Terms Of Cost-effectiveness Research Articles

Population cost-effectiveness of the Triple P parenting programme for the treatment of conduct disorder: an economic modelling study

Parenting programmes are the recommended treatments of conduct disorders (CD) in children, but little is known about their longer term cost-effectiveness. This study aimed to evaluate the population cost-effectiveness of one of the most researched evidence-based parenting programmes, the Triple P—Positive Parenting Programme, delivered in a group and individual format, for the treatment of CD in children. A population-based multiple cohort decision analytic model was developed to estimate the cost per disability-adjusted life year (DALY) averted of Triple P compared with a ‘no intervention’ scenario, using a health sector perspective. The model targeted a cohort of 5–9-year-old children with CD in Australia currently seeking treatment, and followed them until they reached adulthood (i.e., 18 years). Multivariate probabilistic and univariate sensitivity analyses were conducted to incorporate uncertainty in the model parameters. Triple P was cost-effective compared to no intervention at a threshold of AU$50,000 per DALY averted when delivered in a group format [incremental cost-effectiveness ratio (ICER) = $1013 per DALY averted; 95% uncertainty interval (UI) 471–1956] and in an individual format (ICER = $20,498 per DALY averted; 95% UI 11,146–39,470). Evidence-based parenting programmes, such as the Triple P, for the treatment of CD among children appear to represent good value for money, when delivered in a group or an individual face-to-face format, with the group format being the most cost-effective option. The current model can be used for economic evaluations of other interventions targeting CD and in other settings.

Cost effectiveness of neoadjuvant chemotherapy followed by interval cytoreductive surgery versus primary cytoreductive surgery for patients with advanced stage ovarian cancer during the initial treatment phase

ObjectiveAdvanced stage epithelial ovarian cancer (AEOC) can be treated with either neoadjuvant chemotherapy (NACT) or primary cytoreductive surgery (PCS). Although randomized controlled trials show that NACT is non-inferior in overall survival compared to PCS, there may be improvement in short-term morbidity. We sought to investigate the cost-effectiveness of NACT relative to PCS for AEOC from the US Medicare perspective. MethodsA cost-effectiveness analysis using a Markov model with a 7-month time horizon comparing (1) 3cycles of NACT with carboplatin and paclitaxel (CT), followed by interval cytoreductive surgery, then 3 additional cycles of CT, or (2) PCS followed by 6cycles of CT. Input parameters included probability of chemotherapy complications, surgical complications, treatment completion, treatment costs, and utilities. Model outcomes included costs, life-years gained, quality-adjusted life-years (QALYs) gained, and incremental cost-effectiveness ratios (ICER), in terms of cost per life-year gained and cost per QALY gained. We accounted for differences in surgical complexity by incorporating the cost of additional procedures and the probability of undergoing those procedures. Probabilistic sensitivity analysis (PSA) was performed via Monte Carlo simulations. ResultsNACT resulted in a savings of $7034 per patient with a 0.035 QALY increase compared to PCS; therefore, NACT dominated PCS in the base case analysis. With PSA, NACT was the dominant strategy more than 99% of the time. ConclusionsIn the short-term, NACT is a cost-effective alternative compared to PCS in women with AEOC. These results may translate to longer term cost-effectiveness; however, data from randomized control trials continues to mature.

Discrete Event Simulation Modelling of Long Term Cost-Effectiveness of Internet-Based Blended Cognitive Behavioural Therapy for Major Depressive Disorder: Extrapolation of the E-Compared Randomised Controlled Trial

Discrete Event Simulation Modelling of Long Term Cost-Effectiveness of Internet-Based Blended Cognitive Behavioural Therapy for Major Depressive Disorder: Extrapolation of the E-Compared Randomised Controlled Trial

FeCo-Anchored Reduced Graphene Oxide Framework-Based Soft Composites Containing Carbon Nanotubes as Highly Efficient Microwave Absorbers with Excellent Heat Dissipation Ability.

