Cost-effectiveness Considerations Research Articles

Effect of cavity surface coating on mold temperature variation and the quality of injection molded parts

Suiting for high gloss surface of injection molded parts free of painting is a great concern from both environment and cost effective considerations. As a result, variable mold temperature controls to achieve the mentioned goal have been paid great attentions. In this study, TiN and Teflon of various thicknesses were coated on the cavity surface of a tensile bar mold designed with double gate. During the injection molding process, melt–mold interface temperature was analyzed and simulated. In a regular injection molding of ABS resin using P20 as the mold material, the initial melt temperature may drop from 240 °C to about 65 °C after 0.01 s of contact with the cavity surface when the coolant temperature is 60 °C. For a TiN surface coating of 4 µm, the interface contact temperature was raised to 73.6 °C. For a Teflon coating of 22 µm, the contact surface temperature is as high as 100 °C initially (about 25 °C higher) and remains above 80 °C for about 0.4 s. Teflon coating on the cavity surface eliminates the weld-line marks, improves part surface smoothness and results in better tensile strength for weld line than TiN coating. Moreover, the cooling time was almost not affected. When surface coating is combined with infrared heating, not only the tensile strengths of the weld line were further enhanced but also the heating rate at mold surface is enhanced.

Cost-effectiveness Considerations of Cardiovascular Therapeutics

As medical knowledge advances, potential new tests and treatments are usually evaluated in randomised clinical trials and may then be adopted into clinical practice. Some are adopted because they are more effective than what went before, improving quality and/or quantity of life, others because they can achieve a similar clinical outcome at a lower cost. Comparing the costs and effects of various treatment options in the management of cardiac conditions is a fundamental process towards achieving the best outcomes for our own patients and our whole population with available resources. We all make daily decisions about treatment choices for our patients that no doubt take these issues into account, at least in a qualitative way, but formal quantitative methods are now well developed and will become increasingly important as we try to do the most good for the most people using our departmental, state and national health budgets.

Environmental rather than genetic fetal overgrowth: defining the difference and hints for diagnosis and management

Environmental rather than genetic fetal overgrowth: defining the difference and hints for diagnosis and management

A Survey Research of Contemporary Management Development Practices In Malaysian Corporations

This survey was designed and developed to assess key issues related to management development practices in Malaysian corporations especially on needs assessment, programme selection, programme evaluation, and future directions and trends. The survey research instrument is a questionnaire that was distributed to 189 selected Malaysian corporations listed on the Main Board of the Bursa Malaysia or formerly known as Kuala Lumpur Stock Exchange (KLSE). These corporations represent a cross-section of local industries and was selected through stratified random sampling. The 16-percent or 31 responses were collated and the data analyzed and interpreted using descriptive statistics. The major findings suggest that despite being aware of the importance of MD practices to achieve productivity and enhance corporate performance, most Malaysian corporations are unsure how to practise MD. They seldom implement value-added MD programmes to improve managerial productivity and enhance managerial performance achievements. The main reason given is cost-effective considerations vis-à-vis actual bottom-line results. Specifically, the majority of the respondents articulated their concern over several areas such as the lack of needs assessment, indiscriminate programme selection, non-standardized programme evaluation and vague ideas about future directions and trends in MD activities. On the whole, the survey research suggests that there is a need for Malaysian corporations to redress the prevailing weaknesses so that any concrete management development initiative undertaken can produce the desired results and productivity outcomes including bottom-line achievements.

Editorial

Editorial

The Treatment of Ankylosing Spondylitis and Psoriatic Arthritis with Etanercept: A Comprehensive Review

Etanercept is a dimeric recombinant soluble tumor necrosis factor (TNF) receptor protein utilized in the treatment of various inflammatory diseases, including ankylosing spondylitis and psoriatic arthritis. Etanercept binds the proinflammatory cytokine TNF and blocks its interaction with soluble TNF receptors, thus decreasing the inflammatory response. Several randomized controlled clinical trials have demonstrated the efficacy, safety and tolerability of etanercept in the treatment of both ankylosing spondylitis and psoriatic arthritis. These trials have also shown significant reductions in markers of systemic inflammation and improvements in patient-reported quality of life measures. Inhibition of radiographic progression has been established in etanercept-treated psoriatic arthritis patients, and ankylosing spondylitis patients have demonstrated decreases in bony inflammation; however, current data does not support a reduction in bone proliferation in ankylosing spondylitis patients. Concerns regarding long-term toxicity, efficacy, and cost-effectiveness considerations persist and guidelines have been published to assist the clinician with appropriate patient selection for this biologic therapy. Current data indicates etanercept therapy has been a very successful and well-tolerated therapy for numerous ankylosing spondylitis and psoriatic arthritis patients and will likely continue to be a cornerstone therapy for treatment of these challenging diseases in the foreseeable future.

