Economic Simulation Model Research Articles

The Use of Cost-Effectiveness Analysis in Sickle Cell Disease: A Critical Review of the Literature.

Novel interventions for sickle cell disease (SCD) bring hope to patients, yet concern about the associated economic costs exists. Cost-effectiveness analysis (CEA) uses standardized methods, with robust underpinnings in health economics, to estimate the value of these interventions compared with usual care. However, because of the complexity and lifetime trajectory of SCD, CEAs are challenging to conduct. The objectives of this rapid review were to summarize the main characteristics, components, and results of published CEAs of existing interventions for SCD, identify research gaps, and provide directions for future analyses. We identified records through searches of bibliographic databases, from reference lists of relevant review articles, and through consultation with experts. A total of 13 CEAs met our inclusion criteria and were qualitatively synthesized. These evaluated blood transfusions (n = 2), hematopoietic stem cell transplantation (n = 1), pharmaceuticals (n = 2), hypothetical cell or genetic therapy (n = 1), screening programs (n = 4), and interventions for SCD treatment complications (n = 3). A limited number of potential SCD and treatment complications were evaluated. No study adopted a societal perspective in the base case, six studies examined lifetime cost-effectiveness, seven studies employed a Markov or discrete-event simulation model, and eight studies used an outcome metric that captured both quality and length of life. To better compare the value of emerging and current therapies, future CEAs should adopt a societal perspective incorporating both medical and nonmedical costs, comprehensively model SCD complexity using robust health economic simulation models over the patient's entire lifespan, and capture the intervention's effect on both survival and quality of life.

ECONOMIC-FISHING ANALYSIS OF THE PRAWN <i>Cryphiops caementarius</i> (MOLINA, 1782) IN THE MAJES-CAMANÁ RIVER AREQUIPA-PERí­Å¡ (2019)

The prawn (Cryphiops caementarius) is the only resource in the Peruvian coastal rivers that supports a commercial fishery. Bioeconomic-fishing aspects are reported based on data (fishing, costs and income derived from fishing) acquired in situ monthly in four altitudinal strata (every 200 meters above sea level - masl) of the Majes-Camaná river during 2019. The catch per unit of effort (CPUE) was expressed in kg h-1, monthly income was estimated based on the average catch values, number of tasks and price of the resource. To evaluate the profitability of the activity of an average fisherman (by stratum), a cash flow based on income and expenses was executed under situations with a constant future, using economic profitability indicators such as the Net Present Value (NPV), Internal Rate of Return (IRR), Benefit-Cost ratio (B/C) and Discounted Payback Period (DPB). There was a predominance of the diving method, the catches (kg) and the fishing yield increased throughout the fishing period (April-December) with a maximum value of 4.8 kg h-1 (December - high strata). Investment costs per fisherman were low, roughly 1,000 soles. The sale price increases with altitude, decreasing over the course of the year depending on the availability of the resource; the monthly income per fisherman varied from 964 soles (April - low stratum) to 6,760 soles (December - high stratum). The economic simulation model showed that the income exceeded the costs of the fishing activity from the first year of activity in all the altitudinal strata, the economic profitability indicators showed high profitability for the activity.

Adjusting Nitrogen Rates with Split Applications: Modelled Effects on N Losses and Profits Across Weather Scenarios

The frequency and timing of nitrogen (N) application on corn strongly influences environmental N losses and yield, particularly in different weather. Split N application is a 4R (Right Source, Right Rate, Right Time, Right Place) nutrient management practice that ensures sufficient N supply when the crop needs it most, minimizing N losses to the environment, while allowing N rate adaptations as the season evolves. The purpose of this study is to investigate the agronomic, environmental, and economic performance of split N application on corn compared to traditional pre-plant broadcast methods under alternative timings, weather scenarios and N rates at Elora, Ontario, using biophysical and economic simulation models. The modelled results show that split N application with rate adjustments may increase profit between 14.6% and 19.5% in dry conditions and between 1.4% and 15.7% in wet conditions, while lowering environmental NO3- leaching, N2O emissions and NH3 volatilization losses in most weather. However, only in dry weather does the profit maximizing split N application strategy maximize environmental benefits, giving rise to the potential for government policy to address this trade-off between economic pursuits and environmental goals.

