Cost-effective Research Articles

Updated cost-effectiveness analysis of tislelizumab in combination with chemotherapy for the first-line treatment of advanced gastric cancer or gastroesophageal junction adenocarcinoma

ObjectiveThe RATIONALE-305 trial demonstrated that tislelizumab in combination with chemotherapy regimens was more beneficial than chemotherapy regimens alone in the treatment of patients with advanced gastric cancer or gastroesophageal junction adenocarcinoma (GC/GEJC). This study aimed to evaluate the cost-effectiveness of tislelizumab combination chemotherapy in the treatment of advanced GC/GEJC from the perspective of the Chinese health service system.MethodsA three-state partition survival model was constructed to evaluate the economics of tislelizumab combined with chemotherapy as the first-line treatment of advanced GC/GEJC. Clinical data were collected from the RATIONALE-305 trial, and the incremental cost-effectiveness ratio (ICER) was calculated using quality-adjusted life years (QALYs) as the output index. The stability of the results was verified using sensitivity and subgroup analyses. In addition, scenario analysis was conducted for the model simulation time and different parameter extrapolation models.ResultsThe results of basic analysis showed an increase of 0.31 QALYs in the tislelizumab group compared with the placebo group (1.53 QALYs vs 1.22 QALYs), and a concomitant increase in cost of 10,326.68 USD, with an ICER of 33,876.38 USD/QALY, which is less than the current Chinese willingness-to-pay threshold (36,924.80 USD/QALY). Sensitivity analyses demonstrated that the utility values of progression-free survival, progressive disease and the price of capecitabine had a greater impact on the model. Subgroup analysis revealed that combination therapy was equally cost-effective in people with a program death ligand 1 tumor area positivity score of ≥5%.ConclusionFrom the perspective of the Chinese health service system, the treatment of advanced GC/GEJC with tislelizumab combined with chemotherapy has a cost-effective advantage over chemotherapy alone.

Spatial Agglomeration, Industrial Land Price and Enterprise Innovation: Evidence from Micro-data of Land Transactions in Industrial Enterprises

It has become a consensus in academic circles that enterprise spatial agglomeration promotes technological innovation through comparative advantage of factor cost and knowledge spillover effect. With the increase of agglomeration degree, the advantage of low cost is gradually lost, and even under the constraint of financing, it will inhibit the innovation and development of enterprises. By constructing a new micro-level spatial agglomeration index, this paper investigates the dynamic impact of corporate spatial agglomeration on corporate innovation from the perspective of agglomeration cost. On the basis of using the longitude and latitude of industrial enterprises to construct a new index of agglomeration, this paper further carries out a comprehensive matching on the land market transaction data, patent application data and industrial enterprise data, obtains the micro-data at the enterprise level from 2007 to 2014, and constructs a non-linear intermediary effect model with industrial land price as the breakthrough point. The empirical results show that corporate spatial agglomeration has an “inverted U” effect on corporate innovation. The reason is that agglomeration costs such as increased competition caused by excessive spatial agglomeration and the rise in industrial land prices tighten corporate capital constraints, affect corporate resource allocation, and cause enterprises to reduce research and development investment. Research on heterogeneity shows that industrial enterprises have obvious preference characteristics for the direction of innovation investment in different stages of spatial agglomeration. According to this, the local government should scientifically control the agglomeration layout, on the one hand, give full play to the knowledge spillover effect of agglomeration, and on the other hand, mitigate the adverse impact of the rapid increase in land prices on innovation.

Medical costs of treating myasthenia gravis in patients who need intravenous immunoglobulin (IVIg) – a register-based study