Research around practice partnerships: an example of building partnerships to address overweight and obesity in children

Prevention and management of childhood overweight and obesity is a health priority for governments and communities throughout the developed world. A conceptual model, Research around Practice in Childhood Obesity (RAPICO), has been developed to guide capacity building in a coordinated ‘bench to fieldwork’ initiative to address this public health problem. Translation of research findings into sustainable responses with optimal fit requires consideration of context-specific relevance, cost-effectiveness, feasibility and levels of available support. The RAPICO model uses program theory to describe a framework for progressing practitioner–community–research partnerships to address low, medium and high levels of risk for childhood overweight and obesity within community settings. A case study describing the development of a logic model to inform risk-linked responses to childhood overweight and obesity is presented for the Ipswich community in south-east Queensland.

Colorectal Cancer Risk

Colorectal Cancer Risk

Effective ways to grow urban bus markets – a synthesis of evidence

This paper provides a synthesis of the evidence on the patronage growth performance of bus improvement measures in urban settings. The evidence includes a summary of experience in Europe, North America and Australasia focusing on service improvement measures including network structure and service levels, bus priority measures, vehicles and stop infrastructure, fares and ticketing systems, passenger information and marketing, personal safety and security and synergy effects of measures. The source is the research literature and documented experienced from a series of studies undertaken by the authors over the last decade. It includes the results of an international bus expert ‘Delphi’ survey concerning bus improvement measures focussed on patronage growth. The paper synthesises the evidence to identify measures which are most likely to grow patronage including consideration of cost-effectiveness of measures.

Cost-effectiveness considerations for home health V.A.C. Therapy in the United States of America and its potential international application.

Vacuum-assisted closure (V.A.C.) Therapy (KCI International, San Antonio, TX) has been widely used in hospital settings. However, use of V.A.C.) Therapy in home health settings outside of the United States of America (USA) is often limited because of financial considerations. This review paper considers the published evidence on V.A.C. Therapy in home health settings from the USA and beyond and explores the potential economic implications of V.A.C. Therapy in home health settings.

The cost of vision for vitreoretinal interventions

This article reviews the current status of treatments for age-related macular degeneration from a cost-effectiveness perspective. Treatments are now available to a broad range of patients with age-related macular degeneration, but they are pharmaceutical based and require repeated evaluation and treatment. The resulting unprecedented levels of cost make cost-effectiveness considerations more prescient. Newer methods to evaluate cost-effectiveness and treatment outcomes have included utility and value-based analyses. These have attempted to utilize accurate, objective parameters, but are calibrated by subjective patient assessments and are limited by certain methodological assumptions. Treatment methods to improve outcomes are increasingly being considered within the context of cost-effectiveness. Although improved understanding of basic, cellular processes has led to markedly improved treatment options for age-related macular degeneration within the past decade, the high costs and wide applicability threaten the balance and viability of the payor system. Accurate means of assessing cost-effectiveness are critical to defining clinical applications.

Mobile PET in the UK: legislative, regulatory and cost-effectiveness considerations

Mobile PET/CT or mobile stand alone PET, is becoming more widely available throughout the developed world, allowing many small and medium-sized hospitals that do not have the scale or financial resources to purchase the static diagnostic equipment, to benefit from this imaging technology. Before embarking on such a service, a number of legislative, logistical and administrative issues have to be addressed to ensure that a mobile PET/CT service is run with optimal efficiency and safety and in compliance with the regulations governing the use of radioactive substances. Some of these issues are similar to those encountered in operating a mobile magnetic resonance imaging scanner but there are important differences owing to the use of both sealed and open radioactive sources. This article highlights the legislative, administrative and practical issues relevant to the UK and also discusses some of the practical issues that need to be addressed to ensure the operation of a safe and effective PET service.

Transition care: will it deliver?