Flexibility of joint production in mixed fisheries and implications for management

Abstract Over the past decade, efforts have been made to factor technical interactions into management recommendations for mixed fisheries. Yet, the dynamics underlying joint production in mixed fisheries are generally poorly captured in operational mixed fisheries models supporting total allowable catch advice. Using an integrated ecological–economic simulation model, we explore the extent to which fishers are likely to alter the species composition of their landings in a mixed fishery managed with individual transferable quotas, the Australian Southern and Eastern Scalefish and Shark Fishery. Our simulations capture three different types of joint production problems, highlighting the flexibility that exists in terms of achievable catch compositions when quota markets provide the economic incentives to adapt fishing practices to quota availability. These results highlight the importance of capturing the drivers of fishing choices when advising TAC decisions in mixed fisheries. We also identify a hierarchy of species in this fishery, with harvest targets set for primary commercial species determining most of its socio-economic performance.

Beyond ratios - flexible and resilient nurse staffing options to deliver cost-effective hospital care and address staff shortages: A simulation and economic modelling study

BackgroundIn the face of pressure to contain costs and make best use of scarce nurses, flexible staff deployment (floating staff between units and temporary hires) guided by a patient classification system may appear an efficient approach to meeting variable demand for care in hospitals. ObjectivesWe modelled the cost-effectiveness of different approaches to planning baseline numbers of nurses to roster on general medical/surgical units while using flexible staff to respond to fluctuating demand. Design and settingWe developed an agent-based simulation, where hospital inpatient units move between being understaffed, adequately staffed or overstaffed as staff supply and demand (as measured by the Safer Nursing Care Tool patient classification system) varies. Staffing shortfalls are addressed by floating staff from overstaffed units or hiring temporary staff. We compared a standard staffing plan (baseline rosters set to match average demand) with a higher baseline ‘resilient’ plan set to match higher than average demand, and a low baseline ‘flexible’ plan. We varied assumptions about temporary staff availability and estimated the effect of unresolved low staffing on length of stay and death, calculating cost per life saved. ResultsStaffing plans with higher baseline rosters led to higher costs but improved outcomes. Cost savings from lower baseline staff mainly arose because shifts were left understaffed and much of the staff cost saving was offset by costs from longer patient stays. With limited temporary staff available, changing from low baseline flexible plan to the standard plan cost £13,117 per life saved and changing from the standard plan to the higher baseline ‘resilient’ plan cost £8,653 per life saved.Although adverse outcomes from low baseline staffing reduced when more temporary staff were available, higher baselines were even more cost-effective because the saving on staff costs also reduced. With unlimited temporary staff, changing from low baseline plan to the standard cost £4,520 per life saved and changing from the standard plan to the higher baseline cost £3,693 per life saved. ConclusionShift-by-shift measurement of patient demand can guide flexible staff deployment, but the baseline number of staff rostered must be sufficient. Higher baseline rosters are more resilient in the face of variation and appear cost-effective. Staffing plans that minimise the number of nurses rostered in advance are likely to harm patients because temporary staff may not be available at short notice. Such plans, which rely heavily on flexible deployments, do not represent an efficient or effective use of nurses.Study registration: ISRCTN 12307968Tweetable abstract: Economic simulation model of hospital units shows low baseline staff levels with high use of flexible staff are not cost-effective and don't solve nursing shortages.

