Terms Of Cost-effectiveness Research Articles

Performance Analysis of Machine Learning Algorithms for Cervical Cancer Detection

Cervical cancer is second most prevailing cancer in women all over the world and the Pap smear is one of the most popular techniques used to diagnosis cervical cancer at an early stage. Developing countries like India has to face the challenges in order to handle more cases day by day. In this article, various online and offline machine learning algorithms has been applied on benchmarked data sets to detect cervical cancer. This article also addresses the problem of segmentation with hybrid techniques and optimizes the number of features using extra tree classifiers. Accuracy, precision score, recall score, and F1 score are increasing in the proportion of data for training and attained up to 100% by some algorithms. Algorithm like logistic regression with L1 regularization has an accuracy of 100%, but it is too much costly in terms of CPU time in comparison to some of the algorithms which obtain 99% accuracy with less CPU time. The key finding in this article is the selection of the best machine learning algorithm with the highest accuracy. Cost effectiveness in terms of CPU time is also analysed.

P88 Intensive management in moderate established rheumatoid arthritis: the titrate trial

Abstract Background Intensive management (IM) using treat-to-target principles has been shown to be effective in many trials of early rheumatoid arthritis (RA) in patients with high disease activity levels. There is no trial evidence that this approach benefits patients with moderately active RA - a dominant group in clinics. We tested the hypothesis that IM increases remission rates in established moderate RA patients (DAS28-ESR 3.2-5.1) receiving stable conventional synthetic disease modifying drugs (csDMARDs) compared to standard care (SC). IM comprised of: (a)monthly clinical assessments; (b)treat-to-target titrated medication including biologics; (c)psycho-social support delivered by trained nurses and other practitioners in motivational interviewing techniques. Methods A multicentre individually randomised trial compared IM (using combination DMARDs, depot steroid, biologics in non-responders, alongside supportive care using motivational interviewing techniques from trained nurses) to standard care (SC) patients receiving their usual clinical care. The primary outcome was 12-months remission by DAS28-ESR. Secondary outcomes: alternative remission assessments, disability via the health assessment questionnaire (HAQ), pain, fatigue, erosive progression and harm. Multivariable logistic and linear regression compared treatment approaches under intention-to-treat with multiple imputation for missing data. Cost, quality-adjusted life years (QALYs) from the EQ-5D-5L instrument mapped to EQ5D-3L, and incremental cost-effectiveness ratios (ICERs) were calculated, for within trial period. Results 459 patients were screened and 335 randomised (168 IM; 167 SC); 303(90%) gave 12-month outcome measures. 139(83%) IM patients attended sessions. At 12 months IM significantly increased DAS28-ESR remissions compared to SC (32% vs 18%, p = 0.004) and other remission assessments. IM increased DAS28-ESR low disease activity (48% vs 32%, p = 0.005). Clinically important reductions in HAQ were seen in patients who achieved remission following IM (mean change at 12-months -0.40; 95% confidence intervals -0.57,-0.22), as well as improvements in both fatigue and pain. There was a minimal increase in erosive damage over 12 months in both groups. Serious adverse events (IM = 15 vs SC = 11) and other adverse events (114 IM,151 SC) were similar between groups. The base case ICER was £43,972 (€51,474) with a probability of being cost effective at £30,000/€35,000 of 0.17. The ICER fell to £29,363 (€24,384) after including patients’ personal costs and lost working time with a probability IM is cost-effective of 0.5 at UK willing to pay thresholds. This estimate was based on the historic prices of biologics and the probability is higher when current drug acquisition costs are applied. Conclusion IM by trained nurses in motivational interviewing techniques is clinically effective in moderate established RA, achieving more remission without increasing harm. It also gave clinically important improvement in pain and fatigue. There is a strong case to adopt this approach in routine practice as increasing remission rates may improve long-term outcomes, reduce future biologic prescribing and thereby improve long term cost-effectiveness. Disclosures E. Nikiphorou None.