Conducting polymer composites containing ferromagnetic grafted-graphene derivatives are already appreciated for their lightweight, flexibility, and cost effectiveness in terms of microwave absorption. To further leverage the said properties of this wonder material, we propose a highly efficient replacement by blending conducting multiwall carbon nanotube (MWCNT) and FeCo anchored covalent cross-linked reduced graphene oxide (rGO) with poly(vinylidene fluoride) (PVDF). Interconnected conducting network of MWCNTs introduces higher electrical conductivity in the blend which is essential for microwave absorption. FeCo-anchored porous interconnected rGO framework was designed via solvent-mediated in situ coreduction in the presence of Fe(II) and Co(II) precursors. Resulting cross-linked-rGO/FeCo displays fascinating coexistence of ferromagnetism and conducting-dielectric behavior, while largely preserving the robust 3D porous interconnected structure. Coupled with conducting MWCNTs, diamine cross-linked rGO/FeCo in a soft polymer matrix yields remarkably high total shielding effectiveness (SET) of -41.2 dB at 12 GHz, for a meager 10 wt % filler content. In addition, the composite materials display efficient heat dissipation abilities in conjunction with the trend in their thermal conductivities. This new-age microwave-absorbing material, powered by multifunctionality and tunable magnetodielectric properties, henceforth offers an amendable, cost-effective replacement to the existing solutions.

Cost-effectiveness analysis of typhoid conjugate vaccines in five endemic low- and middle-income settings

BackgroundTyphoid fever remains endemic in low- and middle-income countries. Programmatic use of existing vaccines is limited, but upcoming typhoid conjugate vaccines (TCVs) could warrant wider use. We evaluated the cost-effectiveness of five TCV delivery strategies in three urban areas (Delhi and Kolkata, India and Nairobi, Kenya) and two rural settings (Lwak, Kenya and Dong Thap, Vietnam) with varying incidence. Methods and findingsWe evaluated routine infant vaccination with and without catch-up campaigns among older individuals. We used a dynamic model of typhoid transmission to simulate cases, hospitalizations, deaths, disability-adjusted life-years (DALY) lost, treatment and intervention costs. We estimated cost-effectiveness (in terms of cost in international dollars (I$) per DALY averted) from the healthcare payer perspective, and assessed how it was influenced by uncertain model parameters. Compared to no vaccination, routine infant vaccination at I$1/dose was cost-saving in Delhi and Dong Thap, “very cost-effective” in Kolkata and Nairobi, and “cost-effective” in Lwak according to World Health Organization thresholds. However, routine vaccination was not the optimal strategy compared to strategies that included a catch-up campaign, which yielded the highest probability of being cost-saving in Delhi and Dong Thap and were most likely to provide a return on investment above a willingness-to-pay threshold of I$1440 in Kolkata, I$2300 in Nairobi, and I$5360 in Lwak. Vaccine price impacted the optimal strategy, and the number of doses required and rate of hospitalization were the primary sources of uncertainty. ConclusionRoutine vaccination with TCV would be cost-effective in most settings, and additional one-time catch-up campaigns would also be economically justified.

Guaranteeing Traffic Survivability and Latency Awareness in Multilayer Network Design

The massive adoption of real-time Internet services (e.g., online gaming or video streaming) is threatening the way in which operators and service providers design and operate their networks. New requirements, such as maximum latency, are becoming de facto indicators to measure network quality, complementing the classical requisites of fault tolerance to increase network availability. However, finding fault-tolerant designs that also limit the end-to-end latency of IP flows is challenging in multilayer IP-over-WDM networks, since traffic routed over IP links depends on the actual sequences of the traversed fibers and how they change in each failure state. Despite its practical importance, the research on joint optimization of end-to-end latencies and fault tolerance in multilayer optical networks is minimal. In this context, this paper presents a planning algorithm for multilayer IP-over- WDM (with OSPF-ECMP routing in the IP layer), considering both survivability and end-to-end latency awareness. Three versions of the algorithm are provided, assuming three different recovery mechanisms in the optical layer: 1 + 1 lightpath protection, unprotected lightpaths, and lightpath restoration. In all cases, as is customary, the optical layer is assumed to react first to the failures, and after that, the IP/OSPF layer adapts to the surviving topology. The aim of our algorithm is to design minimum cost networks that guarantee not only 100% survivability under some representative failure states, but also the maximum end-to-end latency for IP flows in the case of any failures. According to our results, a careful and holistic design may achieve both objectives simultaneously, without, in most cases, noticeable side effects in terms of cost and/or throughput. In its turn, we see that, when end-to-end latencies are not considered, designs tend to produce very high latencies in some flows and failure states.