Cost-efficiency and expanded access modeling of conversion to biosimilar trastuzumab-dkst with or without pertuzumab in metastatic breast cancer

Aims To investigate the cost-efficiency and budget-neutral expanded access of biosimilar intravenous trastuzumab-dkst versus reference intravenous (trastuzumab-IV) and subcutaneous trastuzumab (trastuzumab-SC) (with/without pertuzumab) in metastatic breast cancer (MBC). Methods Economic simulation modeling in a panel of 1,000 MBC patients to estimate: 1) cost-savings by conversion from trastuzumab-IV or trastuzumab-SC to trastuzumab-dkst at 10-100% conversion rates in 3 weight groups: first quartile (Q1:62.2 kg), median (73.1 kg), third quartile (Q3:88.6 kg), and 2) budget-neutral expanded access to trastuzumab-dkst from cost-savings. Results In monotherapy, conversion (%) from trastuzumab-IV generates one-year cost-savings from $2,272,189 (Q1;10%) to $31,506,804 (Q3;100%) and from trastuzumab-SC monotherapy savings range from $2,071,277 (Q3;10%) to $35,775,475 (Q1;100%). In combination with pertuzumab, trastuzumab-dkst is cost-efficient in all patient weights with one-year savings over trastuzumab-IV up to $32,662,714 (Q3;100%) and over trastuzumab-SC up to $35,322,461 (Q1;100%). Savings from conversion from trastuzumab-IV monotherapy could provide between 3,087 (Q1;10%) and 30,911 (Q3;100%) additional trastuzumab-dkst doses—enough to treat 58 to 583 patients for one year. Conversion from trastuzumab-SC monotherapy could provide between 1,559 (Q3;10%) and 48,598 (Q1;100%) additional trastuzumab-dkst doses or 38 to 918 additional one-year treatments with trastuzumab-dkst. In combination with pertuzumab, conversion from trastuzumab-IV could provide from 311 (Q1;10%) to 3,939 (Q3;100%) maintenance doses (pertuzumab + trastuzumab-dkst) or 17 to 210 additional one-year regimens (all agents). Savings from conversion from trastuzumab-SC could expand access to 226 (Q3;10%) to 4,782 (Q1;100%) additional maintenance doses or 12 to 254 one-year regimens. Conclusions This first cost-efficiency and expanded access study of biosimilar therapeutic cancer agents shows that trastuzumab-dkst is cost-efficient over trastuzumab-IV and trastuzumab-SC across all patient weights in both monotherapy and combination with pertuzumab and paclitaxel. These cost savings could provide more patients with trastuzumab-dkst treatment on a budget-neutral basis.

Economic and environmental consequences of nitrogen application rates, timing and methods on corn in Ontario

Large scale adoption of nitrogen (N) management practices, including the 4Rs, could lead to beneficial environmental and economic outcomes, but only if they improve agricultural profit or are driven by policy and legislation. This study uses a spatial economic maximization and environmental simulation model to examine the economic and environmental tradeoffs of adopting three different 4R practices, specifically N rate reduction, timing (sidedress versus at-planting) and placement methods (broadcast versus injection) in Ontario corn production, under alternative annual weather conditions. The study shows that the use of optimized agronomic, based on meeting crop N requirements specific to each fertilizer management practice, rather than historic, N application increases annual average Ontario-wide farm profit from $124 million to $173 million (39.5%), decreases N application from 122 to 97 kt (20.5%), decreases nitrous oxide (N2O) emissions from 3.4 to 2.4 kt (29.4%), decreases ammonia (NH3) volatilization from 12.4 to 1.2 kt (90.3%) and decreases nitrate (NO3−) leaching from 47 to 13 kt (72.3%), over 30-years of weather data. Injection and sidedress appear to be more N use efficient than broadcast, with sidedress becoming increasingly important as N prices and constraints increase. N2O emissions appear to be more difficult to mitigate compared to NH3 emissions and NO3− leaching. Regarding the 4Rs, right placement and right timing play a role under specific spatial conditions, while right rate appears to be the most effective means to mitigate the environmental impacts of corn N application and may be mutually beneficial to farmers and society.

Discrete-event simulation and agent-based modeling in the tasks of the school informatics course

In order to study processes and phenomena, it is necessary to create their models. The most interesting and valuable for the analysis of current situations are models that describe processes as if they were happening in reality. These are the so-called simulation models. The scope of application of simulation models is extensive. The most in demand are economic, sociological and biological simulation models. The relevance of simulation is obvious, and it is natural that the theme of simulation is present in the content of the school informatics course. The article provides guidelines for studying the basics of modeling in a school informatics course related to the creation and research of discrete-event and agent-based simulation models. Examples of tasks recommended for consideration in the 9–11th grades at informatics lessons or in extracurricular activities are given, these are task based on the information-cybernetic approach, implemented in the PascalABC environment, and the task using a cellular automaton, implemented in the Cellular environment.

