeholder team to explore use and importance of programmatic elements, and motivators and barriers for degree attainment, using an online survey and focus groups. Respondents revealed a significant association between BSN degree attainment and financial assistance and perceived importance of financial assistance and educational fairs. Validating organizational tactics is important for achieving increased numbers of baccalaureate-prepared nurses and supportive of the cost-effective use of resources.

Economic models of community-based falls prevention: a systematic review with subsequent commissioning and methodological recommendations

BackgroundFalls impose significant health and economic burdens among older populations, making their prevention a priority. Health economic models can inform whether the falls prevention intervention represents a cost-effective use of resources and/or meet additional objectives such as reducing social inequities of health. This study aims to conduct a systematic review (SR) of community-based falls prevention economic models to: (i) systematically identify such models; (ii) synthesise and critically appraise modelling methods/results; and (iii) formulate methodological and commissioning recommendations.MethodsThe SR followed PRISMA 2021 guideline, covering the period 2003–2020, 12 academic databases and grey literature. A study was included if it: targeted community-dwelling persons aged 60 and over and/or aged 50–59 at high falls risk; evaluated intervention(s) designed to reduce falls or fall-related injuries; against any comparator(s); reported outcomes of economic evaluation; used decision modelling; and had English full text. Extracted data fields were grouped by: (A) model and evaluation overview; (B) falls epidemiology features; (C) falls prevention intervention features; and (D) evaluation methods and outcomes. A checklist for falls prevention economic evaluations was used to assess reporting/methodological quality. Extracted fields were narratively synthesised and critically appraised to inform methodological and commissioning recommendations. The SR protocol is registered in the Prospective Register of Systematic Reviews (CRD42021232147).ResultsForty-six models were identified. The most prevalent issue according to the checklist was non-incorporation of all-cause care costs. Based on general population, lifetime models conducting cost-utility analyses, seven interventions produced favourable ICERs relative to no intervention under the cost-effectiveness threshold of US$41,900 (£30,000) per QALY gained; of these, results for (1) combined multifactorial and environmental intervention, (2) physical activity promotion for women, and (3) targeted vitamin D supplementation were from validated models. Decision-makers should explore the transferability and reaches of interventions in their local settings. There was some evidence that exercise and home modification exacerbate existing social inequities of health. Sixteen methodological recommendations were formulated.ConclusionThere is significant methodological heterogeneity across falls prevention models. This SR’s appraisals of modelling methods should facilitate the conceptualisation of future falls prevention models. Its synthesis of evaluation outcomes, though limited to published evidence, could inform commissioning.

Cost-Effectiveness of Lipid-Lowering Therapies for Cardiovascular Prevention in Germany

PurposeNovel pharmaceutical treatments reducing cardiovascular events in dyslipidaemia patients must demonstrate clinical efficacy and cost-effectiveness to promote long-term adoption by patients, physicians, and insurers.ObjectiveTo assess the cost-effectiveness of statin monotherapy compared to additive lipid-lowering therapies for primary and secondary cardiovascular prevention from the perspective of Germany’s healthcare system.MethodsTransition probabilities and hazard ratios were derived from cardiovascular outcome trials for statin combinations with icosapent ethyl (REDUCE-IT), evolocumab (FOURIER), alirocumab (ODYSSEY), ezetimibe (IMPROVE-IT), and fibrate (ACCORD). Costs and utilities were retrieved from previous literature. The incidence of major adverse cardiovascular events was simulated with a Markov cohort model. The main outcomes were the incremental cost-effectiveness ratios (ICER) per quality adjusted life year (QALY) gained.ResultsFor primary prevention, the addition of icosapent ethyl to statin generated 0.81 QALY and €14,732 costs (ICER: 18,133), whereas fibrates yielded 0.63 QALY and € − 10,516 costs (ICER: − 16,632). For secondary prevention, the addition of ezetimibe to statin provided 0.61 QALY at savings of € − 5,796 (ICER: − 9,555) and icosapent ethyl yielded 0.99 QALY and €14,333 costs (ICER: 14,485). PCSK9 inhibitors offered 0.55 and 0.87 QALY at costs of €62,722 and €87,002 for evolocumab (ICER: 114,639) and alirocumab (ICER: 100,532), respectively. A 95% probability of cost-effectiveness was surpassed at €20,000 for icosapent ethyl (primary and secondary prevention), €119,000 for alirocumab, and €149,000 for evolocumab.ConclusionsFor primary cardiovascular prevention, a combination therapy of icosapent ethyl plus statin is a cost-effective use of resources compared to statin monotherapy. For secondary prevention, icosapent ethyl, ezetimibe, evolocumab, and alirocumab increase patient benefit at different economic costs.