Preeclampsia biomarkers

Preeclampsia, which affects 3–5% of pregnant women, is the most common serious medical disorder of human pregnancy and a major cause of maternal and perinatal morbidity and mortality world-wide. Its prediction (either before, or in the early months of pregnancy, or at a pre-clinical stage in later pregnancy) offers the possibility of significant improvement in both the maternal and perinatal clinical outcomes in pregnancies complicated by this disorder. To date, no single predictive test (e.g., clinical, biophysical, biochemical, genetic) has proven sufficiently effective for it to have gained widespread acceptance into clinical practice. Instead, thus far, the most promising predictive approach has involved the use of a combination of variables (e.g., maternal risk factors, mean arterial blood pressure, uterine artery Doppler and various biomarkers). However, recent studies (e.g., Zeisler et al.1) now increasingly support the stand-alone clinical utility of especially angiogenic biomarkers (e.g., sFlt-1, PlGF) as predictive and diagnostic aids for preeclampsia. That said, further prospective studies are still required to detail the predictive characteristics of such biomarker approaches in both uni- and multi-parametric models, and to definitively determine their cost effectiveness in terms of improved maternal and perinatal outcomes in various clinical settings.

Bringing infrastructure into pricing in road freight transportation – A measuring concept based on navigation service data

Differences in road infrastructure, such as capacity, congestion, speed limits affect the productivity and the costs of short-distance freight operations. This article introduces a novel methodology that is based on navigation service data to measure the effects in terms of cost per kilometer using navigation and shipment data. The methodology is applied to five terminals of a forwarding cooperation and has been able to document significant differences in cost per kilometer across the terminals. The research results can be used by logistics service providers to better understand how productivity and thus profitability is affected by the quality of the transportation infrastructure in the particular areas they operate in. Furthermore, the insights will help these companies for better, i.e. cost-based pricing and will allow to document why and where prices need to be adapted.

АНАЛИЗ ЭФФЕКТИВНОСТИ ПРИМЕНЕНИЯ ГИДРАВЛИЧЕСКОГО РАЗРЫВА ПЛАСТА В УСЛОВИЯХ УРШАКСКОГО МЕСТОРОЖДЕНИЯ

Background Creation and implementation of an improved technology of oil deposit development and application of new enhanced oil recovery (EOR) methods, in particular, is the most important task facing oil industry. The authors review hydrofrac application under conditions of Urshak field. Aims and Objectives To analyze the results of applying treatment methods to the bottom hole zone in the well № 398 of Urshak field; to assess the performance of the well after treatments; to calculate the cost-effectiveness in terms of the impact of hydraulic fracturing technology. Methods The algorithm and computational methods for estimating technological effect of the bottom hole zone treatment are presented. Results The effectiveness of hydraulic fracturing was analyzed. It was proved that the technology was effective for the well № 398, and additional oil production made 16,221.16 t. Further use of hydraulic fracturing in Urshak field is recommended, as it is the most effective EOR method which allows to involve remote and low-permeability parts of reservoir in the filtering process. One should keep in mind that after the fracturing water cut has increased 1.87 times.

A pilot randomized controlled trial of a tailored cognitive behavioural therapy based intervention for depressive symptoms in those newly diagnosed with multiple sclerosis.

