Terms Of Cost-effectiveness Research Articles

Comparison of long term efficacy and cost-effectiveness of omalizumab in 150 mg and 300 mg doses in patients with chronic spontaneous urticaria

BackgroundChronic spontaneous urticaria (CSU) is a clinical condition that affects patients quality of life. Omalizumab is preferred in antihistamines resistant CSU cases. Urticaria activity score-7 (UAS-7) is a scale that shows the severity of the disease. ObjectivesThe authors aimed to compare the long-term (60 months) efficacy and side effects of 150 mg and 300 mg doses of omalizumab in patients with CSU. Methods108 patients followed up at the clinic with the diagnosis of CSU were included. Omalizumab was started in patients who were resistant to conventional CSU treatment. Two groups were formed to receive 150 mg and 300 mg doses of omalizumab. Urticaria activity score (UAS-7), antihistamine usage, time to achieve disease-free stage, relapse after treatment, and side effects of omalizumab treatment were compared in the two groups. ResultsThere were no statistically significant differences between the groups regarding basal characteristics and laboratory findings. Average follow-up time was sixty months. UAS-7 scores were similar in the follow-up. There were no adverse events in both groups. Study limitationsRetroactive design and single-center nature to reach a more significant number of patients. Lack of patients receiving the lowest dose 75 mg and the highest dose 600 mg of omalizumab. Absence of total body mass indexes of all patients. Besides, the use of distinct drugs may contribute to non confident results and is another limitation of this study. ConclusionSince there is no significant difference between 150–300 mg omalizumab doses regarding long-term treatment efficacy and side effects in CSU patients, starting treatment with a 150 mg dose may be suitable. In patients who do not respond to 150 mg, the omalizumab dose can be increased to 300 mg. It will prevent unpredictable dose and time-dependent complications and will be a cost-effective approach even in strong economies.

Severity of lumbar spinal stenosis does not impact responsiveness to exercise-based rehabilitation.

Spine pain is a prevalent and costly condition affecting up to 85% of individuals throughout their lifetime, and spinal stenosis is one of the most debilitating sources of spine pain. Although conservative management is the first line of treatment for spinal stenosis, severe cases often are directly referred to surgical intervention due to the belief that conservative strategies delay necessary treatment. However, there are no studies supporting the premise that individuals with more severe stenosis respond poorly to conservative management. The purpose of this study was to compare improvements in pain, disability, strength, medication usage, and patient goals in response to an exercise-based physical therapy program across 1,806 individuals with mild, moderate, or severe lumbar spine stenosis. Participants demonstrated significant improvements in all variables of interest (p<0.001), and 11.5% of participants reported cessation of narcotic use with treatment. There were no significant differences in treatment response across mild, moderate, or severe stenosis groups for any outcome (p>0.546). Exercise-based rehabilitation is as beneficial in the short term for individuals presenting for nonoperative care with severe stenosis compared to their milder counterparts. Future research is needed to evaluate long term durability and cost effectiveness of rehabilitation in this patient population.

Short Term Cost Effectiveness of Radiofrequency Ablation and High Ligation and Stripping for Great Saphenous Vein Incompetence

Short Term Cost Effectiveness of Radiofrequency Ablation and High Ligation and Stripping for Great Saphenous Vein Incompetence

Project CHARIOT: study protocol for a hybrid type 1 effectiveness-implementation study of comprehensive tele-harm reduction for engagement of people who inject drugs in HIV prevention services