Cost-Utility of Dialysis in Canada: Hemodialysis, Peritoneal Dialysis, and Nondialysis Treatment of Kidney Failure

Rationale & ObjectiveThe kidney failure population is growing, necessitating the expansion of dialysis programs. These programs are costly and require a substantial amount of health care resources. Tools that accurately forecast resource use can aid efficient allocation. The objective of this study is to describe the development of an economic simulation model that incorporates treatment history and detailed modality transitions for patients with kidney disease using real-world data to estimate associated costs, utility, and survival by initiating modality.Study DesignCost-utility model with microsimulation.Setting & PopulationAdult incident maintenance dialysis patients in Canada who initiated facility-based hemodialysis (HD) or home peritoneal dialysis (PD) between 2004 and 2013.InterventionHD and PD.OutcomesCosts (related to dialysis, transplantation, infections, and hospitalizations), survival, utility, and dialysis modality mix over time.Model, Perspective, & TimeframeThe model took the perspective of the health care payer. Patients were followed up for 10 years from initiation of dialysis. Our cost-utility analysis compared the intervention with receiving no treatment.ResultsDuring a 10-year time horizon, the cost-utility ratio for all patients initiating dialysis was $103,779 per quality-adjusted life-year (QALY) in comparison to no treatment. Patients who initiated with facility-based HD were treated at a cost-utility ratio of $104,880/QALY and patients who initiated with home PD were treated at a cost-utility ratio of $83,762/QALY. During this time horizon, the total mean cost and QALYs per patient were estimated at $350,774 ± $204,704 and 3.38 ± 2.05) QALYs respectively.LimitationsThe results do not include costs from the societal perspective. Rare patient trajectories were unable to be assessed.ConclusionsThis model demonstrates that patients who initiated dialysis with PD were treated more cost-effectively than those who initiated with HD during a 10-year time horizon.

Long-term Healthcare Expenditures Over Time for Tissue and Mechanical Aortic Valve Replacement

Guidelines currently indicate the use of surgical aortic valve replacement (SAVR) to treat severe cases of aortic stenosis, particularly for low- to medium-risk patients. Although several studies have compared health outcomes of tissue and mechanical SAVR, this economic simulation model estimates the difference in long-term healthcare costs associated with tissue relative to mechanical SAVR. The deterministic and Monte Carlo simulation models used literature-based epidemiologic and cost inputs to calculate annual expenditures related to SAVR for up to 25 years after initial surgery. A series of 3 cohort studies across different age groups provided the health outcome probabilities for tissue valve patients. Outcome probabilities for mechanical valve patients were based on relative risks reported in comparative meta-analyses or large cohort studies. Relative to mechanical SAVR the expected net discounted savings for a patient receiving tissue SAVR at ages 45, 55, and 65 years were $12,266, $15,462, and $16,008, respectively (based on 2018 US dollars) over a 25-year horizon (95% confidence intervals exceed $0). For a 45-year-old tissue SAVR patient, the estimated per-patient cost difference (relative to mechanical SAVR) of reoperation over 25 years ($16,201) were offset by expected savings on anticoagulation monitoring ($26,257) over the same period. In a sensitivity analysis in which mortality risk was assumed equal, significant long-term savings associated with tissue SAVR still accrued in each of the 3 age cohorts. Payers, providers, and the healthcare system may financially benefit from the use of tissue valves because significant savings were associated with the use of tissue valves relative to mechanical valves for SAVR.