Transition care is a new program to Australia that is designed to facilitate transitions of frail older people between the hospital and aged care systems. This program is designed to deliver potentially important improvements to the Australian health care system--but will it deliver? The current evidence base regarding the efficacy of this type of program is mixed, and there is little evidence to indicate improved patient outcomes. An average transition care episode is expensive (about $11 000). Therefore, careful consideration of the relative cost-effectiveness compared with other interface programs such as inpatient subacute services is essential. Transition care services should be established within the context of overall regional plans for aged care, incorporating hospital acute and subacute inpatient services, and long-term community and residential care programs.

Cost-effectiveness criteria for marine oil spill preventive measures

Oil tanker accidents resulting in large quantities of oil spills and severe pollution have occurred in the past, leading to major public attention and an international focus on finding solutions for minimising the risks related to such events. This paper proposes a novel approach for evaluating measures for prevention and control of marine oil spills, based on considerations of oil spill risk and cost effectiveness. A cost model that incorporates all costs of a shipping accident has been established and oil tanker spill accidents have been further elaborated as a special case of such accidents. Utilising this model, novel implementation criteria, in terms of the Cost of Averting a Tonne of oil Spilt (CATS), for risk control options aiming at mitigating the environmental risk of accidental oil spills, are proposed. The paper presents a review of previous studies on the costs associated with oil spills from shipping, which is a function of many factors such as location of spill, spill amount, type of oil, etc. However, ships are designed for global trade, transporting different oil qualities. Therefore, globally applicable criteria must average over most of these factors, and the spill amount is the remaining factor that will be used to measure cost effectiveness against. A weighted, global average cleanup cost of USD 16,000/tonne of oil spilt has been calculated, considering the distribution of oil tanker traffic densities. Finally, the criteria are compared with some existing regulations for oil spill prevention, response and compensation (OPA 90).

Notions of just health care at three Swedish hospitals

This article investigates what notions of "just health care" are found at three Swedish hospitals among health care personnel and whether these notions are relevant to what priorities are actually made. Fieldwork at all three hospitals and 114 in-depth interviews were conducted. Data have been subject to conceptual and ethical analysis and categorisation. According to our findings, justice is an important idea to health care personnel at the studied hospitals. Two main notions of just health care were found. The main idea was the notion of "equal treatment according to need", the basic idea being that differences in treatment should be justified by differences in needs. The competing idea that merit should affect the treatment received is occasionally encountered, the idea here being that patients, by acting irresponsibly, may no longer deserve to be treated strictly according to needs. In practice, priorities are made on grounds that only partly comply with the basic idea of justice in health care, as it is understood by staff at the studied hospitals. Exceptions are made due to regional differences, considerations of cost-effectiveness, economic incentives, tradition, the daily patient flow, research, private alternatives, patient influence and favouritism of health care personnel.

Assessment and initial management of feverish illness in children younger than 5 years: summary of NICE guidance

Among children presenting with fever, especially in a primary care setting, serious illness is uncommon. The prevalence of serious illness has been reported at 0.8% in primary care1 and 7.2%...

Trends in Cost Effectiveness Analyses in Orthopaedic Surgery

Worldwide, programs dealing with musculoskeletal health are required to set priorities and allocate resources within the constraint of limited funding. There is increasing pressure for medical technology assessment, which traditionally has involved evaluating safety and effectiveness, to also include consideration of cost effectiveness. We updated our database of orthopaedic cost-effectiveness studies, critically reviewed their methods, and examined trends over time. Current analyses have numerous shortcomings, such as the inclusion of relatively few studies, inconsistent methodologic approaches, and lack of transparency. The wide variation in cost-effectiveness ratios observed among current interventions suggests efficiency can be improved. Despite reimbursement authorities in many other countries formally considering cost-effectiveness when determining coverage of new technologies, Medicare has been resistant to considering costs of treatments. Regardless of this policy deficiency, conducting cost-effectiveness analyses represents a prudent step forward in illuminating the tradeoffs involved in difficult resource allocation decisions, and there is an urgent need to consider economic impact in future studies using standardized and transparent methods.

