Costs Of Different Approaches Research Articles

Cost-effectiveness of approaches to cervical cancer screening in Malawi: comparison of frequencies, lesion treatment techniques, and risk-stratified approaches

BackgroundRecently-updated global guidelines for cervical cancer screening incorporated new technologies—most significantly, the inclusion of HPV DNA detection as a primary screening test—but leave many implementation decisions at countries’ discretion. We sought to develop recommendations for Malawi as a test case since it has the second-highest cervical cancer burden globally and high HIV prevalence. We incorporated updated epidemiologic data, the full range of ablation methods recommended, and a more nuanced representation of how HIV status intersects with cervical cancer risk and exposure to screening to model outcomes of different approaches to screening.MethodsUsing a Markov model, we estimate the relative health outcomes and costs of different approaches to cervical cancer screening among Malawian women. The model was parameterized using published data, and focused on comparing “triage” approaches—i.e., lesion treatment (cryotherapy or thermocoagulation) at differing frequencies and varying by HIV status. Health outcomes were quality-adjusted life years (QALYs) and deaths averted. The model was built using TreeAge Pro software.ResultsThermocoagulation was more cost-effective than cryotherapy at all screening frequencies. Screening women once per decade would avert substantially more deaths than screening only once per lifetime, at relatively little additional cost. Moreover, at this frequency, it would be advisable to ensure that all women who screen positive receive treatment (rather than investing in further increases in screening frequency): for a similar gain in QALYs, it would cost more than four times as much to implement once-per-5 years screening with only 50% of women treated versus once-per-decade screening with 100% of women treated. Stratified screening schedules by HIV status was found to be an optimal approach.ConclusionsThese results add new evidence about cost-effective approaches to cervical cancer screening in low-income countries. At relatively infrequent screening intervals, if resources are limited, it would be more cost-effective to invest in scaling up thermocoagulation for treatment before increasing the recommended screening frequency. In Malawi or countries in a similar stage of the HIV epidemic, a stratified approach that prioritizes more frequent screening for women living with HIV may be more cost-effective than population-wide recommendations that are HIV status neutral.

Cost Analysis of Pathways for the U.S. Shipping Fleet to Comply with the IMO 2020 Rule

Since 2020, ocean-going vessels must comply with the International Maritime Organization (IMO) mandate to reduce the sulfur content of marine fuels (outside emission control areas) to no more than 0.5%. This paper analyzes the cost of different approaches for the U.S. fleet, which has special cost considerations because of the Jones Act, to comply with the regulation. We perform a cost analysis for a suite of options for compliance by U.S. shippers, including low-sulfur petroleum-based fuels and alternative fuels (liquefied natural gas [LNG], ammonia, methanol, and ethanol). The cost analysis compares the average annual costs (capital and fuel) out to 2050 of each compliance approach for a representative U.S. tanker and U.S. containership under alternative scenarios with regard to fuel prices, policy, and technology innovation. We also consider the sensitivity of results with respect to vessel age, interest rates, and scrubber fuel efficiency penalties. We find the least costly compliance strategies across future fuel price scenarios and vessel types. The lower-cost compliance pathways typically deliver limited improvement in CO2 emissions which makes them riskier in the context of potential more ambitious emissions targets by IMO. This paper is derived from a technical report (ORNL/SPR-2021/2088) first prepared for the U.S. Maritime Administration.

Towards carbon neutrality in the agri-food sector: Drivers and barriers

Agri-food companies are developing carbon neutral strategies to set long-term targets to reduce carbon emissions while implementing short terms solutions to boost the transition towards a low-carbon agri-food sector. However, the uptake of the carbon neutrality process presents some limitations and difficulties. The paper analyzes the different aspects that characterize the carbon neutrality strategy in the agri-food sector also highlighting both drivers and shortcomings, specifically related to the sector. To better analyze companies' carbon neutrality approaches and to identify the costs of different approaches to carbon neutrality, this paper presents the results of semi-structured interviews with sustainability managers of agri-food companies and consultancy firms that are dealing specifically with the carbon neutrality process. Moreover, a survey was conducted to evaluate the interest of companies in receiving technical assistance, free or subsidized certifications/verifications, and favorable borrowing conditions. Results from this study show how major drivers for agri-food companies are the possibility of saving costs and increasing profit, external pressures, and the possibility of minimizing corporate risks. Moreover, costs related to the carbon neutrality process and companies’ lack of resources and budget has been found as one of the main barriers along with the lack of a strong and robust policy framework and carbon offsetting mistrust. Analyzing costs, time, and complexity of the different phases, the paper shows how the development of internal offsetting/insetting projects is the most complicated for companies, contrary to the acquisition of carbon neutral certifications and labels. Finally, from the survey, we found that financial enabling factors for companies are receiving free or subsidized certifications/verifications and accessing packages of technical assistance, especially for their supply-chain.