BackgroundPeople who inject drugs (PWID) remain a high priority population under the federal Ending the HIV Epidemic initiative with 11% of new HIV infections attributable to injection drug use. There is a critical need for innovative, efficacious, scalable, and community-driven models of healthcare in non-stigmatizing settings for PWID. We seek to test a Comprehensive-TeleHarm Reduction (C-THR) intervention for HIV prevention services delivered via a syringe services program (SSP).MethodsThe CHARIOT trial is a hybrid type I effectiveness-implementation study using a parallel two-arm randomized controlled trial design. Participants (i.e., PWID; n = 350) will be recruited from a syringe services program (SSP) in Miami, Florida. Participants will be randomized to receive either C-THR or non-SSP clinic referral and patient navigation. The objectives are: (1) to determine if the C-THR intervention increases engagement in HIV prevention (i.e., HIV pre-exposure prophylaxis; PrEP or medications for opioid use disorder; MOUD) compared to non-SSP clinic referral and patient navigation, (2) to examine the long-term effectiveness and cost-effectiveness of the C-THR intervention, and (3) to assess the barriers and facilitators to implementation and sustainment of the C-THR intervention. The co-primary outcomes are PrEP or MOUD engagement across follow-up at 3, 6, 9 and 12 months. For PrEP, engagement is confirmed by tenofovir on dried blood spot or cabotegravir injection within the previous 8 weeks. For MOUD, engagement is defined as screening positive for norbuprenorphine or methadone on urine drug screen; or naltrexone or buprenorphine injection within the previous 4 weeks. Secondary outcomes include PrEP adherence, engagement in HCV treatment and sustained virologic response, and treatment of sexually transmitted infections. The short and long term cost-effectiveness analyses and mixed-methods implementation evaluation will provide compelling data on the sustainability and possible impact of C-THR on comprehensive HIV prevention delivered via SSPs.DiscussionThe CHARIOT trial will be the first to our knowledge to test the efficacy of an innovative, peer-led telehealth intervention with PWID at risk for HIV delivered via an SSP. This innovative healthcare model seeks to transform the way PWID access care by bypassing the traditional healthcare system, reducing multi-level barriers to care, and meeting PWID where they are.Trial Registration: ClinicalTrials.gov NCT05897099. Trial registry name: Comprehensive HIV and Harm Prevention Via Telehealth (CHARIOT). Registration date: 06/12/2023.

Combining Similarity Measures and Left-Right Hidden Markov Models for Prognostics of Items Subjected to Perfect and Imperfect Maintenance

In the nuclear industry, high system reliability requirements are essential since in-service failure can result in undesirable consequences in terms of costs or safety. However, the current approach to maintaining systems and components is costly and known to involve overly conservative periodic maintenance activities. It is, therefore, appropriate to develop monitoring, detection, and predictive tools to enable operators to create optimal maintenance strategies. These strategies can vary from the substitution of an item to its repair, intending to avoid unexpected consequences. The repair can restore the item’s functionality to an as-good-as-new condition (perfect repair) or sometimes can keep some accumulated degradation and change the item’s degradation rate (imperfect or partial repair). Current techniques and models that can perform prognostics with extraordinary accuracy are often designed on the assumption that following maintenance, the item is restored to an as-good-as-new condition. When these models are used to predict items that follow imperfect repairs, the predictions are likely to be inaccurate. Therefore, the present work focuses on the condition-based prognostics of items, considering and handling the criticalities that arise after the items undergo different kinds of repairs. The proposed solution involves a data-driven framework that employs Left-Right Gaussian Hidden Markov Models (LR-GHMMs). These models can intrinsically manage accumulated degradation. The idea is to train different LR-GHMMs, each specific to a degradation path, and then combine them to cover possible intermediate paths. The effectiveness of the approach is tested in two case studies. In the first one, we consider simple artificial sequences that are useful to explain the method’s capabilities. In the second case study, we consider semi-simulated nuclear data describing the degradation transients of a condenser that undergoes fouling. The framework is trained with data collected from items that start without accumulated degradation. The test data represent either new items or items that undergo imperfect repairs. The results demonstrate an attractive elasticity of the framework in adapting to nonstandard degradation behaviors. In addition, the applications provide interpretable and highly accurate outputs.