Multi-Constituent Cardiovascular Pills (MCCP) - Challenges and Promises of Population-Based Prophylactic Drug Therapy for Prevention of Heart Attack

Risk factors for atherosclerotic cardiovascular disease (CVD) are highly co-prevalent but poorly identified and treated. The Screening for Heart Attack Prevention and Education (SHAPE) Task Force from the Association for Eradication of Heart Attack (AEHA) has recently proposed a new strategy that recommends screening for subclinical atherosclerosis and implementing aggressive treatment of "vulnerable patients". The Task Force has also envisioned future developments that may shift mass screening strategies to mass prophylactic therapy. The "Polypill" concept, introduced by Wald and Law suggests a combination of statin, low-dose antihypertensives, aspirin and folic acid, in a single pill, taken prophylactically by high risk population can cut CVD event rates by as much as 80%. In this communication, we review the challenges and promises of such a strategy. "Polypill" is but one of an astronomical number of possible multiconstituent pills (MCCP). Attractive as the MCCP concept is, it lacks evidence from randomized controlled trials, and begs numerous questions about the credibility of the concept, the design and synthesis of such complex pills, pharmacokinetics, pharmacodynamics, bioequivalence, "class" vs. unique properties, interactions, evidence of clinical efficacy and safety, regulatory approval, post-marketing surveillance, prescription vs. over-the-counter use, responsibility for initiating and monitoring therapy, patient education, counterfeiting and importation, reimbursement, advertisement, patent protection, commercial viability, etc. If these issues are favorably addressed, MCCP stand to dramatically change the manner in which CVD is prevented particularly in developing societies. Notwithstanding, assuming low commercial interests, realizing the promises of MCCP will demand serious attention from national public health policymakers. The clinical and regulatory implications of population-based secondary prevention (which rely on a different evidence base, and in which entirely different risk-benefit and cost-effectiveness considerations apply) remain issues for active debate.

Cost-effectiveness analysis of cetuximab/irinotecan vs active/best supportive care for the treatment of metastatic colorectal cancer patients who have failed previous chemotherapy treatment

The treatment of colorectal cancer is rapidly becoming a significant financial burden to health-care systems within economically developed nations. A current challenge for oncologists and health-care payers is to integrate new, often high-cost, biologic therapies into clinical practice. Inherent to this process is the consideration of cost-effectiveness. The aim of this study was to compare the cost-effectiveness of cetuximab plus irinotecan with an appropriate comparator from a National Health Service (NHS) perspective. This economic evaluation is a trial-based study of cetuximab vs active/best supportive care. Effectiveness estimates for the treatment groups were modelled from key clinical trials. Cunningham et al (2004) compared cetuximab/irinotecan with cetuximab monotherapy; Cunningham et al (1998) compared irinotecan monotherapy in a second-line setting with supportive care. Modelling was necessary owing to an absence of head-to-head clinical trial data of cetuximab/irinotecan vs current standard care. Costs were calculated for the study drugs received, associated administration, palliative chemotherapy for patients in the standard care arm and other nonchemotherapy resources. The discounted life-expectancy of patients treated with cetuximab/irinotecan was 0.91 life-years, and 0.47 discounted life-years for patients receiving active/best supportive care. Patients treated with cetuximab/irinotecan accumulated mean additional costs of £18 901 per patient relative to the comparator arm, with £11 802 attributable to cetuximab. The incremental cost per life-year gained with cetuximab/irinotecan therapy compared with active/best supportive care was £42 975. The incremental cost per quality adjusted life-year gained was £57 608. The incremental cost per life-year gained for cetuximab/irinotecan is relatively high compared with other health-care interventions. However, this result should be considered in the context of a number of factors specific to the treated patient population.

Chronic Cough From the Patient's Perspective

To identify the factors that patients consider most concerning about their cough. All consecutive patients who presented with a complaint of chronic cough between November 1, 2000, and February 28, 2001, were prospectively surveyed for cough-related complaints using an 18-item symptom-complaint questionnaire. We analyzed frequencies of responses and response patterns to specific items on the questionnaire. We also examined whether the responses to individual items related to the patient's age, sex, and duration of cough. Of the 146 consecutive patients referred for evaluation of chronic cough, 136 were eligible for inclusion in the study. These patients cited feelings of frustration, irritability, or anger (43%), frequent physician visits and testing (41%), and sleep disturbances (38%) as the most prevalent major problems. The responses to individual items on the questionnaire were not related to patients' age, sex, and cough duration. Anxiety about underlying serious illness continued to be a concern for most patients. Frustration, anger, or anxiety was the most frequent major problem cited by patients. Frequent physician visits and testing was the unexpected second most frequent major problem. These findings are important because most chronic cough guidelines are based on clinical efficacy and cost-effectiveness considerations rather than on patient satisfaction. Future studies regarding chronic cough evaluation should take into account patient satisfaction and perceived burden of disease as outcome variables.