BackgroundSeveral innovative treatments are expected for myasthenia gravis (MG) in the coming years. Healthcare payers usually require cost-effectiveness analyses before reimbursement. We aimed to investigate resource utilization and direct medical costs for patients with MG treated with intravenous immunoglobulin (IVIg) to inform such analyses.MethodsWe identified patients with MG in the Norwegian Patient Registry based on at least two hospital encounters with an MG diagnosis (ICD-10 G70.0) from 1 Jan 2010 to 31 Dec 2021. IVIg treatment was identified by medical procedure and Anatomical Therapeutic Chemical (ATC) codes (RPGM05 and J06BA02). Using Diagnosis-Related Group (DRG) cost weights, we estimated direct medical costs for each year following the first MG diagnosis.ResultsOver the study period, 1083 patients were diagnosed with MG in Norway, of whom 155 (14.3%) were treated with IVIg. No significant differences in age or sex were observed between IVIg and non-IVIg patients. Compared with non-IVIg patients, IVIg-patients had 2.3 times higher direct medical costs during the first year after MG diagnosis (EUR 35,714 vs. EUR 15,457) and 3.1 times higher costs during the second year (EUR 19,119 vs. EUR 6256). In the fifth year after diagnosis, IVIg-patients still had higher costs and resource utilization than non-IVIg patients (EUR 9953 vs. EUR 5634).ConclusionIVIg treatment represents an important marker for high direct medical costs among patients with MG. The costs continue to be high during the first five years after MG diagnosis.

Beyond Housing First: rethinking neoliberal policies impacting homelessness.

This article critically examines the Housing First model within the broader context of neoliberal policies impacting homelessness, particularly at the intersection of mental illness, poverty, and addiction. While Housing First is celebrated for its effectiveness in providing immediate housing to chronically homeless individuals, this model's alignment with neoliberal principles prioritizes cost effectiveness and visible outcomes over comprehensive care. As a harm reduction approach, Housing First often overlooks the underlying mental health and addiction issues that maintain homelessness, resulting in a cycle of dependency rather than long-term recovery. In this article, we argue that the reduction in funding for transitional housing and mental health services, driven by neoliberal policies, has exacerbated the challenges faced by marginalized populations. A call is made for a shift toward more holistic and integrated approaches that balance immediate housing solutions with robust mental health care and social support systems, aiming for sustained recovery, independence, and social reintegration for individuals experiencing homelessness.

Performance analysis of UAV-enabled dual-hop mixed RF-FSO communication systems with user scheduling

Abstract Using UAVs as relays in wireless communication offers several advantages like flexibility, coverage, line-of-sight communication, cost effectiveness, adaptability to changing network demands, etc. UAVs can perform surveillance, delivery, mapping, and disaster response. They offer real-time data collection, high maneuverability, and access to remote areas. In this manuscript, we consider a UAV-enabled dual hop mixed RF/FSO wireless communication system. The system includes a UAV acting as a decode-and-forward relay, facilitating communication from the base station (B) to multiple mobile users. The opportunistic scheduling scheme is used to select the user with the best instantaneous channel conditions, typically based on the highest signal-to-noise ratio (SNR) or lowest outage probability, to maximize throughput and ensure more reliable communication. The first hop from B to the UAV relay R, employs a free space optics (FSO) link modeled with gamma–gamma fading. The second hop, from R to multiple users, is a radio frequency (RF) link modeled with Rayleigh fading. The direct communication between base station and mobile users is not possible due to the blockage by various natural and man-made obstacles. We analyze the outage probability at high SNR values to gain further insights into system performance. Additionally, closed-form analytical expressions for the outage probability and average bit error rate (ABER) of the proposed system are derived.

Advances in preparation of acellular human dermis for tissue banking and transplantation

Non-healing wounds cost the National Health Service over £5.6 billion annually in wound management. Skin allografts are used to treat non-healing wounds, ulcers and burns, offering the best protection against infection. In order to allow host cells to repopulate and to avoid immunogenicity, cell components are removed through decellularisation. Decellularisation of human dermis has so far been performed in NHS Blood and Transplant using a combination of two enzymes (RNase T1 and the recombinant human DNase Pulmozyme)®. This study aims at validating a new method to remove DNA from donated dermis via the use of a single enzyme, Benzonase, known for its effectiveness of DNA digestion. Skin samples were decellularised by removing the epidermis, lysing of dermal cells, removal of cellular fragments by a detergent wash and removal of nucleic acids by a nuclease incubation with either Benzonase or Pulmozyme + RNase T1. DNA quantification with PicoGreen, as well as histology on wax-embedded biopsies, stained with DAPI and haemotoxylin and eosin, were performed. In vitro toxicity test on human osteosarcoma immortalised cells and skin fibroblasts, and biomechanical (tensile) testing, were also performed. The effectiveness of DNA digestion with the new methodology was comparable to previous procedure. Mean DNA removal percentage following decellularisation with Pulmozyme + RNase was 99.9% (3.83 ng/mg). Mean DNA removal percentage with Benzonase was 99.8% (9.97 ng/mg). Histology staining showed complete decellularisation following either method. Benzonase was proven to be non-toxic to both cell lines used, and a one-way Anova test showed no significant difference in neither stress nor strain between acellular dermal matrix decellularised with either Benzonase or Pulmozyme + RNase T1. Benzonase was able to effectively decellularise dermis after prior removal of epidermis. It performed just as well as the combination of Pulmozyme + RNase T1, but represents significant advantages in terms of cost effectiveness, procurement and storage; Benzonase has been successfully used in the decellularisation of other tissues, thus would be better for Tissue Banking use. Switching to this combined DNase/RNase can have far-reaching consequences in the production of acellular human dermal matrix by NHSBT and in the treatment of patients requiring it.

