Framework For Economic Evaluation Research Articles

Coronary artery bypass grafting with minimal versus conventional extracorporeal circulation; an economic analysis

BackgroundThis study aims to develop a methodological framework for the comparative economic evaluation between Minimal Extracorporeal Circulation (MECC) versus conventional Extracorporeal Circulation (CECC) in patients undergoing coronary artery bypass grafting (CABG) in different healthcare systems. Moreover, we evaluate the cost-effectiveness ratio of alternative comparators in the healthcare setting of Greece, Germany, the Netherlands and Switzerland. MethodsThe effectiveness data utilized were derived from a recent meta-analysis which incorporated 24 randomized clinical trials. Total therapy cost per patient reflects all resources expensed in delivery of therapy and the management of any adverse events, including drugs, diagnostics tests, materials, devices, blood units, the utilization of operating theaters, intensive care units, and wards. Perioperative mortality was used as the primary health outcome to estimate life years gained in treatment arms. Bias-corrected uncertainty intervals were calculated using the percentile method of non-parametric Monte-Carlo simulation. ResultsThe MECC circuit was more expensive than CECC, with a difference ranging from €180 to €600 depending on the country. However, in terms of total therapy cost per patient the comparison favored MECC in all countries. Specifically it was associated with a reduction of €635 in Greece, €297 in Germany, €1590 in the Netherlands and €375 in Switzerland. In terms of effectiveness, the total life-years gained were slightly higher in favor of MECC. ConclusionsSurgery with MECC may be dominant (lower cost and higher effectiveness) compared to CECC in coronary revascularization procedures and therefore it represents an attractive new option relative to conventional extracorporeal circulation for CABG.

Economic evaluation in the field of mental health: conceptual basis

Technological advances in medicine have given rise to a dilemma concerning the use of new health technologies in a context of limited financial resources. In the field of psychiatry, health economic evaluation is a recent method that can assist in choosing interventions with different cost and/or effectiveness for specific populations or conditions. This article introduces clinicians to the fundamental concepts required for critical assessment of health economic evaluations. The authors conducted a review with systematic methods to assess the essential theoretical framework of health economic evaluation and mental health in Brazil through textbooks and studies indexed in the PubMed, Cochrane Central, LILACS, NHS CRD, and REBRATS databases. A total of 334 studies were found using the specified terms (MeSH - Mental Health AND Economic, Medical) and filters (Brazil AND Humans); however, only five Brazilian economic evaluations were found. Economic evaluation studies are growing exponentially in the medical literature. Publications focusing on health economics as applied to psychiatry are increasingly common, but Brazilian data are still very incipient. In a country where financial resources are so scarce, economic analyses are necessary to ensure better use of public resources and wider population access to effective health technologies.

A framework for economic demand forecast evaluation

Accurate demand forecasting is crucial for companies, since both overage and shortage of products can reduce company profits. Numerous statistical measures have been proposed to evaluate the accuracy of forecasts, but these measures tend to neglect the different economic impact of forecast errors for different items. Motivated by industry practitioners’ need to evaluate their forecasting processes and identify potentials for improvement, we develop a framework to evaluate demand forecasts. The framework consists of statistical measures and a scoring model and allows for an analysis of forecast accuracy on different levels of aggregation. A case study from a large retailing company shows that the framework is easy to implement in standard software and can provide relevant managerial insights.

Economic Evaluation of RFID Technology in the Production Environment

The aim of this paper is to present an economic evaluation framework of an RFID system implementation through a pilot project with the aim of streamlining logistic processes and compliance with higher level requirements. The company involved in the project belongs to the CPG (Consumer Packaged Goods) food industry, and in particular to the alimentary industry, whose principal scope was to comply the new norms of the sector by implementation of a better traceability system. This system, besides being very effective for the scope of the project, also had a huge impact in economic terms on logistics resources and cost reduction. For this reason, the discover of the RFID technology for the company has been greatly appreciated at management level, and today other fields of application are under evaluation. The added value of this article is contained not only in the results obtained in the economic evaluations, but also in the applied methodology, evidencing the advantages obtainable in the processes by cutting no added value operations. The economic analysis has thus been conducted on the basis of this TO-BE process streamlining.