775 COST UTILITY ANALYSIS COMPARING DUODENOSCOPE REPROCESSING/STERILIZATION, NOVEL DUODENOSCOPES WITH DISPOSABLE ENDCAPS AND FULLY DISPOSABLE DUODENOSCOPES

Transmission of multi-drug resistant organisms by duodenoscopes used during ERCP is problematical. The FDA (Food & Drug Administration) recently issued a communique recommending transition away from reusable fixed endcap duodenoscopes to those with newer design features that facilitate or eliminate the need for reprocessing. Duodenoscopes with disposable endcap and fully disposable duodenoscopes have now been developed This analysis evaluates the relative cost of different approaches to minimizing infection risk, taking into account the cost associated with duodenoscope-transmitted infection. We developed a Monte Carlo analysis model in R to assess the cost-effectiveness of various approaches: (1) Single High Level Disinfection (HLD), (2) Double HLD, (3) Ethylene oxide (EtO) sterilization, (4) Culture & hold, (5) Duodenoscope with disposable endcap and (6) Disposable duodenoscope. This model utilizes a multi-state trial framework and institutional cost estimates (Table 1). We assumed a triangular distribution with 3 parameters: minimum, maximum and most probable infection rate (MPIR), which vary across the six options. Using these values, we simulated quality adjusted life years (QALY) lost by duodenoscope-transmitted infection and factored this into the average cost for each approach. Our model’s simulated cost for each approach at variable rates of MPIR is depicted in Figure 1. At all rates of infection transmission below 1%, the duodenoscope with disposable endcap was the most cost-effective approach (Figure 1). The fully disposable duodenoscope eliminates the potential for infection transmission and is more cost effective than single/double HLD at all infection transmission rates, more cost effective than EtO for MPIR <0.22%, and more cost effective than culture & hold for MPIR <0.49%. Single and double HLD are the two most costly approaches at all potential infection transmission rates. The next two most costly approaches: EtO and culture & hold, require more duodenoscopes and costly transport/institutional infrastructure. Our model indicates that novel duodenoscopes with a disposable endcap represent the most cost-effective option performing ERCP, with an anticipated very low infection transmission rate and disposable element costing approximately 1/5th that of the fully disposable duodenoscope. Limitations of this model include necessary assumptions and the potential lack of generalizability to lower volume community facilities. These data underscore the importance of cost calculations which account for the potential for infection transmission and associated patient morbidity/mortality associated with each approach. Institution-specific cost analyses will become increasingly relevant as the FDA recommendation for transitioning to duodenoscopes with newer design features gains momentum.Figure 1Simulated cost for each duodenoscope-associated infection minimization approach at variable rates of ‘most probable infection rate.’View Large Image Figure ViewerDownload Hi-res image Download (PPT)

10 Decision analysis modelling of diagnostic strategies for suspected pulmonary embolism in pregnancy: the DiPEP economic evaluation

BackgroundUsing diagnostic imaging for suspected pulmonary embolism (PE) in pregnancy involves weighing the benefits, harms and costs of different approaches to selecting women for imaging.ObjectivesTo estimate the effectiveness of diagnostic...