Cost-effectiveness of remote sensing technology for spruce budworm monitoring in Maine, USA

Forest pests are a major disturbance factor in forest ecosystems, which can result in tree mortality and loss of ecosystem services, leading to further negative impacts on the forest economy. Spruce budworm (Choristoneura fumiferana (Clem.); SBW) is a native forest pest in the northeastern USA and Canada, including the state of Maine, which defoliates balsam fir (Abies balsamea (L.) Mill.) and spruce (Picea spp.) trees with cyclical outbreaks every 30-60 years. SBW is typically monitored via ground sampling techniques such as pheromone traps and overwintering second instar larvae (L2) branch sampling. Remote sensing data can also provide information about defoliation patterns across the landscape and forest susceptibility to outbreaks. This study presents a cost-effectiveness analysis comparing remote sensing data, ground sampling techniques, and an integrated monitoring approach, combining remote sensing change detection with field sampling. Over a 10-year project period, Sentinel-2 imagery emerged as the most cost-effective option, ranging from US$33 to US$63/square kilometer (sq km), offering wide spatial coverage and moderate resolution suitable for the identification of defoliation patterns. PlanetScope imagery ranged from US$77 to US$241/sq km, and unmanned aerial vehicle (UAV) imagery had the greatest variation, from US$9,220 to US$58,481/sq km. Labor costs are the most influential in our study, ranging from 30% of total costs for remote sensing approaches to 80% for field sampling. The integrated monitoring approach proposed in this study presents a synergistic strategy for effective and timely SBW monitoring, ranging from US$144 to US$213/sq km. Utilizing this integrated approach leverages both remote sensing and L2 branch surveys to enhance the accuracy and timeliness of monitoring efforts, leading to more effective management strategies for mitigating pest outbreaks for landowners. Our research highlights the importance of adaptive monitoring strategies and integrating remote sensing for forest pest detection.

COVID-19 transmission dynamics in close-contacts facilities: Optimizing control strategies

Abstract Close-contact places such as long-term facilities have been found to be high-risk and high-morbidity places in the United States during COVID-19 outbreaks. This could be due to the presence of vulnerable resident population, frequent contacts of residents with visitors, staff working at multiple facilities, and potential contaminated surfaces at these facilities. Here, we model close-contacts places to evaluate the role of different transmission pathways of COVID-19 in the presence of adaptable interventions. The model captures a coupled dynamics between three subpopulations (staff, residents, and visitors) and incorporates infection from infectious individuals and through the environment. By using parameterization of the models via real data from facilities in the United States, we identify and quantify the impact of duration and choice of interventions in real time for subpopulations to mitigate disease burden. We study the trade-off between disease burden and prevention cost using cost-effectiveness analysis. It was found that the specific time interval in which an intervention is included has an important effect when maximizing the effectiveness while minimizing the costs. We find that the presence of super-spreader healthcare workers contribute to a significantly higher peak of the number of infected cases compared to similar situation in the presence of super-spreader residents. Considering two nonpharmaceutical interventions: the use of face masks and cleaning surfaces, we observe that the later is an optimum intervention at the beginning of the system’s evolution, while wearing masks becomes an optimum strategy once the infection is widely established and population behavior changes.