Discrete choice experiments in pharmacy: a review of the literature

Discrete choice experiments (DCEs) have been widely used to elicit patient preferences for various healthcare services and interventions. The aim of our study was to conduct an in-depth scoping review of the literature and provide a current overview of the progressive application of DCEs within the field of pharmacy. Electronic databases (MEDLINE, EMBASE, SCOPUS, ECONLIT) were searched (January 1990-August 2011) to identify published English language studies using DCEs within the pharmacy context. Data were abstracted with respect to DCE methodology and application to pharmacy. Our search identified 12 studies. The DCE methodology was utilised to elicit preferences for different aspects of pharmacy products, therapy or services. Preferences were elicited from either patients or pharmacists, with just two studies incorporating the views of both. Most reviewed studies examined preferences for process-related or provider-related aspects with a lesser focus on health outcomes. Monetary attributes were considered to be important by most patients and pharmacists in the studies reviewed. Logit, probit or multinomial logit models were most commonly employed for estimation. Our study showed that the pharmacy profession has adopted the DCE methodology consistent with the general health DCEs although the number of studies is quite limited. Future studies need to examine preferences of both patients and providers for particular products or disease-state management services. Incorporation of health outcome attributes in the design, testing for external validity and the incorporation of DCE results in economic evaluation framework to inform pharmacy policy remain important areas for future research.

An economic evaluation framework for membrane reactor modules in the presence of uncertainty: The case for process safety investment and risk reduction

A comprehensive Net Present Value (NPV) model has been developed to demonstrate the economic advantages of process safety and risk reduction investments on Pd/Au-based membrane reactors. In particular, the economic viability of Pd/Au-based membrane reactor modules incorporated into Integrated Gasification Combined Cycle (IGCC) plants is evaluated within the aforementioned framework by pro-actively following sound process safety design principles. Sources of irreducible uncertainty (market, technological, operational) as well as safety risk are explicitly recognized, such as the Pd/Au prices, membrane life-time and loss in the power plant capacity factor due to possible accidents. The effect of the above uncertainty drivers on the membrane module cost along with production disruption and associated revenue losses is elucidated using Monte-Carlo simulation techniques that enable the propagation of the above uncertain inputs through the NPV-model, and therefore, generate a more realistic distribution of the process system's value rather than a single-point/estimate that overlooks these uncertainties. Pre-investment on risk reducing measures, such as spare safety relief systems (cautionary redundancy) for membrane reactor modules operating at high pressures (e.g. 50 atm), is shown to be economically more attractive than cases where analogous safety measures are not implemented. Since accidents and possibly catastrophic events do happen in an uncertain world, additional investment on safety measures could ensure a safer and more profitable operation of the process system under consideration giving credence to the thesis that process safety investments may result in enhanced techno-economic performance in the presence of irreducible uncertainties.

Exploring non-health outcomes of health promotion: The perspective of participants in a lifestyle behaviour change intervention

ObjectiveTo provide insights into health promotion outcomes that are not captured by conventional measures of health outcome used in economic evaluation studies, such as EQ5D based QALYs. MethodsTwelve semi-structured interviews and five focus group discussions were conducted with participants of a randomized controlled trial (n=52) evaluating the effectiveness of a theory-based lifestyle intervention in Dutch adults at risk for diabetes mellitus and/or cardiovascular disease. Transcripts were analysed by two independent researchers using a thematic analysis approach. ResultsIn total we identified twelve non-health outcome themes that were important from the participant perspective. Four of these were reported as direct outcomes of the lifestyle intervention and eight were reported as consequences of lifestyle behaviour change. Our findings also suggest that lifestyle behaviour change may have spillover effects to other people in the participants’ direct environment. ConclusionThis study provides evidence that in the context of lifestyle behaviour change EQ5D based QALYs capture health promotion outcomes only partially. More insights are needed into non-health outcomes and spillover effects produced by health promotion in other contexts and how participants and society value these. Methods to account for these outcomes within an economic evaluation framework need to be developed and tested.

Perspectives on anaerobic membrane bioreactor treatment of domestic wastewater: A critical review

Interest in increasing the sustainability of water management is leading to a reevaluation of domestic wastewater (DWW) treatment practices. A central goal is to reduce energy demands and environmental impacts while recovering resources. Anaerobic membrane bioreactors (AnMBRs) have the ability to produce a similar quality effluent to aerobic treatment, while generating useful energy and producing substantially less residuals. This review focuses on operational considerations that require further research to allow implementation of AnMBR DWW treatment. Specific topics include membrane fouling, the lower limits of hydraulic retention time and temperature allowing for adequate treatment, complications with methane recovery, and nutrient removal options. Based on the current literature, future research efforts should focus on increasing the likelihood of net energy recovery through advancements in fouling control and development of efficient methods for dissolved methane recovery. Furthermore, assessing the sustainability of AnMBR treatment requires establishment of a quantitative environmental and economic evaluation framework.