Mapping the benefit-cost ratios of interventions against bovine trypanosomosis in Eastern Africa

This study builds upon earlier work mapping the potential benefits from bovine trypanosomosis control and analysing the costs of different approaches. Updated costs were derived for five intervention techniques: trypanocides, targets, insecticide-treated cattle, aerial spraying and the release of sterile males. Two strategies were considered: continuous control and elimination. For mapping the costs, cattle densities, environmental constraints, and the presence of savannah or riverine tsetse species were taken into account. These were combined with maps of potential benefits to produce maps of benefit-cost ratios.The results illustrate a diverse picture, and they clearly indicate that no single technique or strategy is universally profitable. For control using trypanocide prophylaxis, returns are modest, even without accounting for the risk of drug resistance but, in areas of low cattle densities, this is the only approach that yields a positive return. Where cattle densities are sufficient to support it, the use of insecticide-treated cattle stands out as the most consistently profitable technique, widely achieving benefit-cost ratios above 5. In parts of the high-potential areas such as the mixed farming, high-oxen-use zones of western Ethiopia, the fertile crescent north of Lake Victoria and the dairy production areas in western and central Kenya, all tsetse control strategies achieve benefit-cost ratios from 2 to over 15, and for elimination strategies, ratios from 5 to over 20. By contrast, in some areas, notably where cattle densities are below 20per km2, the costs of interventions against tsetse match or even outweigh the benefits, especially for control scenarios using aerial spraying or the deployment of targets where both savannah and riverine flies are present. If the burden of human African trypanosomosis were factored in, the benefit-cost ratios of some of the low-return areas would be considerably increased.Comparatively, elimination strategies give rise to higher benefit-cost ratios than do those for continuous control. However, the costs calculated for elimination assume problem-free, large scale operations, and they rest on the outputs of entomological models that are difficult to validate in the field. Experience indicates that the conditions underlying successful and sustained elimination campaigns are seldom met.By choosing the most appropriate thresholds for benefit-cost ratios, decision-makers and planners can use the maps to define strategies, assist in prioritising areas for intervention, and help choose among intervention techniques and approaches. The methodology would have wider applicability in analysing other disease constraints with a strong spatial component.

Addressing gender inequality and intimate partner violence as critical barriers to an effective HIV response in sub-Saharan Africa.

IntroductionIn Africa, women and girls represent 57% of people living with HIV, with gender inequality and violence being an important structural determinant of their vulnerability. This commentary draws out lessons for a more effective combination response to the HIV epidemic from three papers recently published in JIAS.DiscussionHatcher and colleagues present qualitative data from women attending ante-natal clinics in Johannesburg, describing how HIV diagnosis during pregnancy and subsequent partner disclosure are common triggers for violence within relationships. The authors describe the challenges women face in adhering to medication or using services. Kyegombe and colleagues present a secondary analysis of a randomized controlled trial in Uganda of SASA! – a community violence prevention programme. Along with promising community impacts on physical partner violence, significantly lower levels of sexual concurrency, condom use and HIV testing were reported by men in intervention communities. Remme and her colleagues present a systematic review of evidence on the costs and cost-effectiveness of gender-responsive HIV interventions. The review identified an ever-growing evidence base, but a paucity of accompanying economic analyses, making it difficult to assess the costs or value for money of gender-focused programmes.ConclusionsThere is a need to continue to accumulate evidence on the effectiveness and costs of different approaches to addressing gender inequality and violence as part of a combination HIV response. A clearer HIV-specific and broader synergistic vision of financing and programming needs to be developed, to ensure that the potential synergies between HIV-specific and broader gender-focused development investments can be used to best effect to address vulnerability of women and girls to both violence and HIV.

Regulatory Experience in the US and Its Lessons for European Banking Union

The regulatory system has taken 150 years to develop in the US. Even today it is far from unified with four supervisory agencies overseeing banking organizations, i.e., 50 State Regulatory bodies, the OCC, the FDIC and the Federal Reserve, with a wide variety of individual and often overlapping powers such as in examination and supervision. The Euro-zone is at the very start of what will be a long and difficult process and whether unification is achievable across such a diverse set of economies with competing local supervisors and diverse bankruptcy laws remains to be seen. Nevertheless, the US is a useful laboratory to examine the benefits and costs of different approaches to the three legs of European bank union, i.e., supervision, deposit insurance and restructuring/resolution.