Conceptual Design of Simulation-Based Approach for Robotic Automation Systems: A Case Study of Tray Transporting

This study investigated the application of robotic automation in food manufacturing, focusing on enhancing tray transporting operations through a simulation-based approach. The findings primarily focused on bakery production but also demonstrate broader applicability to other sectors that involve repetitive and labor-intensive tasks. The researchers analyzed worker fatigue and limited productivity associated with manual tray handling. To evaluate these issues, simulations were conducted for two scenarios (Case A and Case B), applying robotic automation systems at different stages of production. Key performance indicators (throughput and utilization rates) were analyzed to assess improvements in process efficiency and reductions in worker strain. The results showed that robotic automation significantly increased throughput by 83.7% in simpler processes and by 27.1% in more complex ones, highlighting the impact of task complexity on automation effectiveness. Workforce demands decreased and demonstrated the potential of automation to alleviate physical strain in repetitive tasks. Simulations provided insights into workflow optimization, confirming their value as reliable tools for planning and refining automation strategies. The proposed framework offers a flexible and scalable solution for enhancing efficiency and consistency in manufacturing. Future research should apply similar approaches to other industries and explore the integration of human and robotic labor to further optimize safety, productivity, and cost effectiveness.

A Big Data Discriminatory Pricing Strategy for Takeaway Platforms Considering Different Attributional Behaviors of Users

To address the big data discriminatory pricing problem of two takeout platforms with different attribution behaviors of platform users, the equilibrium pricing of the two platforms under different attribution behaviors is analyzed and compared based on the Hotelling model, and the effects of switching costs and network effects on pricing strategies are examined. The results show that: in the single-attribution-single-attribution model, the network effect affects the user scale of the platform, and then the pricing of the platform is affected by the switching costs and the network effect, and the pricing of the platform in the first stage affects the pricing decision in the second stage; in the single-attribution-partial-multi-attribution model, the pricing of the platform is affected not only by the switching cost and the network effect but also by the switching costs and the network effect of the user base. In the single-attribution-partial-multi-attribution model, platform pricing is not only affected by switching costs and network effects but also by users' base utility, and the platform's pricing in the first stage partially affects the pricing decision in the second stage.

Optimization of water distribution networks using simulated annealing (SA) with variable neighbourhood search (VNS): a case study in the city of Malard

ABSTRACT Water distribution networks (WDNs) are essential for modern cities, as effective design can reduce construction costs and ensure reliable service. As cities expand, optimizing these large networks becomes increasingly complex. In this work, we introduce a novel approach by combining simulated annealing (SA) with variable neighbourhood search (VNS) into a single heuristic algorithm for WDN optimization, marking the first use of the SA-VNS method in this context. Additionally, we apply Taguchi's design of experiments (DOE) to tune the parameters of the SA-VNS algorithm specifically for water networks. We tested our new algorithm on four standard benchmark networks and a real-world WDN, including a case study of a large city. Our results demonstrate that the SA-VNS algorithm outperforms existing methods in terms of cost, speed, and overall effectiveness, making this research a significant advancement in both heuristic methods and parameter-tuning techniques for WDN optimization.

Cost-utility analysis of newborn screening for spinal muscular atrophy in Japan

ABSTRACT Aims Spinal muscular atrophy (SMA) is a rare genetic disorder characterized by progressive muscle weakness, atrophy, respiratory failure, and in severe cases, infantile death. Early detection and treatment before symptom onset may substantially improve outcomes, allowing patients to achieve age-appropriate motor milestones and longer survival. We assessed the cost-utility of newborn screening (NBS) for SMA in Japan. Materials and Methods A cost-utility model (decision tree and Markov model) compared lifetime health effects and costs between “NBS” for SMA (presymptomatic treatment) or “no NBS” (treatment initiated at symptom onset). Model inputs were sourced from literature, local data, and expert opinion. Sensitivity and scenario analyses were conducted to assess model robustness and data validity. Results Based on the 1:10,000 SMA incidence, it was estimated that 43 newborns/year would have SMA, and a total of 39 patients with SMA would initiate presymptomatic treatment after NBS. An estimated 736 quality-adjusted life-years were gained per annual birth cohort with NBS. NBS for SMA was dominant compared with no NBS (i.e., less costly and more effective), with ¥8,856,960,096 reduced total costs with NBS versus no NBS (base-case). Sensitivity and scenario analyses supported cost effectiveness of NBS for SMA versus no NBS. A greater percentage of patients was estimated to enjoy longer survival and be without permanent assisted ventilation with NBS versus no NBS. Limitations Real-world observations may differ from single-arm clinical trial outcomes. It was assumed that patients with SMA identified via NBS were asymptomatic and would receive treatment prior to symptoms. Best supportive care was not considered, and Japan-specific variations in gene replacement therapy protocol were not fully reflected. Conclusion NBS for SMA allows for early identification of patients with SMA and treatment initiation before symptom onset, improving health outcomes and reducing total costs than without NBS.