A Dominance based Rough Set analysis for investigating employee perception of safety at workplace and safety compliance

Managing safety in the workplace is a pressing need for organizations and firms especially in the highly competitive world where the success of firms hinges on the overall productivity of organizations. Ensuring high productivity clearly relies on the efficiency of its workforce. Safety of employees is, therefore, an immediate concern that needs to be addressed to avoid negative consequences in terms of cost to the organizations and the subsequent reduction in productivity. Past literature is indicative of the fact that the major reason responsible for accidents occurring at workplace is unsafe behavior. To assess the behavior of the employees in safety context, perception analysis was conducted through a survey-based study of 98 employees of a construction industry where the Workplace Safety Scale (WSS) was administered and the analysis was performed using Dominance based Rough Set Analysis (DRSA). DRSA proved instrumental in dealing with the ambiguities in the preference ordered scenario and decision rules that were derived were a better and more intuitive display of the real-world situation with exceptionally high accuracy. Analysis revealed that the safety of the Supervisor and the co-workers amounted to be the better predictors of safety compliance of the employees. This primarily signifies the role that management has to play in ensuring the safety at workplace and increasing awareness amongst the employees about the importance of following safety rules while at work. Interestingly, the results also showed that all the constructs in the WSS contributed positively in the prediction of the safety compliance of the employees which was found to be consistent with the past studies done in the field of occupational hazards and safety.

Assertive outreach treatment versus care as usual for the treatment of high-need, high-cost alcohol related frequent attenders: study protocol for a randomised controlled trial

BackgroundAlcohol-related hospital admissions have doubled in the last ten years to > 1.2 m per year in England. High-need, high-cost (HNHC) alcohol-related frequent attenders (ARFA) are a relatively small subgroup of patients, having multiple admissions or attendances from alcohol during a short time period. This trial aims to test the effectiveness of an assertive outreach treatment (AOT) approach in improving clinical outcomes for ARFA, and reducing resource use in the acute setting.MethodsOne hundred and sixty ARFA patients will be recruited and following baseline assessment, randomly assigned to AOT plus care as usual (CAU) or CAU alone in equal numbers. Baseline assessment includes alcohol consumption and related problems, physical and mental health comorbidity and health and social care service use in the previous 6 months using standard validated tools, plus a measure of resource use. Follow-up assessments at 6 and 12 months after randomization includes the same tools as baseline plus standard measure of patient satisfaction. Outcomes for CAU + AOT and CAU at 6 and 12 months will be compared, controlling for pre-specified baseline measures. Primary outcome will be percentage of days abstinent at 12 months. Secondary outcomes include emergency department (ED) attendance, number and length of hospital admissions, alcohol consumption, alcohol-related problems, other health service use, mental and physical comorbidity 6 and 12 months post intervention. Health economic analysis will estimate the economic impact of AOT from health, social care and societal perspectives and explore cost-effectiveness in terms of quality adjusted life years and alcohol consumption at 12-month follow-up.DiscussionAOT models piloted with alcohol dependent patients have demonstrated significant reductions in alcohol consumption and use of unplanned National Health Service (NHS) care, with increased engagement with alcohol treatment services, compared with patients receiving CAU. While AOT interventions are costlier per case than current standard care in the UK, the rationale for targeting HNHC ARFAs is because of their disproportionate contribution to overall alcohol burden on the NHS. No previous studies have evaluated the clinical and cost-effectiveness of AOT for HNHC ARFAs: this randomized controlled trial (RCT) targeting ARFAs across five South London NHS Trusts is the first.Trial registrationInternational standard randomized controlled trial number (ISRCTN) registry: ISRCTN67000214, retrospectively registered 26/11/2016.