Editor's Choice – Short Term Cost Effectiveness of Radiofrequency Ablation and High Ligation and Stripping for Great Saphenous Vein Incompetence

Superficial venous incompetence (SVI) is a common disease that causes significant quality of life (QoL) impairment. There is a need for more health economic evaluations of SVI treatment. The aim of this study was to perform a cost effectiveness analysis in patients with great saphenous vein (GSV) incompetence comparing radiofrequency ablation (RFA), high ligation and stripping (HL/S), and no treatment or conservative treatment with one year follow up. Randomised controlled trial economic analysis from an ongoing trial; 143 patients (156 limbs) with GSV incompetence (CEAP clinical class 2 - 6) were included. Treatment was performed with RFA or HL/S. Follow up was performed up to one year using duplex ultrasound, revised venous clinical severity score (r-VCSS), Aberdeen Varicose Vein Questionnaire (AVVQ), and EuroQol-5D-3L (EQ-5D-3L). Seventy-eight limbs were treated with RFA and HL/S respectively. No treatment or conservative treatment was assumed to have zero in treatment cost and no treatment benefit. In the RFA group, one limb had reflux in the GSV after one month and three limbs after one year. In HL/S, two limbs had remaining reflux in the treated area at one month and one year. Both disease severity (r-VCSS, p= .004) and QoL (AVVQ, p= .021 and EQ-5D-3L, p= .028) were significantly improved over time. The QALY gain was 0.21 for RFA and 0.17 for HL/S. The cost per patient was calculated as €1 292 for RFA and €2 303 for HL/S. The cost per QALY (compared with no treatment or conservative treatment) was €6 155 for RFA and €13 549 for HL/S. With added cost for days absent from work the cost per QALY was €7 358 for RFA and €24 197 for HL/S. The cost per QALY for both methods was well below the threshold suggested by Swedish National Board of Health. RFA is more cost effective than HL/S and no treatment or conservative treatment at one year followup.

Real-time detecting deformation on pantograph contact strip based on image processing technique

Railway vehicles’ traction power supply system has two main components, the catenary contact and the pantograph. During the operation, contact is influenced by electromechanical wear phenomena. Deformation on the pantograph contact strip affects its power transmission quality because contact loos with the catenary reduces the railway system’s overall reliability. Their maintenance and inspection are usually done for periods of time with negative consequences in terms of costs and safety. Thus, in this study, we developed a contact strip monitoring method based on image processing for inspection to measure the contact strip thickness. The measurement system is made through a single camera that acquires images from the contact area, measuring the contact strip’s thickness using image processing techniques.

Evaluation of the efficacy of pulsed radiofrequency therapy in patients with lumbosacral radicular pain: An analysis of single-center data.

Lumbosacral radicular pain (LRP) is one of the most common causes of neuropathic pain. This pain often arises from inflammation in the dorsal root ganglia (DRG) or spinal nerves. Despite various treatment modalities, success rates are not very high in chronic LRP cases. Pulsed radiofrequency (PRF) therapy, frequently applied to the DRG, is widely used, but its effectiveness is often questioned in various studies. The primary aim of our study is to evaluate the effectiveness of PRF treatment in 154 patients. Patients with LRP for longer than 3 months, treated with PRF, were included in this study. To assess the efficacy of PRF treatment, numerical rating scale (NRS) scores were evaluated at the 4th-week and 6th-month follow-ups. The NRS scores were significantly lower at the 4th-week and 6th-month follow-ups compared to pre-treatment levels (p<0.001). However, there was no significant difference between the mean NRS scores at the 4th week and 6th month. Success in interventional pain procedures is often considered as at least a 50% reduction in pain scores. The success rate for PRF treatment for LRP in the literature varies between 30% and 60%, which is similar to our findings at the 4th week and 6th month. PRF treatment is widely used due to its low side-effect profile and cost-effectiveness in the long term. There is no fully standardized practice regarding procedural aspects, such as the duration of the application, and prospective studies with larger participation are needed.

Cost effectiveness of spread mitigation strategies for polyphagous shot hole borer Euwallacea fornicatus (Coleoptera: Curculionidae: Scolytinae).