Screening of pregnant women for foetal neonatal alloimmune thrombocytopenia: A cost-utility analysis.

Foetal and neonatal alloimmune thrombocytopenia (FNAIT) results from maternal platelet-directed antibodies and can result in severe intracranial haemorrhage (ICH) in foetuses and newborns. Screening for human platelet antigen-1a (HPA-1a)-directed antibodies during pregnancy could allow timely intervention with antenatal treatment and prevent ICH. We assessed the cost effectiveness of HPA-1a typing and anti-HPA-1a-screening as part of the prenatal screening programme. Different HPA-1a screening scenarios were tested in a decision analysis model and assessed for diagnostic, treatment, intervention and lifetime costs and prevention effects compared to the current situation without screening in the Netherlands. Model parameters were based on available data, literature and expert opinions. One-way sensitivity analysis and probabilistic sensitivity analysis were performed. Adding screening for anti-HPA-1a antibodies to the current antenatal screening programme of the Netherlands will lead to an additional cost of €4.7 million per year and a gain of 226 quality-adjusted life years (QALYs) per year, indicating an incremental cost-effectiveness ratio (ICER) of €20,782 per QALY gained. One-way sensitivity analysis showed that the uncertainty around the incidence of ICH, lifetime costs of disabled children and the probability of having antibody quantitation >3.0 IU/mL at 20 weeks had the highest effect on the ICER. Antenatal anti-HPA-1a screening might be cost effective. To obtain more knowledge and thereby to improve risk stratification, a pilot screening programme is warranted.

Cost-effectiveness of human papillomavirus (HPV) vaccination in Tunisia: a modelling study

ObjectivesThe objective of this study is to assess the cost utility of the implementation of the human papillomavirus (HPV) vaccination programme in Tunisia in addition to the current cytology screening...

Intended Conservative Management Versus Caesarean Hysterectomy for Known or Suspected Placenta Accreta Spectrum: A Cost-Effectiveness Analysis.

We examined the cost-effectiveness of conservative management (CM) compared to planned caesarean hysterectomy (CH) for placenta accreta spectrum (PAS). A cost-effectiveness analysis in a theoretical cohort of patients. A decision analytic model. A theoretical cohort of 1000 pregnant patients with PAS greater than 20 weeks gestation. In base case analysis, we assumed that between 20% and 40% of individuals would be eligible for CM. Model inputs were derived from the literature. Analysis was conducted from a healthcare system perspective with a 1 year analytic horizon. Outcomes included hysterectomy, surgical site infection (SSI), length of hospitalisation, intensive care unit (ICU) admission and death. An incremental cost-effectiveness ratio (ICER) of $50 000 per quality-adjusted life year (QALY) defined cost-effectiveness. Sensitivity analyses were performed. The cost gained per life year and per QALY. For base case estimates, CM was the cost-saving strategy with an ICER of $9330.51 USD. Compared to CH, CM resulted in 905 fewer hysterectomies, 80 fewer instances of SSI and five fewer deaths. CM resulted in 149 more admissions with length of stay > 5 days and 25 more ICU admissions. In probabilistic sensitivity analysis, CM was the cost-effective strategy in 71% of runs and the dominant strategy in 42% of runs. CM was the cost-effective strategy for the management of PAS in greater than 70% of iterations of our model. Modelling demonstrated significant uncertainty in the comparative effectiveness of the two strategies, highlighting the need for prospective research evaluating the effectiveness of CM.

Latent solvent-induced inorganic-rich interfacial chemistry to achieve stable potassium-ion batteries in low-concentration electrolyte.