BackgroundTo examine the effectiveness and acceptability of an 8-week individual tailored cognitive behavioural therapy (CBT) intervention for the treatment of depressive symptoms in those newly diagnosed with multiple sclerosis.MethodsThe current study presents a pilot, parallel group randomized controlled trial (RCT) with an allocation ratio of 1:1 conducted in a large research and teaching hospital in Melbourne, Australia. 30 individuals with a mean age of 36.93 years (SD = 9.63) who were newly diagnosed with multiple sclerosis (MS) (X = 24.87 months, SD = 15.61) were randomized to the CBT intervention (n = 15) or treatment as usual (TAU) (n = 15). The primary outcome was level of depressive symptoms using the Beck Depression Inventory-II (BDI-II). Secondary outcomes were level of anxiety, fatigue and pain impact, sleep quality, coping, acceptance of MS illness, MS related quality of life, social support, and resilience. Tertiary outcomes were acceptability and adherence to the intervention.ResultsLarge between group treatment effects were found for level of depressive symptoms at post and at 20 weeks follow-up (d = 1.66–1.34). There were also small to large group treatment effects for level of anxiety, fatigue and pain impact, sleep quality, MS related quality of life, resilience, and social support at post and at 20 weeks follow-up (d = 0.17–1.63). There were no drop-outs and participants completed all treatment modules. All participants reported the treatment as ‘very useful’, and most (73.4%) reported that the intervention had addressed their problems ‘completely’.ConclusionsThese data suggest that the tailored early intervention is appropriate and clinically effective for the treatment of depressive symptoms in those newly diagnosed with MS. A larger RCT comparing the CBT intervention with an active comparative treatment with longer term follow-up and cost effectiveness analyses is warranted. The pilot trial has been retrospectively registered on 28/04/2016 with the ISRCTN registry (trial ID ISRCTN10423371).

Extending 'Contact Tracing' into the Community within a 50-Metre Radius of an Index Tuberculosis Patient Using Xpert MTB/RIF in Urban, Pakistan: Did It Increase Case Detection?

BackgroundCurrently, only 62% of incident tuberculosis (TB) cases are reported to the national programme in Pakistan. Several innovative interventions are being recommended to detect the remaining ‘missed’ TB cases. One such intervention involved expanding contact investigation to the community using the Xpert MTB/RIF test.MethodsThis was a before and after intervention study involving retrospective record review. Passive case finding and household contact investigation was routinely done in the pre-intervention period July 2011-June 2013. Four districts with a high concentration of slums were selected as intervention areas; Lahore, Rawalpindi, Faisalabad and Islamabad. Here, in the intervention period, July 2013-June 2015, contact investigation beyond household was conducted: all people staying within a radius of 50 metres (using Geographical Information System) from the household of smear positive TB patients were screened for tuberculosis. Those with presumptive TB were investigated using smear microscopy and the Xpert MTB/RIF test was performed on smear negative patients. All the diagnosed TB patients were linked to TB treatment and care.ResultsA total of 783043 contacts were screened for tuberculosis: 23741(3.0%) presumptive TB patients were identified of whom, 4710 (19.8%) all forms and 4084(17.2%) bacteriologically confirmed TB patients were detected. The contribution of Xpert MTB/RIF to bacteriologically confirmed TB patients was 7.6%. The yield among investigated presumptive child TB patients was 5.1%. The overall yield of all forms TB patients among investigated was 22.3% among household and 19.1% in close community. The intervention contributed an increase of case detection of bacteriologically confirmed tuberculosis by 6.8% and all forms TB patients by 7.9%.ConclusionCommunity contact investigation beyond household not only detected additional TB patients but also increased TB case detection. However, further long term assessments and cost-effectiveness studies are required before national scale-up.

Neer Award 2016: Outpatient total shoulder arthroplasty in an ambulatory surgery center is a safe alternative to inpatient total shoulder arthroplasty in a hospital: a matched cohort study

Recent emphasis on safe and efficient delivery of high-quality health care has increased interest in outpatient total joint arthroplasty. The purpose of this study was to evaluate the safety of outpatient total shoulder arthroplasty (TSA) by comparing episode-of-care complications in matched cohorts of patients with anatomic TSA as an outpatient or inpatient procedure. Thirty patients with outpatient TSA at a freestanding ambulatory surgery center (ASC) were compared with an age- and comorbidities-matched cohort of 30 patients with traditional inpatient TSA to evaluate 90-day episode-of-care complications, including hospital admissions or readmissions and reoperations. Two-tailed t-tests were used to evaluate differences, and differences of P < .05 were considered statistically significant. No significant differences were found between the ASC and hospital cohorts regarding average age, preoperative American Society of Anesthesiologists score, operative indications, or body mass index. No patient required reoperation. There were no hospital admissions from the ASC cohort and no readmissions from the hospital cohort. Minor complications in the ASC cohort were arthrofibrosis in 2 patients and mild asymptomatic anterior subluxation in 1 patient; the only major complication was in an outpatient who fell 11 weeks after surgery and disrupted his subscapularis repair. Three minor complications in the hospital cohort were mild asymptomatic anterior subluxation, blood transfusion, and superficial venous thrombosis. The complication rates (13% vs. 10%) were not significantly different. Outpatient TSA is a safe alternative to hospital admission in appropriately selected patients. Further investigation is warranted to evaluate the longer term outcomes and cost-effectiveness of outpatient TSA.