Polyphagous shot hole borer Euwallacea fornicatus Eichhoff was detected in Western Australia in September 2021, and an eradication campaign funded by the Commonwealth government is underway. As part of contingency planning, we examined the cost effectiveness of alternative control strategies that could be used to mitigate urban forest impacts and maintain the benefits of trees to the local communities if eradication was not feasible. At the time this work was undertaken, decision-makers were concerned about the potential need to replace all urban trees susceptible to attack. We considered this strategy alongside less destructive strategies and assessed their cost effectiveness in terms of material and labor costs and the loss of ecosystem services resulting from reduced tree foliage. Using a stochastic simulation model, we found that a strategy that involved pruning necrotic limbs and treating trees biennially with systemic insecticide was almost always more cost effective than removing infested trees and replanting to resistant varieties. We estimated this strategy would cost A$55-110 million over 50 years, while tree removal would cost $105-195 million. A third strategy using a mix of chemical suppression and tree removal was also considered in light of new information about the pest's host preferences. With an estimated cost of $60-110 million, this strategy was only slightly more expensive than using chemical suppression alone and could actually lead to eradication if the host range is as narrow as recent survey data suggests.

PP09 Capturing Broader Effects Of Influenza Vaccination Program In Economic Evaluation: Systematic Literature Review

IntroductionDecision-making for vaccination programs requires additional consideration on broader effects. The cost-effectiveness guidelines published by the Professional Society for Health Economics and Outcomes Research (ISPOR) working group recommends considering broader effects such as herd protection. Whilst difficulty to produce robust data for such factors might hinder quicker decisions, they are important features of vaccination programs and some of them were the narratives that dominated over the COVID-19 pandemic. In this systematic literature review, the perspectives taken and inclusion of broader effects were investigated for recent influenza vaccine economic evaluations.MethodsThe search strategy based on the terms influenza vaccination and cost-effectiveness was carried out on Embase and PubMed. Considering the publication date of the ISPOR guidelines, articles since 2019 were searched. The review focus was the perspectives taken and inclusion of broader benefits in the analysis. A link between perspective and inclusion of broader effects was tested with a Chi-square test.ResultsThe total number of full cost-effectiveness articles screened was 48. Of those, the number of articles performed from both the perspectives was 18 (37.5%), and 13 articles (27.1%) considered the perspective of payer only. For those that had both perspectives considered, the ICER reported from the societal perspective was consistently lower than that from the payer perspective. Thirty-one articles (65%) included any of the broader effects. However, broader effects considered were limited to indirect protection (17 articles, 35.4%) and productivity loss (22 articles, 45.8%). The relation between perspective and inclusion of broader effects was significant (p=0.04).ConclusionsThis review highlights that studies performed using both payer and societal perspectives as recommended by the ISPOR research guidelines are not many, while more favorable outcomes were presented when the societal perspective was adapted. Broader effects included are productivity loss and indirect protection.For other broader effects specified in the research guidelines, there are not many attempts to include those in economic evaluations.

Hot topics in allergen immunotherapy, 2023: Current status and future perspective.

The importance of allergen immunotherapy (AIT) is multifaceted, encompassing both clinical and quality-of-life improvements and cost-effectiveness in the long term. Key mechanisms of allergen tolerance induced by AIT include changes in memory type allergen-specific T- and B-cell responses towards a regulatory phenotype with decreased Type 2 responses, suppression of allergen-specific IgE and increased IgG1 and IgG4, decreased mast cell and eosinophil numbers in allergic tissues and increased activation thresholds. The potential of novel patient enrolment strategies for AIT is taking into account recent advances in biomarkers discoveries, molecular allergy diagnostics and mobile health applications contributing to a personalized approach enhancement that can increase AIT efficacy and compliance. Artificial intelligence can help manage and interpret complex and heterogeneous data, including big data from omics and non-omics research, potentially predict disease subtypes, identify biomarkers and monitor patient responses to AIT. Novel AIT preparations, such as synthetic compounds, innovative carrier systems and adjuvants, are also of great promise. Advances in clinical trial models, including adaptive, complex and hybrid designs as well as real-world evidence, allow more flexibility and cost reduction. The analyses of AIT cost-effectiveness show a clear long-term advantage compared to pharmacotherapy. Important research questions, such as defining clinical endpoints, biomarkers of patient selection and efficacy, mechanisms and the modulation of the placebo effect and alternatives to conventional field trials, including allergen exposure chamber studies are still to be elucidated. This review demonstrates that AIT is still in its growth phase and shows immense development prospects.