Low-concentration electrolytes (LCEs) have attracted great attention due to their cost effectiveness and low viscosity, but suffer undesired organic-rich interfacial chemistry and poor oxidative stability. Herein, a unique latent solvent, 1,2-dibutoxyethane (DBE), is proposed to manipulate the anion-reinforced solvation sheath and construct a robust inorganic-rich interface in a 0.5 M electrolyte. This unique solvation structure reduces the desolvation energy, facilitating rapid interfacial kinetics and K+ intercalation in graphite. Additionally, enhanced anion-cation interactions promote the formation of a thin and robust interfacial layer with excellent cycling performance of potassium-ion batteries (PIBs). Graphite||perylene-3,4,9,10-tetracarboxylic dianhydride full cell exhibits a good capacity retention of 80.3% after 300 cycles, and delivers a high discharge capacity of 131.3 mAh g-1 even at 500 mA g-1. This study demonstrates the feasibility of latent solvent-optimized electrolyte engineering, providing a pathway of superior electrochemical energy storage in PIBs.

Genome-based newborn screening for severe childhood genetic diseases has high positive predictive value and sensitivity in a NICU pilot trial

Large prospective clinical trials are underway or planned that examine the clinical utility and cost effectiveness of genome-based newborn screening (gNBS). One gNBS platform, BeginNGS, currently screens 53,575 variants for 412 severe childhood genetic diseases with 1,603 efficacious therapies. Retrospective evaluation of BeginNGS in 618,290 subjects suggests adequate sensitivity and positive predictive value (PPV) to proceed to prospective studies. To inform pivotal clinical trial design, we undertook a pilot clinical trial. We enrolled 120 infants in a regional neonatal intensive care unit (NICU) who were not under consideration for rapid diagnostic genome sequencing (RDGS). Each enrollee received BeginNGS and two index tests (California state NBS and RDGS). California NBS identified 4 of 4 true positive (TP) findings (TP rate 3.6%, sensitivity 100%) and 11 false positive (FP) findings (PPV 27%). RDGS identified 41 diagnostic findings in 36 neonates (diagnostic rate 30%). BeginNGS identified 5 of 6 on-target TP disorders (TP rate 4.2%, 95% confidence interval 1%-8%, sensitivity 83%) and no FPs (PPV 100%). Changes in management were anticipated following the return of 27 RDGS results in 25 enrollees (clinical utility [CU] 21%), 3 of 4 NBS TPs (CU 2.7%), and all BeginNGS TPs (CU 4.2%). The incidence of actionable genetic diseases in NICU infants not being considered for RDGS suggests (1) performance of RDGS in ∼20% of admissions misses many genetic diagnoses, (2) NICU enrollment in gNBS trials will greatly increase power to test endpoints, and (3) NICUs may be attractive for early implementation of consented BeginNGS screening.

Cost-Effectiveness of Capivasertib as a Second-Line Therapy for Advanced Breast Cancer.

Capivasertib, a first-in-class AKT inhibitor, was recently approved as a second-line treatment for advanced breast cancer. However, capivasertib is expensive, raising questions over its economic value. This study provides the first evidence on the cost effectiveness of adding capivasertib to endocrine therapy (fulvestrant) for patients with PIK3CA/AKT1/PTEN-altered, hormone receptor-positive (HR+) human epidermal growth factor receptor2-negative (HER2-) advanced breast cancer. A Markov model was built to compare the costs and effectiveness of three treatment strategies. The first strategy involved adding capivasertib to fulvestrant for all patients, while the second strategy involved adding it for only postmenopausal women. The third strategy involved treatment with fulvestrant alone. Analyses were conducted from a US payer perspective over a lifetime horizon. Costs were measured in 2023 US dollars, and effectiveness was measured in life years (LYs) and quality adjusted life years (QALYs), discounted at 3% per year. One-way sensitivity analyses, probabilistic sensitivity analyses, and scenario analyses were conducted to assess the robustness of results. The addition of capivasertib to fulvestrant for all patients was associated with $410,765 higher costs and 1.46 additional quality adjusted life years (QALYs) compared with fulvestrant alone, resulting in an incremental cost effectiveness ratio of $280,854/QALY. The strategy of adding capivasertib for only patients who are postmenopausal was extended dominated, i.e., yielded fewer QALYs at a higher cost per QALY than if capivasertib was added for all patients. These results were found to be robust in sensitivity and scenario analyses. At its current price, our analysis suggests that theaddition of capivasertib to fulvestrant as a second line treatment is not cost effective versus fulvestrant alone at a willingness-to-pay threshold of $100,000/QALY. The price of capivasertib will need to be reduced by nearly 70% (to $7000 per cycle) for it to become cost effective.