Estimating the economic impact of a possible equine and human epidemic of West Nile virus infection in Belgium.

This study aimed at estimating, in a prospective scenario, the potential economic impact of a possible epidemic of WNV infection in Belgium, based on 2012 values for the equine and human health sectors, in order to increase preparedness and help decision-makers. Modelling of risk areas, based on the habitat suitable for Culex pipiens, the main vector of the virus, allowed us to determine equine and human populations at risk. Characteristics of the different clinical forms of the disease based on past epidemics in Europe allowed morbidity among horses and humans to be estimated. The main costs for the equine sector were vaccination and replacement value of dead or euthanised horses. The choice of the vaccination strategy would have important consequences in terms of cost. Vaccination of the country’s whole population of horses, based on a worst-case scenario, would cost more than EUR 30 million; for areas at risk, the cost would be around EUR 16–17 million. Regarding the impact on human health, short-term costs and socio-economic losses were estimated for patients who developed the neuroinvasive form of the disease, as no vaccine is available yet for humans. Hospital charges of around EUR 3,600 for a case of West Nile neuroinvasive disease and EUR 4,500 for a case of acute flaccid paralysis would be the major financial consequence of an epidemic of West Nile virus infection in humans in Belgium.

General Practitioner Antimicrobial Stewardship Programme Study (GAPS): protocol for a cluster randomised controlled trial.

BackgroundThere is a strong link between antibiotic consumption and the rate of antibiotic resistance. In Australia, the vast majority of antibiotics are prescribed by general practitioners, and the most common indication is for acute respiratory infections. The aim of this study is to assess if implementing a package of integrated, multifaceted interventions reduces antibiotic prescribing for acute respiratory infections in general practice.Methods/designThis is a cluster randomised trial comparing two parallel groups of general practitioners in 28 urban general practices in Queensland, Australia: 14 intervention and 14 control practices. The protocol was peer-reviewed by content experts who were nominated by the funding organization.This study evaluates an integrated, multifaceted evidence-based package of interventions implemented over a six month period. The included interventions, which have previously been demonstrated to be effective at reducing antibiotic prescribing for acute respiratory infections, are: delayed prescribing; patient decision aids; communication training; commitment to a practice prescribing policy for antibiotics; patient information leaflet; and near patient testing with C-reactive protein.In addition, two sub-studies are nested in the main study: (1) point prevalence estimation carriage of bacterial upper respiratory pathogens in practice staff and asymptomatic patients; (2) feasibility of direct measures of antibiotic resistance by nose/throat swabbing.The main outcome data are from Australia’s national health insurance scheme, Medicare, which will be accessed after the completion of the intervention phase. They include the number of antibiotic prescriptions and the number of patient visits per general practitioner for periods before and during the intervention. The incidence of antibiotic prescriptions will be modelled using the numbers of patients as the denominator and seasonal and other factors as explanatory variables. Results will compare the change in prescription rates before and during the intervention in the two groups of practices.Semi-structured interviews will be conducted with the general practitioners and practice staff (practice nurse and/or practice manager) from the intervention practices on conclusion of the intervention phase to assess the feasibility and uptake of the interventions.An economic evaluation will be conducted to estimate the costs of implementing the package, and its cost-effectiveness in terms of cost per unit reduction in prescribing.DiscussionThe results on the effectiveness, cost-effectiveness, acceptability and feasibility of this package of interventions will inform the policy for any national implementation.Trial registrationThe GAPS trial is registered under the Australian New Zealand Clinical Trials Register, reference number: ACTRN12615001128583 (registered 26/10/2015).