The effectiveness of modified stone recurrence predictive score in predicting recurrence of urinary stone disease

Aims: The present study is intended to define the scoring system consisting of questions to be answered by the patients in an outpatient clinic setting in order to predict recurrence of urinary system stone disease. Methods: Two hundred patients who were admitted for urinary system stone treatment in our clinic between 2016 and 2017 were included in the study. A Modified Stone Recurrence Predictive Score (MSRPS) comprising 23 questions under 14 headings including risk factors such as age, gender, smoking and alcohol consumption, family history of stone, number of stones, additional diseases and medications, presence of urinary tract infection, dietary characteristics, stress factors, occupation, and obesity was created. Three-year follow-up data of all patients were recorded. Results: The mean MSRPS was 18.4±6.2 (6-35). We noted that the high Modified Stone Recurrence Predictive Score correlated significantly with the incidence of recurrent stone formation (p&lt;0.001 r2: 0.923). When the cutoff value was considered as 18, the sensitivity was 89.4% and the specificity was 93.1% in predicting recurrent stones. Recurrent stone formation was observed within 3 years in all patients with an MSRPS value of 26 and above. Conclusion: Thanks to this scoring system developed by expanding the scope of similar studies conducted in previous years, the possibility of recurrence of urinary stone disease is predicted using a questionnaire that can be filled easily, and it would be an appropriate choice regarding both patient health and cost-effectiveness in terms of directing patients to metabolic analyses or recommending preventive measures.

AMP-EBiLSTM: employing novel deep learning strategies for the accurate prediction of antimicrobial peptides.

Antimicrobial peptides are present ubiquitously in intra- and extra-biological environments and display considerable antibacterial and antifungal activities. Clinically, it has shown good antibacterial effect in the treatment of diabetic foot and its complications. However, the discovery and screening of antimicrobial peptides primarily rely on wet lab experiments, which are inefficient. This study endeavors to create a precise and efficient method of predicting antimicrobial peptides by incorporating novel machine learning technologies. We proposed a deep learning strategy named AMP-EBiLSTM to accurately predict them, and compared its performance with ensemble learning and baseline models. We utilized Binary Profile Feature (BPF) and Pseudo Amino Acid Composition (PSEAAC) for effective local sequence capture and amino acid information extraction, respectively, in deep learning and ensemble learning. Each model was cross-validated and externally tested independently. The results demonstrate that the Enhanced Bi-directional Long Short-Term Memory (EBiLSTM) deep learning model outperformed others with an accuracy of 92.39% and AUC value of 0.9771 on the test set. On the other hand, the ensemble learning models demonstrated cost-effectiveness in terms of training time on a T4 server equipped with 16GB of GPU memory and 8 vCPUs, with training durations varying from 0 to 30s. Therefore, the strategy we propose is expected to predict antimicrobial peptides more accurately in the future.

Evolution of Business Models of Mining and Energy Sector Companies according to Current Market Trends

A business model is a “formula” for generating value in a company, and is considered a conceptual object that is part of a company’s intangible resources. It is a company’s unique recipe for sales, cost-effectiveness in operational terms as well as investment, and the financing of operations, both in the short and long term. Due to new challenges, such as sustainable development, faced by enterprises, as well as the new ways of creating and delivering value, such as the closed-loop economy, new concepts of business models are emerging. Presently, there are many different forms of decomposition of a company’s assets that will contribute to the process of creating more sustainable business models to ensure the achievement of cohesion in the financial, environmental and social areas. The purpose of this paper is to present the theoretical assumptions and practical solutions in the field of creating sustainable business models for enterprises by decomposing assets and changing their way of functioning to increase efficiency for stakeholders. The applied research method is based on statistical analysis, with the main focus on the analysis of the correlation between the prices of shares of a parent company and the prices of shares of a company separated from the existing structures.