VA Antibiotic Stewardship Intervention to Improve Outpatient Antibiotic Use for ARIs: A Cost-Effectiveness Analysis

Background: The Core Elements of Outpatient Antibiotic Stewardship provide a framework to improve antibiotic use, but cost-effectiveness data on interventions to improve antibiotic use are limited. Beginning in September 2017, an antibiotic stewardship intervention was launched in within 10 outpatient Veterans Healthcare Administration clinics. The intervention was based on the Core Elements and used an academic detailing (AD) and an audit and feedback (AF) approach to encourage appropriate use of antibiotics. The objective of this analysis was to evaluate the cost-effectiveness of the intervention among patients with uncomplicated acute respiratory tract infections (ARI). Methods: We developed an economic simulation model from the VA’s perspective for patients presenting for an index outpatient clinic visit with an ARI (Fig. 1). Effectiveness was measured as quality-adjusted life-years (QALYs). Cost and utility parameters for antibiotic treatment, adverse drug reactions (ADRs), and healthcare utilization were obtained from the published literature. Probability parameters for antibiotic treatment, appropriateness of treatment, antibiotic ADRs, hospitalization, and return ARI visits were estimated using VA Corporate Data Warehouse data from a total of 22,137 patients in the 10 clinics during 2014–2019 before and after the intervention. Detailed cost data on the development of the AD and AF materials and electronically captured time and effort for the National AD Service activities by specific providers from a national ARI campaign were used as a proxy for the cost estimate of similar activities conducted in this intervention. We performed 1-way and probabilistic sensitivity analyses (PSAs) using 10,000 second-order Monte Carlo simulations on costs and utility values using their means and standard deviations. Results: The proportion of uncomplicated ARI visits with antibiotics prescribed (59% vs 40%) was lower and appropriate treatment was higher (24% vs 32%) after the intervention. The intervention was estimated to cost $110,846 (2018 USD) over a 2-year period. Compared to no intervention, the intervention had lower mean costs ($880 vs $517) and higher mean QALYs (0.837 vs 0.863) per patient because of reduced inappropriate treatment, ADRs, and subsequent healthcare utilization, including hospitalization. In threshold analyses, the antibiotic stewardship strategy was no longer dominant if intervention cost was >$64,415,000 or the number of patients cared for was <3,672. In the PSA, the antibiotic stewardship intervention was dominant in 100% of the 10,000 Monte Carlo iterations (Fig. 2). Conclusions: In every scenario, the VA outpatient AD and AF antibiotic stewardship intervention was a dominant strategy compared to no intervention.Funding: NoneDisclosures: None

Cost of care for persons with dementia: using a discrete-time Markov chain approach with administrative and clinical data from the dementia service Centres in Austria

BackgroundThere is growing evidence that the cost for dementia care will increase rapidly in the coming years. Therefore, the objective of this paper was to determine the economic impact of treating clients with dementia in outpatient Dementia Service Centres (DSCs) and simulate the cost progression with real clinical and cost data.MethodsTo estimate the cost for dementia care, real administrative and clinical data from 1341 clients of the DSCs were used to approximate the total cost of non-pharmaceutical treatment and simulate the cost progression with a discrete-time Markov chain (DTMC) model. The economic simulation model takes severity and progression of dementia into account to display the cost development over a period of up to ten years.ResultsBased on the administrative data, the total cost for treating these 1341 clients of the DSCs came to 67,294,910 EUR in the first year. From these costs, 74% occurred as indirect costs. Within a five-year period, these costs will increase by 7.1-fold (16.2-fold over 10 years). Further, the DTMC shows that the greatest share of the cost increase derives from the sharp increase of people with severe dementia and that the cost of severe dementia prevails the cost in later periods.ConclusionThe DTMC model has shown that the cost increase of dementia care is mostly driven by the indirect cost and the increase of severity of dementia within any given year. The DTMC reveals also that the cost for mild dementia will decrease steadily over the time period of the simulation, whereas the cost for severe dementia increases sharply after running the simulation for 3 years.

Economic evaluation of the Melbourne Mobile Stroke Unit.