ECONOMIC EVALUATION OF RAINBOW TROUT (Oncorhynchus mykiss) FARMING FED WITH DIFFERENT COMPOSITION FEED

This paper evaluates the eff ects of two diff erent feeds on production results and economic performance in the rainbow trout (Oncorhynchus mykiss) farming. The first group (O-1) was fed with a standard complete pelleted feed, and the second group (O-2) was fed with combined feed consisting of 75 % pellets and 25 % of sardines. Better results were obtained with the O-2 group, while the O-1 group achieved results characteristic for local farming conditions and feed quality. Experimental group O-2 had signifi cantly higher (p&lt;0,01) growth rate when compared to group O-1. Considering current feed and fi nal product (fi sh) prices in the market, better results in terms of cost-eff ectiveness were obtained (E&gt;0,00) in O-2 group of trout fed with the combined meal.

Cost-effectiveness of scaling up mass drug administration for the control of soil-transmitted helminths: a comparison of cost function and constant costs analyses

The coverage of mass drug administration (MDA) for neglected tropical diseases, such as the soil-transmitted helminths (STHs), needs to rapidly expand to meet WHO's 2020 targets. We aimed to compare use of a cost function to take into account economies of scale to the standard method of assuming a constant cost per treatment when investigating the cost and cost-effectiveness of scaling up a STH MDA programme targeting Ascaris lumbricoides. We fitted a cost function describing how the costs of MDA change with scale to empirical cost data and incorporated it into a STH transmission model. Using this cost function, we investigated the consequences of taking into account economies of scale on the projected cost-effectiveness of STH control, by comparison with the standard method of assuming a constant cost per treatment. The cost function was fitted to economic cost data collected as part of a school-based deworming programme in Uganda using maximum likelihood methods. We used the model to investigate the total reduction in the overall worm burden, the total number of prevalent infection case-years averted, and the total number of heavy infection case-years averted. For each year, we calculated the effectiveness as the difference between the worm burden or number of cases and the number in absence of treatment. When using the cost function, the cost-effectiveness of STH control markedly increased as the programme was scaled up. By contrast, the standard method (constant cost per treatment) undervalued this and generated misleading conclusions. For example, when scaling up control in the projected district from 10% to 75% coverage of at-risk school-age children, the cost-effectiveness in terms of prevention of heavy burden infections was projected to increase by over 70% when using the cost function, but decrease by 18% when assuming a constant cost per treatment. The current exclusion of economies of scale in most economic analyses must be addressed if the most cost-effective policies for the control of neglected tropical diseases are to be formulated. These findings are also relevant to other large-scale disease interventions. GlaxoSmithKline, Bill & Melinda Gates Foundation, Partnership for Child Development, and Wellcome Trust.

Outcomes for residential or inpatient intensive treatment of obsessive–compulsive disorder: A systematic review and meta-analysis

Little data exist to inform the treatment of severe or treatment refractory obsessive–compulsive disorder (OCD) in an inpatient or residential setting. We aimed to determine effect size of inpatient, residential or day-patient program in people with OCD. Studies were selected if they were conducted in an inpatient, day-patient or residential setting; were using the Yale Brown Obsessive Compulsive Scale (Y-BOCS) as an outcome measure; treatment included cognitive behavior therapy; it involved adult patients; and had a sample size of at least 20. We identified 19 studies with a total of 2306 participants at admission. We extracted the mean and standard deviation pre-admission and at discharge. The overall reduction was 10.7 points (95% CI: 9.8–11.5, z=24.2 p<0.001) with an effect size, Hedges g, of 1.87. Being married or cohabiting consistently predicted better outcomes, and symptoms of hoarding or comorbid alcohol misuse consistently predicted worse outcomes. Clients with severe or treatment refractory OCD can make significant improvements with intensive residential or inpatient therapy but little is known either about its long term benefits or cost effectiveness compared with an alternative. Programs are offered internationally with a variety of inclusion criteria. We discuss how such programs might be optimized.

The Irish Cost-Effectiveness Threshold: Does it Support Rational Rationing or Might it Lead to Unintended Harm to Ireland’s Health System?