Composite membranes for fuel cells

The current ecological situation attracts particular attention to alternative energy sources with no detrimental impact on the ecosystem. In comparison with conventional energy sources, fuel cells exhibit the following advantages: small and compact size, light weight, lack of noise when working, and cost-effectiveness in terms of fuel consumption. Most importantly, fuel cells are environmentally friendly, since no harmful substances are released into the atmosphere during their operation. Their goal is to convert chemical energy from various sources into environmentally friendly electric power. At present, chemical sources of energy are used everywhere, including batteries for mobile phones, laptops, as well as cars and uninterruptible power supplies, to name a few. The main components of solid polymer fuel cells are proton-exchange membranes, the main function of which is to ensure the transfer of protons from the anode to the cathode. The proton conductivity of such materials is determined by the presence of hydrophilic channels that transport mobile protons. The proton-exchange membrane must meet the following requirements: electrochemical and chemical stability in aggressive chemical environments, mechanical and thermal strength, low permeability to reagent gases (fuel and oxidizer), high ion exchange capacity and electrical conductivity, as well as a relatively low cost. This paper considers perfluorinated sulfonic acid membranes, organic–inorganic and acid–base composite membranes, as well as hybrid membranes obtained by sol-gel process, which can contribute to the development of technologies related to fuel cells in the future.

3D PHOTOGRAMMETRY MODELING FOR SAFETY MONITORING OF FORTRESS WALLS

Abstract. In the monitoring to prevent collapse or tipping in the structure of linear-shaped fortress walls, the record of shapes like slope or protrusion is very important(Jo and Hong, 2019). As the way to record the shapes, laser scan or photogrammetric technology is employed. A laser scan that has to install several points of measurement has a limitation in recording them if the terrain is undulating, or the structure becomes huge. Photogrammetry has a shortening effect in terms of cost and process (Kim, 2020) compared to that.This study examined a measure for producing a 3D mesh model with aerial and ground photography for fortress walls. In addition, this study tested if it would be possible to monitor the slope and protrusion, etc. of fortress walls. This study tested the accuracy of the model produced with photogrammetry to use in the diagnosis and monitoring of the structural safety of fortress walls.The research subject was Korea’s cultural heritage, Seosan Haemieupseong Fortress, and a model was produced for the section about 100m of the fortress walls.The positional accuracy, elevation/section accuracy, LOD, and texture joint precision of two models (Model A &amp;amp; Model B) produced with photogrammetry and laser scan were compared.This study revealed that the model produced at LOD Level 4 would be effective for monitoring the displacement since it could measure the shape, curvature, and slope of stones of the fortress walls.

Authors' response to Unjournal evaluations of "Long term cost-effectiveness of resilient foods for global catastrophes compared to artificial general intelligence"

Authors' response to Unjournal evaluations of "Long term cost-effectiveness of resilient foods for global catastrophes compared to artificial general intelligence"

IOT-BASED BABY MONITORING SYSTEM

These days the current number of working women and mothers has skyrocketed. As a result, for many families, baby care has become a daily challenge. As a result, the majority of parents leave their children with their grandparents or at child care facilities. Unfortunately, under both regular and exceptional circumstances, the parents are unable to continuously check their child's health. Thus, an Internet of Things- based baby monitoring system (IoT-BBMS) is suggested as an effective and affordable IoT-based system for real-time monitoring. Also, we suggested a new algorithm for our system that is crucial to delivering superior baby care while parents are abroad. The application of technology such as Internet of Things (IoT) modules for sensing temperature and humidity, cry detection systems, and real-time video surveillance. We are able to monitor the temperature, the sound of the infant crying, and the posture of the baby in the cradle live. The infant cradle in the system architecture uses a motor to swing automatically whenever the baby screams. Parents can also remotely monitor their baby's health using an external web camera and turn on the lullaby in the baby cradle. The proposed system prototype is created and tested to demonstrate its effectiveness in terms of cost and simplicity as well as to guarantee safe operation so that parents can have access to their children whenever and wherever they choose over the network. The prototype has shown that the baby monitoring system is effective at keeping track of the infant's situation and its surroundings. Keywords: Arduino UNO , Temperature Sensor, Moisture Sensor, Sound Sensor , LCD Module , Node MCU, DC / Servo Motor , Music Generated Circuit and Speaker , Wireless Camera , 12V Transformer , Voltage Regulators.