POTENTIAL APPLICATION OF THE MODULAR SYSTEM IN TRADITIONAL MALAY HOUSE IN MODERN CONSTRUCTION INDUSTRY

Modular system allows many advantages in construction process and final production. Some of the lists are cost-effectiveness in terms of time consuming in site, labour, product materials and many more. The quality of modular system also can be monitored wisely as it develop in factory in mass production according to the design. Therefore there are posible to reduce risk in of non-functional components and create standardization of each component and interface. This paper proposes the implementation of modular system integrated with the traditional Malay house components potentianally the non-structural components such as wall, window and staircase. The traditional Malay house system is basically a modular system in terms of measurement, panel dismantle-reassemble method, expandable and moveable as well. The issues of modular using the traditional human measurement will be analysed using observation and site visit and analysis. Details of traditional Malay housing components will be analysed and the suitable components for modular system will be selected. The system that will be generated can be applied to the housing development in Malaysia and meantimes preserving the aesthetic elements of the traditional Malay house. The outcome of this paper will create a conceptual of modular housing system implemented of traditional housing components in building environment.

Sugar or salt ("SOS"): A protocol for a UK multicentre randomised trial of mannitol and hypertonic saline in severe traumatic brain injury and intracranial hypertension.

Hyperosmolar solutions are widely used to treat raised intracranial pressure following severe traumatic brain injury. Although mannitol has historically been the most frequently administered, hypertonic saline solutions are increasingly being used. However, definitive evidence regarding their comparative effectiveness is lacking. The Sugar or Salt Trial is a UK randomised, allocation concealed open label multicentre pragmatic trial designed to determine the clinical and cost-effectiveness of hypertonic saline compared with mannitol in the management of patients with severe traumatic brain injury. Patients requiring intensive care unit admission and intracranial pressure monitoring post-traumatic brain injury will be allocated at random to receive equi-osmolar boluses of either mannitol or hypertonic saline following failure of routine first-line measures to control intracranial pressure. The primary outcome for the study will be the Extended Glasgow Outcome Scale assessed at six months after randomisation. Results will inform current clinical practice in the routine use of hyperosmolar therapy as well as assess the impact of potential side effects. Pre-planned longer term clinical and cost effectiveness analyses will further inform the use of these treatments.

A Comparison of Matching and Weighting Methods for Causal Inference Based on Routine Health Insurance Data, or: What to do If an RCT is Impossible.

Due to a multitude of reasons Randomized Control Trials on the basis of so-called "routine data" provided by insurance companies cannot be conducted. Therefore the estimation of "causal effects" for any kind of treatment is hampered since systematic bias due to specific selection processes must be suspected. The basic problem of counterfactual, which is to evaluate the difference between two potential outcomes for the same unit, is discussed. The focus lies on the comparison of the performance of different approaches to control for systematic differences between treatment and control group. These strategies are all based on propensity scores, namely matching or pruning, IPTW (inverse probability treatment weighting) and entropy balancing. Methods to evaluate these strategies are presented. A logit model is employed with 87 predictors to estimate the propensity score or to estimate the entropy balancing weights. All analyses are restricted to estimate the ATT (Average Treatment Effect for the Treated) Exemplary data come from a prospective controlled intervention-study with two measurement occasions. Data contain 35 857 chronically ill insurants with diabetes, congestive heart failure, arteriosclerosis, coronary heart disease or hypertension of one German sickness fund. The intervention group was offered an individual telephone coaching to improve health behavior and slow down disease progression while the control group received treatment as usual. Randomization took place before the insurants' consent to participate was obtained so assumptions of an RCT are violated. A weighted mixture model (difference-in-difference) as the causal model of interest is employed to estimate treatment effects in terms of costs distinguishing the categories outpatient costs, medication costs, and total costs. It is shown that entropy balancing performs best with respect to balancing treatment and control group at baseline for the first three moments of all 87 predictors. This will result in least biased estimates of the treatment effect.