The Effect of Asset Management On Company’s Logistical Performance. A Case of Strong Construction Ltd

The efficiency of asset management for various reasons has been the focus for companies, Managers and investors doing construction businesses. The main objective of this research is to ascertain the effect of asset management practices on logistical performance within Strong Construction Ltd. To accomplish the main objective, three specific objectives were formulated. These include; to analyze the effect of standards compliance logistical performance within Strong Construction Ltd; to examine the effect of assets maintenance on logistical performance within Strong Construction Ltd and to assess the effect of budget allocation of funds on logistical performance within Strong Construction Ltd. The related theories including the resource based theory and the contingency theory, were used and analyzed. The population of the research are 200 participants and sample size is 66 respondents. The research tools for data collection are questionnaire, interview and documentation. The findings indicated that each unit of compliance with standards do not significantly influence each unit of logistical performance in Strong Construction Ltd. There is increase in each unit of logistical performance when the unit of budget allocation of funds increases at 55.7% in Strong Construction Ltd. There is an increase in each unit of operation performance when the unit of assets maintenance increases at 30.7% in Strong Construction Ltd. Budget allocation of funds affects logistical performance more than assets maintenance in the same perspective compliance with standards in asset management is on the third priority to affect logistical performance in Strong Construction Ltd. The results indicated that there is a positive auto-correlation between asset management (assets maintenance, compliance with standards, budget allocation of funds) and logistical performance in Strong Construction Ltd. This means that asset management can be associated with logistical performance in Strong Construction Ltd. There is a positive strong correlation between asset management and logistical performance (R=0.993). The study concludes also that asset management (compliance with standards; assets maintenance and budget allocation of funds) had positive and significant effect cost efficiency in Strong Construction Ltd. This means that as much as asset management is taught to the employees, there was an improvement on logistical performance that will results in cost effective use of resources in Strong Construction Ltd. This indicates that once employees are integrated in asset management system they will have accountability that will contribute to logistical performance toward the achievement of the set goals within Strong construction Ltd.

Exercise-based cardiac rehabilitation for coronary heart disease.

Exercise-based cardiac rehabilitation for coronary heart disease.

The Impact of Asset Management on Company’s Operational Performance A Case of Horizon Construction Ltd

The efficiency of asset management for various reasons has been the focus for companies, Managers and investors doing construction businesses. The main objective of this research is to ascertain the effect of asset management practices on operational performance within Horizon Construction Ltd. To accomplish the main objective, three specific objectives were formulated. These include; to analyze the effect of standards compliance operational performance within Horizon Construction Ltd; to examine the effect of assets maintenance on operational performance within Horizon Construction Ltd and to assess the effect of budget allocation of funds on operational performance within Horizon Construction Ltd. The related theories including the resource based theory and the contingency theory, were used and analyzed. The population of the research are 200 participants and sample size is 66 respondents. The research tools for data collection are questionnaire, interview and documentation. The findings indicated that each unit of compliance with standards do not significantly influence each unit of operational performance in Horizon Construction Ltd. There is increase in each unit of operational performance when the unit of budget allocation of funds increases at 55.7% in Horizon Construction Ltd. There is an increase in each unit of operation performance when the unit of assets maintenance increases at 30.7% in Horizon Construction Ltd. Budget allocation of funds affects operational performance more than assets maintenance in the same perspective compliance with standards in asset management is on the third priority to affect operational performance in Horizon Construction Ltd. The results indicated that there is a positive auto-correlation between asset management (assets maintenance, compliance with standards, budget allocation of funds) and operational performance in Horizon Construction Ltd. This means that asset management can be associated with operational performance in Horizon Construction Ltd. There is a positive strong correlation between asset management and operational performance (R=0.993). The study concludes also that asset management (compliance with standards; assets maintenance and budget allocation of funds) had positive and significant effect cost efficiency in Horizon Construction Ltd. This means that as much as asset management is taught to the employees, there was an improvement on operational performance that will results in cost effective use of resources in Horizon Construction Ltd. This indicates that once employees are integrated in asset management system they will have accountability that will contribute to operational performance toward the achievement of the set goals within horizon construction Ltd.