The 1,7-malaria reactive community-based testing and response (1,7-mRCTR) approach in Tanzania: a cost-effectiveness analysis

BackgroundReactive case detection (RACD) for malaria control has been found effective in low transmission settings, but its impact and cost-effectiveness in moderate-to-high transmission settings are unknown. We conducted an economic evaluation alongside an empirical trial of a modified RACD strategy (1,7-mRCTR) in three moderate-to-high malaria transmission districts in Tanzania.MethodsThe costs and cost savings associated with the intervention relative to passive case detection alone were estimated in the study sites of Kilwa, Kibiti, and Rufiji districts in Tanzania from 2019–2021. Empirical cost data were collected using household surveys. The incremental costs of the intervention were calculated from under a societal perspective. Costs are reported in 2022 US dollars.Trial data and malaria registers from health facilities were used to calculate the number of malaria cases detected. We simulated unobserved and distal health effects of the intervention to assess cost-effectiveness in terms of incremental cost-effectiveness ratios (ICERs).Propagated uncertainty was assessed via second-order Monte Carlo simulation, including bootstrapping of empirical data distributions. Incremental costs per disability-adjusted life year (DALY) averted were compared to a willingness-to-pay threshold based on estimated opportunity costs of healthcare spending in Tanzania.ResultsThe programmatic cost of the 1,7-mRCTR intervention was 5327 United States Dollars (USD) per 1000 population. The combination of reactive and passive case detection in the intervention arm resulted in an additional 445 malaria cases detected per 1000 compared to passive detection alone, yielding an incremental cost per additional case detected of 12.0 USD. Based on modelling results, for every percentage point decline in malaria prevalence, the intervention averted 95.2 cases and 0.04 deaths per 1000 population. On average, the 1,7-mRCTR intervention averted 19.1 DALYs per 1000 population. Compared to passive malaria detection, the ICERs for the 1,7-mRCTR intervention were 7.3 USD per case averted, 16,884 USD per death averted, and 163 USD per DALY averted.ConclusionsOur analysis demonstrates that the 1,7-mRCTR intervention appears to be cost-effective under a willingness-to-pay threshold of 417 USD per DALY averted, showing that modified RACD strategies can provide value for money in moderate-to-high transmission settings.Graphical

Technology-enabled anticipatory guidance and peer support in empowering parents to prevent early childhood caries: a randomized controlled trial

IntroductionDental caries is one of the most prevalent chronic diseases of childhood. Early childhood caries (ECC), defined as onset of dental caries before 6 years of age, is preventable and reversible in the early stages with proper interventions. The purpose of the study is to assess the clinical effectiveness and cost-effectiveness of technology-enabled anticipatory guidance and peer support in empowering parents to establish good diets, feeding and oral hygiene practices to prevent ECC.Methods and analysisMother-child dyads will be recruited from pre-natal clinics and post-natal wards of a tertiary care hospital in Singapore. The control group will receive conventional oral health education materials while the intervention group will join four rounds of online parent empowerment sessions focusing on anticipatory guidance and peer-support. Mothers will complete a questionnaire and food frequency checklist when their child turns 12, 24 and 36 months; each child will undergo an oral examination at the age of 24 and 36 months. Chi-square tests and two-sample t-tests, or their non-parametric equivalents will be used to compare proportions of children with caries by decayed, missing and filled teeth (dmft) and decayed, missing and filled surfaces (dmfs) scores between groups. Effect sizes and their confidence intervals will be calculated along with number needed to treat. Multivariable analyses will be carried out to assess the effect of the intervention on primary outcomes (caries incidence at 24 and 36 months) and secondary outcomes (including parental efficacy, child’s oral health behaviours and oral hygiene status, quality of life). Cost-effectiveness analyses will also be carried out.Ethics and disseminationThe study was approved by Domain Specific Review Board (DSRB 2024/00244). Results will be published in international peer-reviewed journals.Trial registration numberThe trial was retrospectively registered on ClinicialTrials.gov (NCT06558955) around the time of the commencement of patient recruitment, but prior to the commencement of any intervention.