Estimated Therapy Costs and Downstream Cost Consequences of iBASIS–Video Interaction to Promote Positive Parenting Intervention vs Usual Care Among Children Displaying Early Behavioral Signs of Autism in Australia

The growing global prevalence of autism spectrum disorder (ASD) is associated with increasing costs for support services. Ascertaining the effects of a successful preemptive intervention for infants showing early behavioral signs of autism on human services budgets is highly policy relevant. To estimate the net cost impact of the iBASIS-Video Interaction to Promote Positive Parenting (iBASIS-VIPP) intervention on the Australian government. Infants (aged 12 months) showing early behavioral indicators of autism were recruited through community settings into the multicenter Australian iBASIS-VIPP randomized clinical trial (RCT), a 5- to 6-month preemptive parent-mediated intervention, between June 9, 2016, and March 30, 2018, and were followed up for 18 months to age 3 years. This economic evaluation, including cost analysis (intervention and cost consequences) and cost-effectiveness analyses of iBASIS-VIPP compared with usual care (treatment as usual [TAU]), modeled outcomes observed at age 3 through to 12 years (13th birthday) and was conducted from April 1, 2021, to January 30, 2023. Data analysis was conducted from July 1, 2021, to January 29, 2023. iBASIS-VIPP intervention. To project the diagnostic trajectory and associated disability support costs drawing on the Australian National Disability Insurance Scheme (NDIS), the main outcome was the differential treatment cost of iBASIS-VIPP plus TAU vs TAU and disability-related government costs modeled to age 12 years, using a clinical diagnosis of ASD and developmental delay (with autism traits) at 3 years. Costs were calculated in Australian dollars and converted to US dollars. Economic performance was measured through the following: (1) differential net present value (NPV) cost (iBASIS-VIPP less TAU), (2) investment return (dollars saved for each dollar invested, taking a third-party payer perspective), (3) break-even age when treatment cost was offset by downstream cost savings, and (4) cost-effectiveness in terms of the differential treatment cost per differential ASD diagnosis at age 3 years. Alternate values of key parameters were modeled in 1-way and probabilistic sensitivity analysis, the latter identifying the likelihood of an NPV cost savings. Of the 103 infants enrolled in the iBASIS-VIPP RCT, 70 (68.0%) were boys. Follow-up data at age 3 years were available for 89 children who received TAU (44 [49.4%]) or iBASIS-VIPP (45 [50.6%]) and were included in this analysis. The estimated mean differential treatment cost was A $5131 (US $3607) per child for iBASIS-VIPP less TAU. The best estimate of NPV cost savings was A $10 695 (US $7519) per child (discounted at 3% per annum). For each dollar invested in treatment, a savings of A $3.08 (US $3.08) was estimated; the break-even cost occurred at age 5.3 years (approximately 4 years after intervention delivery). The mean differential treatment cost per lower incident case of ASD was A $37 181 (US $26 138). We estimated that there was an 88.9% chance that iBASIS-VIPP would deliver a cost savings for the NDIS, the dominant third-party payer. The results of this study suggest that iBASIS-VIPP represents a likely good-value societal investment for supporting neurodivergent children. The estimated net cost savings were considered conservative, as they covered only third-party payer costs incurred by the NDIS and outcomes were modeled to just age 12 years. These findings further suggest that preemptive interventions may be a feasible, effective, and efficient new clinical pathway for ASD, reducing disability and the costs of support services. Long-term follow-up of children receiving preemptive intervention is needed to confirm the modeled results.

Macrophyte islands as an experimental model: new perspectives and a step-by-step protocol to access assumptions of Island Biogeography theory and habitat fragmentation

To evaluate whether artificially built macrophyte islands could be used as a short-term and cost-effective experimental model for the study of island biogeography and habitat fragmentation, 20 islands of two different sizes were built and fishes were sampled. Habitat complexity and source-island distance were standardized. A macrophyte bank 200 times larger than the islands was used as a source of individuals. The results show that, in four days, several fish species colonized both small and large islands. After four days, larger islands bore significantly more species than smaller ones. We raise the caveats and new perspectives for studies using this methodology, which can be largely applicable due to its cost-effectiveness in terms of materials, short time required, and flexibility.