Navigation roles support chronically ill older adults through healthcare transitions: a systematic review of the literature

Transitions between various healthcare services are potential points for fragmented care and can be confusing and complicated for patients, formal and informal caregivers. These challenges are compounded for older adults with chronic disease, as they receive care from many providers in multiple care settings. System navigation has been suggested as an innovative strategy to address these challenges. While a number of navigation models have been developed, there is a lack of consensus on the desired characteristics and effectiveness of this role. We conducted a systematic literature review to describe existing navigator models relevant to chronic disease management for older adults and to investigate the potential impact of each model. Relevant literature was identified using five electronic databases - Medline, CINAHL, the Cochrane database, Embase and PsycINFO between January 1999 and April 2011. Following a recommended process for health services research literature reviews, exclusion and inclusion criteria were applied to retrieved articles; 15 articles documenting nine discrete studies were selected. This review suggests that the role of a navigator for the chronically ill older person is a relatively new one. It provides some evidence that integrated and coordinated care guided by a navigator, using a variety of interventions such as care plans and treatment goals, is beneficial for chronically ill older adults transitioning across care settings. There is a need to further clarify and standardise the definition of navigation, as well as a need for additional research to assess the effectiveness and cost of different approaches to the health system.

Safe Motherhood Case Studies: Learning from South Asia

Safe Motherhood Case Studies: Learning from South Asia

Invited commentary

Invited commentary

Lower extremity endovascular interventions: Can we improve cost-efficiency?

Management of lower extremity arterial disease with endovascular intervention is on the rise. Current practice patterns vary widely across and within specialty practices that perform endovascular intervention. This study evaluated reimbursement and costs of different approaches for offering endovascular intervention and identified strategies to improve cost-efficiency. The medical records of all patients admitted to a university health system during 2005 for an endovascular intervention were retrospectively reviewed. Procedure type, setting, admission status, and financial data were recorded. Groups were compared using analysis of variance, Student t test for independent samples, and chi2. A total of 296 endovascular interventions were completed, and 184 (62%) met inclusion criteria. Atherectomy and stenting were significantly more costly when performed in the operating room than in the radiology suite: atherectomy, dollars 6596 vs dollars 4867 (P = .002); stent, dollars 5884 vs dollars 3292, (P < .001); angioplasty, dollars 2251 vs dollars 1881 (P = .46). Reimbursement was significantly higher for inpatient vs ambulatory admissions (P < .001). Costs were lowest when the endovascular intervention was done in the radiology suite on an ambulatory basis and highest when done as an inpatient in the operating room (dollars 5714 vs dollars 12,278; P < .001). Contribution margins were significantly higher for inpatients. Net profit was appreciated only for interventions done as an inpatient in the radiology suite. Reimbursement, contribution margins, and net profit were significantly lower among private pay patients in both the ambulatory and inpatient setting. The 30-day hospital readmission after ambulatory procedures was seven patients (6%). Practice patterns for endovascular interventions differ considerably. Costs vary by procedure and setting, and reimbursement depends on admission status and accurate documentation; these dynamics affect affordability. Organizing vascular services within a hub will ensure that care is delivered in the most cost-efficient manner. Guidelines may include designating the radiology suite as the primary venue for endovascular interventions because it is less costly than the operating room. Selective stenting policies should be considered. Contracts with private insurers must include carve-outs for stent costs and commensurate reimbursement for ambulatory procedures, and Current Procedural Terminology (CPT; American Medical Association, Chicago, Ill) coding must be proficient to make ambulatory endovascular interventions fiscally acceptable.

Survey of the Perceived Benefits and Shortcomings of a Specialist Tinnitus Clinic: Cuestionario sobre las ventajasy desventajas de una clinica especializada en tinnitus

Questions about the clinical effectiveness of tinnitus services are of considerable interest to health professionals and health care providers alike in view of the chronic nature of tinnitus, the diversity of tinnitus-related problems, and the range of costs of different approaches to the clinical management of tinnitus. This study sought to identify the views of patients with tinnitus, who attended a specialist tinnitus clinic in Wales, about their satisfaction with that service. One hundred and forty-eight patients returned an open-ended mail-out questionnaire that asked them to list the perceived benefits and shortcomings of attendance at the specialist clinic. The respondents were classified as current or very recent attenders (43 per cent) and those who had first attended between 18 to 60 months earlier (57 per cent). Respondents cited an average of 2.8 benefits compared to only 0.8 perceived shortcomings per respondent. Major areas of perceived benefit included technical assistance, in the form of h...