Multidimensional optimization of electrical discharge machining for high speed steel (AISI M2) using Taguchi-fuzzy approach

Electrical discharge machining (EDM) is one of the non-traditional machining processes characterized by its ability to machine parts that electrically conductive but difficult to be machined in the traditional machining processes due to its high hardness, complex geometry, and low tolerances. To minimize EDM process cost, ensure the highest process efficiency and achieve the highest product quality, the EDM process needs to be optimized. The aim of this research is optimizing EDM process parameters for machining HSS (AISI M2) material by use of copper electrode and brass electrode considering conflicting performance measures in one and multidimensional levels. The performance measures used in the current research are material removal rate (MRR) and electrode wear rate (EWR), while machining parameters that will subject to optimization process are current (A), pulse on (TON), and pulse off (TOFF). During optimization stages, the Taguchi method, signal to noise ratio (S/N ratio), and analysis of variances (ANOVA) will be used in the first stage to find the optimal machining parameters for each performance measure and for each electrode material. In the second stage, multidimensional optimization approach encompasses using the calculated S/N ratio as input from the first stage, fuzzy logic and ANOVA to calculate multi response performance index which will be used to select optimal machining parameters for each electrode and then select the best electrode and optimal machining parameters for machining AISI M2 steel. In one-dimensional optimization, for brass electrode, to maximize MRR value, the optimal machining parameters combination is A3TON1TOFF3 and to minimize EWR value, the optimal machining parameters combination is A1TON1TOFF2. For copper electrode, to maximize MRR value, the optimal machining parameters combination is A1TON1TOFF3 and to minimize EWR value, the optimal machining parameters combination is A1TON3TOFF1. In multidimensional optimization, for the copper electrode, the optimal machining parameters combination was A1TON1TOFF3 and for the brass electrode, the optimal machining parameters combination is A3TON1TOFF3. It could be concluded that EDM machining of HSS (AISI M2) by using the copper electrode will give the best results and the optimal machining parameters combination is A1TON1TOFF3. Yet, further research needs to be conducted to study these results and analyze machining process effectiveness in terms of cost and process sustainability, i.e. environmental impact. This research has both theoretical and practical implications.

Dominican Provider Practices for Cervical Cancer Screening in Santo Domingo and Monte Plata Provinces.

Cervical cancer is the second leading cause of cancer death for women in the Dominican Republic. Pap smear screening in the Dominican Republic has not achieved adequate reduction in cervical cancer mortality. The purpose of this study was to examine Dominican provider practices for cervical cancer screening and the use of national or international screening guidelines. We surveyed 101 gynecology specialists, 50 non-specialists, and 51 obstetrics-gynecology residents in the Santo Domingo and Monte Plata provinces of the Dominican Republic regarding their cervical cancer screening practices and use of guidelines. Bivariate (chi-square) analyses were conducted to compare screening practices by demographic and practice characteristics. The majority of providers followed WHO guidelines (62.9%) and/or Dominican national norms (59.4%). The majority (87%) of providers use time since first sexual activity as the basis for screening initiation; 96% advise screening every 6-12months. The most commonly used screening test is the conventional Pap smear. Colposcopy was recommended most often for all abnormal Pap results. Dominican providers report they follow national and/or international cervical cancer screening guidelines. They do not follow age-based screening guidelines, nor have they adopted an extended interval for screening and continue to recommend screening at least annually. A culture of early and frequent screening has consequences in terms of cost, high demand for follow-up services, and reduced capacity to reach the populations at highest risk. Early screening also may challenge the acceptability of adopting alternative screening technologies such as HPV testing.