The Melbourne Mobile Stroke Unit (MSU) is the first Australian service to provide prehospital acute stroke treatment, including thrombolysis and facilitated triage for endovascular thrombectomy. To estimate the cost-effectiveness of the MSU during the first full year of operation compared with standard ambulance and hospital stroke care pathways (standard care). The costs and benefits of the Melbourne MSU were estimated using an economic simulation model. Operational costs and service utilization data were obtained from the MSU financial and patient tracking reports. The health benefits were estimated as disability-adjusted life years (DALYs) avoided using local data on reperfusion therapy and estimates from the published literature on their effectiveness. Costs were presented in Australian dollars. The robustness of results was assessed using multivariable (model inputs varied simultaneously: 10,000 Monte Carlo iterations) and various one-way sensitivity analyses. In 2018, the MSU was dispatched to 1244 patients during 200 days of operation. Overall, 167 patients were diagnosed with acute ischemic stroke, and 58 received thrombolysis, endovascular thrombectomy, or both. We estimated 27.94 DALYs avoided with earlier access to endovascular thrombectomy (95% confidence interval (CI) 15.30 to 35.93) and 16.90 DALYs avoided with improvements in access to thrombolysis (95% CI 9.05 to 24.68). The MSU was estimated to cost an additional $30,982 per DALY avoided (95% CI $21,142 to $47,517) compared to standard care. There is evidence that the introduction of MSU is cost-effective when compared with standard care due to earlier provision of reperfusion therapies.

1158-P: Cost-Effectiveness of Empagliflozin vs. Liraglutide as Second-Line Therapy for Type 2 Diabetes in the United States

Background: The ADA’s “Standards of Medical Care in Diabetes” recommends use of an SGLT2 inhibitor or GLP-1 receptor agonist as one of the six drug classes after metformin (MET) in T2D patients. These therapies are preferred among T2D patients with cardiovascular disease (CVD) based on clinical trial results demonstrating significant improvement in clinical outcomes. We sought to examine the economic implications of sequential use of these therapies. Methods: An economic simulation model evaluating treatment in U.S. T2D patients after MET with empagliflozin (EMPA) as 2nd line and liraglutide (LIRA) as 3rd line vs. LIRA as 2nd line and EMPA as 3rd line was used to estimate the lifetime health and cost outcomes of T2D-related complications and adverse events (AEs). Complications, including CV death, myocardial infarction, stroke, and renal outcomes, were predicted using United Kingdom Prospective Diabetes Study risk equations and EMPA-REG OUTCOME data. A meta-analysis informed treatment-induced changes in HbA1c, SBP, and weight in patients without CVD. For each complication in patients with CVD, an indirectly estimated hazard ratio of LIRA vs. EMPA was applied. Costs ($2019), AE rates, and utilities were sourced from published literature. Results: Compared with LIRA as 2nd line, use of EMPA added 0.32 quality-adjusted life-years (QALYs) and led to lower lifetime costs (by $11,422/patient), suggesting dominance over 2nd line LIRA (improved health outcomes at lower cost). These results were similar across CVD subgroups. Patients with CVD at baseline compared to those without CVD showed larger gains in incremental QALYs (0.42 with CVD, 0.29 without CVD) with somewhat lower cost savings (by $9,550, $12,392, respectively) for 2nd line EMPA vs. LIRA, showing dominance in both subpopulations. Conclusion: For T2D patients with and without CVD, the use of EMPA on background MET was a dominant strategy for U.S. payers, associated with improved outcomes and lower costs as compared with LIRA. Disclosure O. Reifsnider: Consultant; Self; Boehringer Ingelheim International GmbH, Boehringer Ingelheim Pharmaceuticals, Inc. P. Pimple: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Employee; Spouse/Partner; CVS Caremark. M.J.D. Stargardter: Consultant; Self; Boehringer Ingelheim International GmbH, Boehringer Ingelheim Pharmaceuticals, Inc. S. Brand: Consultant; Self; Boehringer Ingelheim International GmbH, Boehringer Ingelheim Pharmaceuticals, Inc. N. Desai: None. S. Shetty: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc.

Health Care Costs Associated With Macrovascular, Microvascular, and Metabolic Complications of Type 2 Diabetes Across Time: Estimates From a Population-Based Cohort of More Than 0.8 Million Individuals With Up to 15 Years of Follow-up.