The pursuit of quality in Hong Kong construction

Construction organizations have responded in different ways to the increasing demands for quality. An interim assessment of the benefits and costs of different approaches is useful in determining future directions for organizations that have already, or are about to, set up construction quality management systems. Evidence from a series of surveys in Hong Kong indicates that long term strategies are needed, for example targeting ‘total quality management’ or comprehensive quality management systems, with ISO 9000 certification being only one step along this route. Specific issues to be addressed are identified, such as the development of construction‐specific guidelines and the integration of safety and dispute avoidance systems in a comprehensive quality management system. A framework is also proposed to assist in selecting the optimal quality management route for a given construction organization. Lessons learned from Hong Kong and elsewhere can be incorporated in this framework, and will help separate rhetoric from reality in rationalizing the quality management strategies of construction organizations.

Comparing the effectiveness and costs of different approaches for educating primary school teachers in Sri Lanka

The effectiveness and costs of three approaches to elementary teacher education in Sri Lanka — preservice, conventional inservice, and distance inservice — are examined. The effectiveness of these approaches was measured by teachers' theoretical and applied knowledge, classroom performance, and pupil achievement. Costs borne by the sponsoring institution and the teachers were evaluated. Although distance education was the most cost-effective of the approaches, graduates of colleges of education were significantly effective in producing high achievement in their pupils in mathematics and language. This finding is particularly important given the more difficult teaching situations in which they taught.

Vocal Teachers, Silent Pupils? Life in Botswana Classrooms

Considerable evidence is now available on the human and material inputs that more likely boost pupil achievement in the Third World. Not surprisingly, those factors central to the instructional process-textbooks, exercise books, and teacher literacy levels-are consistently related to children's achievement. Peripheral symbols of quality, including variation in teacher salaries and the character of school facilities, are related less to achievement.'

Is Primary School Quality Eroding in the Third World?