Optimising medication data collection in a large-scale clinical trial

ObjectivePharmaceuticals play an important role in clinical care. However, in community-based research, medication data are commonly collected as unstructured free-text, which is prohibitively expensive to code for large-scale studies. The ASPirin in Reducing Events in the Elderly (ASPREE) study developed a two-pronged framework to collect structured medication data for 19,114 individuals. ASPREE provides an opportunity to determine whether medication data can be cost-effectively collected and coded, en masse from the community using this framework.MethodsThe ASPREE framework of type-to-search box with automated coding and linked free text entry was compared to traditional method of free-text only collection and post hoc coding. Reported medications were classified according to their method of collection and analysed by Anatomical Therapeutic Chemical (ATC) group. Relative cost of collecting medications was determined by calculating the time required for database set up and medication coding.ResultsOverall, 122,910 participant structured medication reports were entered using the type-to-search box and 5,983 were entered as free-text. Free-text data contributed 211 unique medications not present in the type-to-search box. Spelling errors and unnecessary provision of additional information were among the top reasons why medications were reported as free-text. The cost per medication using the ASPREE method was approximately USD $0.03 compared with USD $0.20 per medication for the traditional method.ConclusionImplementation of this two-pronged framework is a cost-effective alternative to free-text only data collection in community-based research. Higher initial set-up costs of this combined method are justified by long term cost effectiveness and the scientific potential for analysis and discovery gained through collection of detailed, structured medication data.

Impact of the Maximum Number of Switching Reconfigurations on the Cost Saving in Network Function Virtualization Environments with Elastic Optical Interconnection

Network Function Virtualization is based on the virtualization of the network functions and it is a new technology allowing for a more flexible allocation of cloud and bandwidth resources. In order to employ the flexibility of the technology and to adapt its use according to the traffic variation, reconfigurations of the cloud and bandwidth resources are needed by means of both migration of the Virtual Machines executing the network functions and reconfiguration of circuits interconnecting the Virtual Machines. The objective of the paper is to study the impact of the maximum number of switch reconfigurations on the cost saving that the Networking Function Virtualization technology allows us to achieve. The problem is studied in the case of a scenario with an elastic optical network interconnecting datacenters in which the Virtual Machines are executed. The problem can be formulated as an Integer Linear Programming one introducing a constraint on the maximum number of switch reconfigurations but due to its computational complexity we propose a low computational complexity heuristic allowing for results close to the optimization ones. The results show how the limitation on the number of possible reconfigurations has to be taken into account to evaluate the effectiveness in terms of cost saving that the Virtual Machine migrations in Network Function Virtualization environment allows us to achieve.

Cost-effectiveness analysis of PSA-based mass screening: Evidence from a randomised controlled trial combined with register data.

In contrast to earlier studies which have used modelling to perform cost-effectiveness analysis, this study links data from a randomised controlled trial with register data from nationwide registries to reveal new evidence on costs, effectiveness, and cost-effectiveness of organised mass prostate-cancer screening based on prostate-specific antigen (PSA) testing. Cost-effectiveness analyses were conducted with individual-level data on health-care costs from comprehensive registers and register data on real-world effectiveness from the two arms of the Finnish Randomised Study of Screening for Prostate Cancer (FinRSPC), following 80,149 men from 1996 through 2015. The study examines cost-effectiveness in terms of overall mortality and, in addition, in terms of diagnosed men's mortality from prostate cancer and mortality with but not from prostate cancer. Neither arm of the FinRSPC was clearly more cost-effective in analysis in terms of overall mortality. Organised screening in the FinRSPC could be considered cost-effective in terms of deaths from prostate cancer: averting just over one death per 1000 men screened. However, even with an estimated incremental cost-effectiveness ratio of below 20,000€ per death avoided, this result should not be considered in isolation. This is because mass screening in this trial also resulted in increases in death with, but not from, prostate cancer: with over five additional deaths per 1000 men screened. Analysis of real-world data from the FinRSPC reveals new evidence of the comparative effectiveness of PSA-based screening after 20 years of follow-up, suggesting the possibility of higher mortality, as well as higher healthcare costs, for screening-arm men who have been diagnosed with prostate cancer but who do not die from it. These findings should be corroborated or contradicted by similar analyses using data from other trials, in order to reveal if more diagnosed men have also died in the screening arms of other trials of mass screening for prostate cancer.