Developing country-specific unit-cost catalogs is a key area for advancing economic research to improve medical and policy decisions. However, little is known about how health care costs vary by type 2 diabetes (T2D) complications across time in Asian countries. We sought to quantify the economic burden of various T2D complications in Taiwan. A nationwide, population-based, longitudinal study was conducted to analyze 802,429 adults with newly diagnosed T2D identified during 1999-2010 and followed up until death or 31 December 2013. Annual health care costs associated with T2D complications were estimated, with multivariable generalized estimating equation models adjusted for individual characteristics. The mean annual health care cost was $281 and $298 (2017 U.S. dollars) for a male and female, respectively, diagnosed with T2D at age <50 years, with diabetes duration of <5 years, and without comorbidities, antidiabetic treatments, and complications. Depression was the costliest comorbidity, increasing costs by 64-82%. Antidiabetic treatments increased costs by 72-126%. For nonfatal complications, costs increased from 36% (retinopathy) to 202% (stroke) in the event year and from 13% (retinopathy or neuropathy) to 49% (heart failure) in subsequent years. Costs for the five leading costly nonfatal subtype complications increased by 201-599% (end-stage renal disease with dialysis), 37-376% (hemorrhagic/ischemic stroke), and 13-279% (upper-/lower-extremity amputation). For fatal complications, costs increased by 1,784-2,001% and 1,285-1,584% for cardiovascular and other-cause deaths, respectively. The cost estimates from this study are crucial for parameterizing diabetes economic simulation models to quantify the economic impact of clinical outcomes and determine cost-effective interventions.

Snakes and ladders: World development pathways’ synergies and trade-offs through the lens of the Sustainable Development Goals

This paper takes three global visions of world development to 2050 and quantifies their implications for sustainable progress employing the metrics of the Sustainable Development Goals (SDGs). The SDG outcomes are structured through the interconnectivities of the three ‘wedding cake’ layers of ‘economy’, ‘society’ and ‘biosphere’, as posited by the Stockholm Resilience Centre. The key policy contribution is to quantify the resulting SDG synergies and trade-offs, whilst also decomposing and calculating the part-worth of the market drivers which contribute to these outcomes. The paper employs a global economic simulation model that combines rational market behaviour with environmental constraints (MAGNET) and is further extended with an SDG metrics module. A ‘non-sustainable’ world reveals trade-offs between economy and biosphere SDGs, with population growth of particular concern to a safe planetary operating space in the world’s poorest regions. Sustainable visions could reduce natural resource pressures and emissions and meet energy requirements at potentially limited economic cost. Notwithstanding, these futures do not address income inequalities and potentially increase food security concerns for the most vulnerable members of society. Consequently, developed region led international cooperation and in-kind income transfers to developing countries, constitutes a necessary prerequisite to help remedy the SDG trade-offs exhibited within the more sustainable global pathways.

Economic Simulation Modeling in Type 2 Diabetes.

This paper provides an overview of type 2 diabetes economic simulation modeling and reviews current topics of discussion and major challenges in the field. Important challenges in the field include increasing the generalizability of models and improving transparency in model reporting. To identify and address these issues, modeling groups have organized through the Mount Hood Diabetes Challenge meetings and developed tools (i.e., checklist, impact inventory) to standardize modeling methods and reporting of results. Accordingly, many newer diabetes models have begun utilizing these tools, allowing for improved comparability between diabetes models. In the last two decades, type 2 diabetes simulation models have improved considerably, due to the collaborative work performed through the Mount Hood Diabetes Challenge meetings. To continue to improve diabetes models, future work must focus on clarifying diabetes progression in racial/ethnic minorities and incorporating equity considerations into health economic analysis.