Previous articleNext article No AccessFocus on the Third WorldIs Primary School Quality Eroding in the Third World?Bruce FullerBruce Fuller Search for more articles by this author PDFPDF PLUS Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by Comparative Education Review Volume 30, Number 4Nov., 1986 Sponsored by the Comparative and International Education Society Article DOIhttps://doi.org/10.1086/446632 Views: 6Total views on this site Citations: 21Citations are reported from Crossref Copyright 1986 The Comparative and International Education SocietyPDF download Crossref reports the following articles citing this article:Carlos Giovanni González Espitia, Hector Ochoa Diaz, and Nathalia Solano Castillo Understanding the Spatial and Temporal Effect of Economic Activity on the Quality of Education: Evidence from Colombia, Comparative Education Review 64, no.44 (Oct 2020): 642–669.https://doi.org/10.1086/710765Marwa Biltagy Quality of Education, Earnings and Demand Function for Schooling in Egypt: An Economic Analysis, Procedia - Social and Behavioral Sciences 69 (Dec 2012): 1741–1750.https://doi.org/10.1016/j.sbspro.2012.12.123Valerie E. Lee and Tia Linda Zuze School Resources and Academic Performance in Sub-Saharan Africa, Comparative Education Review 55, no.33 (Jul 2015): 369–397.https://doi.org/10.1086/660157Tom G. Griffiths, Lisa Knezevic Wallerstein’s world-systems analysis in comparative education: A case study, PROSPECTS 40, no.44 (Nov 2010): 447–463.https://doi.org/10.1007/s11125-010-9168-0Amita Chudgar, M. Najeeb Shafiq Family, community, and educational outcomes in South Asia, PROSPECTS 40, no.44 (Nov 2010): 517–534.https://doi.org/10.1007/s11125-010-9169-zTirth Khaniya, James H Williams Necessary but not sufficient: challenges to (implicit) theories of educational change: reform in Nepal’s primary education system, International Journal of Educational Development 24, no.33 (May 2004): 315–328.https://doi.org/10.1016/j.ijedudev.2004.01.005M.T. Tatto The value and feasibility of evaluation research on teacher development: contrasting experiences in Sri Lanka and Mexico, International Journal of Educational Development 22, no.66 (Nov 2002): 637–657.https://doi.org/10.1016/S0738-0593(01)00032-3Michelle Griffiths Learning for All? Interrogating children's experiences of primary schooling in Mauritius, Teaching and Teacher Education 16, no.77 (Oct 2000): 785–800.https://doi.org/10.1016/S0742-051X(00)00025-1 Bibliography, (Jan 2010).https://doi.org/10.4324/9780203055519.bmattMaria Teresa Tatto Reconstructing teacher education for disadvantaged communities, International Journal of Educational Development 17, no.44 (Oct 1997): 405–415.https://doi.org/10.1016/S0738-0593(97)00010-2P.T.M Marope The impact of educational policy reforms on the distribution of educational outcomes in developing countries: The case of Botswana, International Journal of Educational Development 16, no.22 (Apr 1996): 157–171.https://doi.org/10.1016/0738-0593(95)00039-9Kingsley Banya Quality in an Integrated Rural Development Program: the Sierra Leone experience, Assessment & Evaluation in Higher Education 20, no.22 (Aug 1995): 213–224.https://doi.org/10.1080/02602939508565722Mzobanzi M. Mboya, Tuntufye S. Mwamwenda Quality education in black schools of South Africa, International Journal of Educational Development 14, no.44 (Oct 1994): 385–391.https://doi.org/10.1016/0738-0593(94)90050-7Kathleen S. Gorman, Ernesto Pollitt Determinants of School Performance in Guatemala: Family Background Characteristics and Early Abilities, International Journal of Behavioral Development 16, no.11 (Jun 2016): 75–91.https://doi.org/10.1177/016502549301600105Maria Teresa Tatto, H.Dean Nielsen, William Cummings, N.G. Kularatna, K.H. Dharmadasa Comparing the effectiveness and costs of different approaches for educating primary school teachers in Sri Lanka, Teaching and Teacher Education 9, no.11 (Feb 1993): 41–64.https://doi.org/10.1016/0742-051X(93)90014-8John Oxenham, Jocelyn DeJong, Steven Treagust Improving the Quality of Education in Developing Countries, (Jan 1990): 101–127.https://doi.org/10.1007/978-1-349-21136-4_6Bruce Fuller, Stephen P. Heyneman Third World School Quality, Educational Researcher 18, no.22 (Jul 2016): 12–19.https://doi.org/10.3102/0013189X018002012T.Paul Sciiultz Expansion of public school expenditures and enrollments: Intercountry evidence on the effects of income, prices, and population growth, Economics of Education Review 7, no.22 (Jan 1988): 167–183.https://doi.org/10.1016/0272-7757(88)90042-8T. Paul Schultz Chapter 13 Education investments and returns, (Jan 1988): 543–630.https://doi.org/10.1016/S1573-4471(88)01016-2Kathleen S. Gorman, Susan D. Holloway, Bruce Fuller Pre‐school Quality in Mexico: variation in teachers, organisation and child activities, Comparative Education 24, no.11 (Jan 1988): 91–101.https://doi.org/10.1080/0305006880240108Bruce Fuller What School Factors Raise Achievement in the Third World?, Review of Educational Research 57, no.33 (Jun 2016): 255–292.https://doi.org/10.3102/00346543057003255

Ethics, Justice, and Medical Care Systems

As medical costs mount and as government as sumes increasing responsibility for financing, explicit forms of medical care rationing are likely to be introduced. This paper considers the benefits and costs of different approaches to rationing and their implications for a just medical care system. Rationing may be imposed through financial barriers for the patient in the form of coinsurance and deductibles or in limitations on the funds, facilities, and services made available to the population. It is argued that imposing barriers to access on the theory that consumers are in a good position to make necessary differentiations places the burden of ra tioning on the patient who is least able to make the decision rationally, and places the poor, who have the least medical knowledge and background, in particular jeopardy. Other al ternatives include either the introduction of fixed budgets that require professionals to establish priorities or adminis trative decisions that prescribe the facilities and types of serv ices made available to varying population groups. Rationing techniques have different behavioral and ethical implications, and existing research indicates that the consequences of some rationing approaches are inconsistent with theoretical as sumptions.