On Mimesis, Folkways, and the Impossibility of Christianity

Neither rationally constructed nor intentionally imposed, humans live much of their lives guided by unspoken folkway traditions passed on from genera- tion to generation. As the American sociologist William Graham Sumner reminded us over a century ago, those norms that prescribe “acceptable” social behavior bubble up from everyday life experience, rather than imposed from the top by cultural authorities. Sumner’s insights throw further light on the mimetic theory developed by René Girard and offer a more nuanced understanding of how mimesis actually works. The benefit of the extraordinary grip that folkway traditions hold on us is their utilitarian value and resultant cost-effectiveness in terms of expenditure of mental energy. We follow folkway traditions to save time and mental energy. It is the thesis of this paper that Jesus recognized this power of customary thinking as a determinant of human behavior, and it was his strategy to attack specifically those folkway traditions that were exclusionary in nature in “shocking” ways that agitated many who followed generally accepted behavioral norms. As a result, it is wrong to take Jesus for a moral law-giver, even with such benign terms as a new “law of love,” or the like. In fact, he did not propose a new formal legal tradition, but challenged individuals to reflect consciously on their unthinking behavior and assume responsible ownership of it. To follow Jesus, therefore, does not so much imply a deeper understanding of love, but a deeper understanding of the unconscious decision-making processes that unwittingly guide our everyday lives.

A randomised controlled trial exploring the impact of a dedicated health and social care professionals team in the emergency department on the quality, safety, clinical and cost-effectiveness of care for older adults: a study protocol

BackgroundOlder people are frequent emergency department (ED) users who present with complex issues that are linked to poorer health outcomes following the index visit, often have increased ED length of stay, and tend to have raised healthcare costs. Encouraging evidence suggests that ED teams involving health and social care professionals (HSCPs) can contribute to enhanced patient flow and an improved patient experience by improving care decision-making and thus promoting timely and effective care. However, the evidence supporting the impact of HSCP teams assessing and intervening with older adults in the ED is limited and identifies important methodological limitations, highlighting the need for more robust and comprehensive investigations of this model of care. This study aims to evaluate the impact of a dedicated ED-based HSCP team on the quality, safety, and clinical- and cost-effectiveness of care of older adults when compared with usual care.MethodsThe study is a single-site randomised controlled trial whereby patients aged ≥65 years who present to the ED of a large Irish hospital will be randomised to the experimental group (ED-based HSCP assessment and intervention) or the control group (usual ED care). The recruitment target is 320 participants. The HSCP team will provide a comprehensive functional assessment as well as interventions to promote a safe discharge for the patient. The primary outcome is ED length of stay (from arrival to discharge). Secondary outcomes include: rates of hospital admissions from the ED, ED re-visits, unplanned hospital admissions and healthcare utilisation at 30 days, and 4 and 6 months of follow-up; patient functional status and quality of life (at baseline and follow-up); patient satisfaction; cost-effectiveness in terms of costs associated with ED-based HSCP compared with usual care; and perceptions on implementation by ED staff members.DiscussionThis is the first randomised controlled trial testing the impact of HSCPs working in teams in the ED on the quality, safety, and clinical- and cost-effectiveness of care for older patients. The findings of this study will provide important information on the effectiveness of this model of care for future implementation.Trial registrationClinicalTrials.gov, NCT03739515. Registered on 12 November 2018.

Progressive Infrastructure Projects in Indonesia: Views on Potential Growing Geoforensic and Dispute Cases

Recently, progressive government infrastructure projects on: roads and bridges, harbour, oil and gas, water and sanitation, railroad, electricity, city transportation and information technology have reached big records of government projects since the independence of Indonesia – A country with 17.504 islands and projected population in 2030 of 350 million. Every construction project carries its years of serviceability usually between 50 – 100 years. During and before that time, cost of risk due to the unfulfillment of engineering standard of design, construction, management, usage and maintenance can cause problems. Cases of past project failures that bring consequences in terms of cost, disfunction/failure and sometimes people’s lives in some of the past projects are analyzed from the geoforensic point of view as cases to be avoided from the early beginning when the project was physically decided to be constructed in a certain geophysical area in specific parts of Indonesia.