Short communication: Economic impact among 7 reproductive programs for lactating dairy cows, including a sensitivity analysis of the cost of hormonal treatments

Although hormonal synchronization programs can improve reproductive efficiency of dairy herds, some farmers question the economics of these programs based on the upfront cost of hormonal treatments as opposed to the economic value of the resulting reproductive performance. Our aim was to compare the economic impact of reproductive management programs that incorporate varying degrees of detection of estrus and timed artificial insemination (AI) in dairy herds with year-round calving in confinement total mixed ration systems. A reproductive economic analysis simulation model was used to compare the economic impact of pairs of reproductive management programs. We simulated sets of scenarios for 2 analyses. In the first analysis, we calculated the economic impact of switching from a Presynch-Ovsynch program to a Double-Ovsynch program that included a second PGF2α treatment during the Breeding-Ovsynch portion of the program (Double-Ovsynch+PGF). In the second analysis, we conducted a break-even analysis in which the cost of hormonal treatments was incrementally increased within various reproductive management programs. Our analyses revealed that a Double-Ovsynch+PGF program, the most intensive program evaluated, was more profitable than other programs compared, including a Presynch-Ovsynch program with 100% timed AI or a Presynch-Ovsynch program that incorporated detection of estrus, despite the higher upfront cost incurred by using more hormonal treatments. This advantage remained until the cost of hormones was increased 5 to 14 times current US market prices and 2 to 6 times current European market prices. The cost of GnRH had a greater impact on net profit gain than the cost of PGF2α. In conclusion, more intensive reproductive programs that use more hormonal treatments but result in substantially increased reproductive performance are more profitable than less intensive programs and remain so even if hormone prices are unusually high.

Global land-use and carbon emission implications from biochar application to cropland in the United States

Biochar has the potential to increase crop yields when applied to agricultural land. We integrate agronomic and economic simulation models to determine the expected yield increase from biochar applications in the United States. We calculate the location-specific willingness to pay of U.S. farmers to apply biochar to their cropland if biochar increases yields over 20 years. In addition to the potential benefit of higher revenue for farmers, biochar applications also have policy implications if biochar production is combined with bio-fuel production or used to reduce greenhouse gas emissions from indirect land-use change. Thus, the results are then combined with an agricultural outlook model to determine the effects on global land-use change and net carbon emissions. Our results indicate that biochar application is most profitable for croplands in the Southeast U.S. due to the combination of high yield increases and availability of biomass to produce biochar. An increase in U.S. yields above trend by 1% for corn, soybeans, and wheat would decrease net total global emissions by 25–87 Tg of CO2-equivalent.

Annual transition probabilities of overweight and obesity in older adults: Evidence from World Health Organization Study on global AGEing and adult health

Overweight/obesity is becoming increasingly prevalent in sub-Saharan Africa including Ghana. However, transition probabilities, an essential component to develop cost-effective measures for weight management is lacking in this population. We estimated annual transition probabilities between three body mass index (BMI) categories: normal weight (BMI ≥18.5 and <25.0 kg/m2), overweight (BMI ≥25.0 and <30.0 kg/m2), and obesity (BMI ≥30.0 kg/m2), among older adults aged ≥50 years in Ghana. Data were used from a nationally representative, multistage sample of 1496 (44.3% females) older adults in both Waves 1 (2007/8) and 2 (2014/15) of the Ghana WHO SAGE. A multistage Markov model was used to estimate annual transition probabilities. We further examined the impact of specific socio-economic factors on the transition probabilities. At baseline, 22.8% were overweight and 11.1% were obese. The annual transition probability was 4.0% (95% CI: 3.4%, 4.8%) from normal weight to overweight, 11.1% (95% CI: 9.5%, 13.0%) from overweight to normal weight and 4.9% (95% CI: 3.8%, 6.2%) from overweight to obesity. For obese individuals, the probability of remaining obese, transitioning to overweight and completely reverting to normal weight was 90.2% (95% CI: 87.7%, 92.3%), 9.2% (95% CI: 7.2%, 11.6%) and 0.6% (95% CI: 0.4%, 0.8%) respectively. Being female, aged 50–65 years, urban residence, having high education and high wealth were associated with increased probability of transitioning into the overweight or obese categories. Our findings highlight the difficulty in transitioning away from obesity, especially among females. The estimated transition probabilities will be essential in health economic simulation models to determine sustainable weight management interventions.