Ireland is one of the few countries worldwide to have an explicit cost-effectiveness threshold. In 2012, an agreement between government and the pharmaceutical industry that provided substantial savings on existing medications set the threshold at €45,000/quality-adjusted life-year (QALY). This replaced a previously unofficial threshold of €20,000/QALY. According to the agreement, drugs within the threshold will be granted reimbursement, whereas those exceeding it may still be approved following further negotiation. A number of drugs far exceeding the threshold have been approved recently. The agreement only applies to pharmaceuticals. There are four reasons for concern regarding Ireland's threshold. The absence of an explicit threshold for non-drug interventions leaves it unclear if there is parity in willingness to pay across all interventions. As the threshold resembles a price floor rather than a ceiling, in principle it only offers a weak barrier to cost-ineffective interventions. It has no empirical basis. Finally, it is probably too high given recent estimates of a threshold for the UK based on the cost effectiveness of services forgone of approximately £13,000/QALY. An excessive threshold risks causing the Irish health system unintended harm. The lack of an empirically informed threshold means the policy recommendations of cost-effectiveness analysis cannot be considered as fully evidence- based rational rationing. Policy makers should consider these issues and recent Irish legislation that defined cost effectiveness in terms of the opportunity cost of services forgone when choosing what threshold to apply once the current industry agreement expires at the end of 2015

Restricting Second-Generation Energy Crop Production to Marginal Land

Production of switchgrass as a dedicated energy crop in the USA was proposed as a way to produce valuable products on millions of hectares that had been bid from traditional crop production by a variety of federal programs. The objective of the present study is to determine the expected economic consequences in terms of cost to deliver biomass feedstock, from restricting switchgrass production to marginal land for a case study region, when (a) land use is restricted to class IV; (b) land use is restricted to classes III and IV; and (c) use of land capability classes I, II, III, and IV is permitted. A hypothetical biorefinery with a processing capacity of 2000 Mg/day is assumed with switchgrass as the single biomass source. Soils and weather data were used in combination with crop management data to simulate switchgrass yields for each land capability class, for 50 years, for each of 30 Oklahoma counties. Land opportunity cost required to bid land from current use for each land capability class and each county were simulated based on the 2013 revealed county average Conservation Reserve Program (CRP) rental rates adjusted across capability class by relative productivity. A mathematical programming model was constructed and solved to determine the optimal quantity, location, and quality of the land leased. For the case study region, restricting land use to only capability class IV increases the land requirement by 44 % and increases the cost to deliver feedstock by 32 % compared to when switchgrass production is permitted on land classes I–IV.

Spatial prioritisation for conserving ecosystem services: comparing hotspots with heuristic optimisation.

ContextThe variation in spatial distribution between ecosystem services can be high. Hence, there is a need to spatially identify important sites for conservation planning. The term ‘ecosystem service hotspot’ has often been used for this purpose, but definitions of this term are ambiguous.ObjectivesWe review and classify methods to spatially delineate hotspots. We test how spatial configuration of hotspots for a set of ecosystem services differs depending on the applied method. We compare the outcomes to a heuristic site prioritisation approach (Marxan).MethodsThe four tested hotspot methods are top richest cells, spatial clustering, intensity, and richness. In a conservation scenario we set a target of conserving 10 % of the quantity of five regulating and cultural services for the forest area of Telemark county, Norway.ResultsSpatial configuration of selected areas as retrieved by the four hotspots and Marxan differed considerably. Pairwise comparisons were at the lower end of the scale of the Kappa statistic (0.11–0.27). The outcomes also differed considerably in mean target achievement, cost-effectiveness in terms of land-area needed per unit target achievement and compactness in terms of edge-to-area ratio.Conclusions An ecosystem service hotspot can refer to either areas containing high values of one service or areas with multiple services. Differences in spatial configuration among hotspot methods can lead to uncertainties for decision-making. This also has consequences for analysing the spatial co-occurrence of hotspots of multiple services and of services and biodiversity.Electronic supplementary materialThe online version of this article (doi:10.1007/s10980-015-0258-5) contains supplementary material, which is available to authorized users.