A cost-effectiveness analysis of dialectical behaviour therapy for treating individuals with borderline personality disorder in the community.

This paper investigates the cost-effectiveness of dialectical behaviour therapy (DBT) for treating individuals with borderline personality disorder (BPD) in a community setting in Ireland, in the short term. Resource utilisation and effectiveness data were collected as part of the National DBT Project, Ireland, and are incorporated into a cost-effectiveness analysis. The perspective taken was that of the service provider and payer. Direct health resources were included and effectiveness was measured using the EQ-5D-5L questionnaire. To examine cost-effectiveness, incremental costs are compared with incremental quality-adjusted life years, to estimate an incremental cost-effectiveness ratio. A probabilistic sensitivity analysis was employed to investigate parameter uncertainty. Scenario analyses are employed to investigate cost-effectiveness of DBT with varying assumptions around effectiveness and costs. The baseline analysis reveals that DBT is more expensive and more effective than routine clinical care (without DBT). The low incremental cost-effectiveness ratio suggests DBT can be considered cost effective in the short term. In each scenario analyses considered, the probability that DBT is cost effective is greater than 50%. Mental health care provision, including that of DBT, varies across jurisdictions, necessitating economic evaluations of current practice in community-based services, on a country-by-country basis, to inform resource allocation decisions. In line with previous research, the analysis here indicates DBT can be considered cost effective in the short term. Future data collection on alternative comparators and long-term outcomes associated with DBT is warranted to investigate the longer term cost-effectiveness of DBT.

Protocols for early discharging of premature infants: an empirical assessment on safety and savings.

Background Preterm newborns may be discharged when clinical conditions are stable. Several criteria for early discharge have been proposed in the literature. This study carried out the first quantitative comparison of their impact in terms of hospitalization savings, safety and costs. Methods This study was based on the clinical histories of 213 premature infants born in the Neonatal Intensive Care Unit of Padova University Hospital between 2013 and 2014. Seventeen early discharge criteria were drawn from the literature and retrospectively applied to these data, and computation of hospitalization savings, safety and costs implied by each criterion was carried out. Results Among the criteria considered, average gains ranged from 1.1 to 10.3 hospital days and between 0.3 and 1.1 fewer infections per discharged infant. Criteria that led to saving more hospital days had higher cost-effectiveness in terms of crisis and infection, and they spared infants from more infections. However, episodes of apnea and bradycardia were detected after the potential early discharge date for all criteria, with a mean number of episodes numbering between 0.3 and 1.4. Conclusion The results highlight a clear trade-off between days saved and health risks for infants, with potential consequences for health care costs.

Type 2 diabetes remission: economic evaluation of the DiRECT/Counterweight-Plus weight management programme within a primary care randomized controlled trial.

The Counterweight-Plus weight management programme achieved 46% remission of Type 2 diabetes at 1year in the DiRECT trial. We estimated the implementation costs of the Counterweight-Plus programme and its 1-year cost-effectiveness in terms of diabetes remission, compared with usual care, from the UK National Health Service (NHS) perspective. Within-trial total costs included programme set-up and running costs (practitioner appointment visits, low-energy formula diet sachets and training), oral anti-diabetes and anti-hypertensive medications, and healthcare contacts. Total costs were calculated for aggregated resource use for each participant and 95% confidence intervals (CI) were based on 1000 non-parametric bootstrap iterations. One-year programme costs under trial conditions were estimated at £1137 per participant (95% CI £1071, £1205). The intervention led to a significant cost-saving of £120 (95% CI £78, £163) for the oral anti-diabetes drugs and £14 (95% CI £7.9, £22) for anti-hypertensive medications compared with the control. Deducting the cost-savings of all healthcare contacts from the intervention cost resulted an incremental cost of £982 (95% CI £732, £1258). Cost per 1year of diabetes remission was £2359 (95% CI £1668, £3250). Remission of Type 2 diabetes within 1-year can be achieved at a cost below the annual cost of diabetes (including complications). Providing a reasonable proportion of remissions can be maintained over time, with multiple medical gains expected, as well as immediate social benefits, there is a case for shifting resources within diabetes care budgets to offer support for people with Type 2 diabetes to attempt remission. (Clinical Trial Registry No.: ISRCTN03267836).

2399-PUB: Multidisciplinary Clinic-Based Model for Mild Ketosis and Dehydration Management in Youth with Diabetes

Background: Diabetic ketoacidosis (DKA) is a major cause of emergencies in youth with type 1 diabetes constituting a health burden. Nonadherence and knowledge gaps are key contributors. Patients with mild ketosis and dehydration are typically managed in the EC without multidisciplinary evaluation. Objective: We developed a quality improvement initiative to improve access and reduce emergency center (EC) visits for pediatric patients with type I diabetes with mild ketosis not tolerating oral intake, and to deliver family centered multidisciplinary education addressing diabetes knowledge gaps and psychosocial barriers. Methods: A multidisciplinary focus group of physicians, nurses, certified diabetes educators (CDE), and social workers (SW), determined criteria for patients who could be cared for in Urgent Care Bay (UCB) rather than EC. Eligible patients with type 1 diabetes were >5 years old who could not tolerate oral intake, and had low-to-moderate ketones. SW identified and addressed psychosocial barriers to optimal diabetes management. CDE assessed and provided structured education addressing knowledge gaps. Results: Of 17 referred patients, 9 were seen in UCB (8 by CDE; 7 by SW). None required transfer to EC. SW referred 4 patients to psychology: 2 seen in UCB, 2 referred to community psychology. Time spent in multidisciplinary UCB visit was not longer than traditional EC-managed visits. Conclusion: This multidisciplinary approach may help pediatric patients with diabetes with mild ketosis who are not tolerating oral intake. Multidisciplinary teaching and psychosocial interventions provided while patients are only mildly sick may help patients avoid future admissions. It remains to be seen whether this comprehensive model of education and hydration of mildly sick patients with diabetes will provide cost effectiveness in terms of overall EC admissions. Disclosure G.K. Kim: None. A. Mixon: None. M.A. Marshall: None. M.E. Taub: None. M. Jaramillo: None. D. Scroggins: None. N. Bansal: None. L. Karaviti: None. S. Mckay: None.

Three-Dimensional (3-D) Printing Technology Exploited for the Fabrication of Drug Delivery Systems.

The conventional dosage forms cannot be administered to all patients because of interindividual variability found among people of different race coupled with different metabolism and cultural necessities. Therefore, to address this global issue there is a growing focus on the fabrication of new drug delivery systems customised to individual needs. Medicinal products printed using 3-D technology are transforming the current medicine business to a plausible alternative of conventional medicines. The PubMed database and Google scholar were browsed by keywords of 3-D printing, drug delivery, and personalised medicine. The data about techniques employed in the manufacturing of 3-D printed medicines and the application of 3-D printing technology in the fabrication of individualised medicine were collected, analysed and discussed. Numerous techniques can fabricate 3-D printed medicines however, printing-based inkjet, nozzle-based deposition and laser-based writing systems are the most popular 3-D printing methods which have been employed successfully in the development of tablets, polypills, implants, solutions, nanoparticles, targeted and topical dug delivery. In addition, the approval of Spritam® containing levetiracetam by FDA as the primary 3-D printed drug product has boosted its importance. However, some drawbacks such as suitability of manufacturing techniques and the available excipients for 3-D printing need to be addressed to ensure simple, feasible, reliable and reproducible 3-D printed fabrication. 3-D printing is a revolutionary in pharmaceutical technology to cater the present and future needs of individualised medicines. Nonetheless, more investigations are required on its manufacturing aspects in terms cost effectiveness, reproducibility and bio-equivalence.