Conceptual Framework for Standard Economic Evaluation of Physical Activity Programs in Primary Prevention

Economic evaluations of primary prevention physical activity programs have gained importance because of scarce resources in health-care-systems. A concept for economic evaluation should be based on the efficacy of physical activity, the standard methods of economic evaluation and the aims of public health. Previous publications have examined only parts of these components and have not developed a comprehensive conceptual framework; it is the objective of this article to develop such a framework. The derived method should aid decision makers and staff members of intervention programs in reviewing and conducting an economic evaluation. A literature search of articles was done using six electronic databases. Referenced works for standard methods and more comprehensive approaches for evaluation of preventive programs were studied. The newly developed conceptual framework for economic evaluation includes: (1) the type of physical activity program; (2) features of a selected study population; (3) the outcome dimension comprising exercise efficacy, reach, recruitment, response rate, maintenance, compliance and adverse health effects plus the social impact; and (4) the cost dimension consisting of program development costs, program implementation costs including the implementation, recruitment, program, participants' time costs and savings resulting from the health effects of the intervention. Cost-effectiveness also depends on the methodology, such as the chosen perspective, data collection, valuation methods and discounting. If an intervention is not considered cost-effective, it is necessary to check each dimension to find possible failures in order to learn for future interventions. A more detailed economic evaluation is of utmost importance for improved comparability and transferability.

Analysis of Resource and Emission Impacts: An Emergy-Based Multiple Spatial Scale Framework for Urban Ecological and Economic Evaluation

The development of the complex and multi-dimensional urban socio-economic system creates impacts on natural capital and human capital, which range from a local to a global scale. An emergy-based multiple spatial scale analysis framework and a rigorous accounting method that can quantify the values of human-made and natural capital losses were proposed in this study. With the intent of comparing the trajectory of Beijing over time, the characteristics of the interface between different scales are considered to explain the resource trade and the impacts of emissions. In addition, our improved determination of emergy analysis and acceptable management options that are in agreement with Beijing’s overall sustainability strategy were examined. The results showed that Beijing’s economy was closely correlated with the consumption of nonrenewable resources and exerted rising pressure on the environment. Of the total emergy use by the economic system, the imported nonrenewable resources from other provinces contribute the most, and the multi‑scale environmental impacts of waterborne and airborne pollution continued to increase from 1999 to 2006. Given the inputs structure, Beijing was chiefly making greater profits by shifting resources from other provinces in China and transferring the emissions outside. The results of our study should enable urban policy planners to better understand the multi-scale policy planning and development design of an urban ecological economic system.

The ability of cancer-specific and generic preference-based instruments to discriminate across clinical and self-reported measures of cancer severities

ObjectiveTo evaluate the validity of cancer-specific and generic preference-based instruments to discriminate across different measures of cancer severities.MethodsPatients with breast (n = 66), colorectal (n = 57), and lung (n = 61) cancer completed the EORTC QLQ-C30 and the FACT-G, as well as three generic instruments: the EQ-5D, the SF-6D, and the HUI2/3. Disease severity was quantified using cancer stage, Eastern Cooperative Oncology Group Performance Status (ECOG-PS) score, and self-reported health status. Comparative analyses confirmed the multi-dimensional conceptualization of the instruments in terms of construct and convergent validity.ResultsIn general, the instruments were able to discriminate across severity measures. The instruments demonstrated moderate to strong correlation with each other (r = 0.37-0.73). Not all of the measures could discriminate between different groups of disease severity: the EQ-5D and SF-6D were less discriminative than the HUI2/3 and the cancer-specific instruments.ConclusionThe cancer-specific and generic preference-based instruments demonstrated to be valid in discriminating across levels of ECOG-PS scores and self-reported health states. However, the usefulness of the generic instruments may be limited if they are not able to detect small changes in health status within cancer patients. This raises concerns regarding the appropriateness of these instruments when comparing different cancer treatments within an economic evaluation framework.

The added value of thorough economic evaluation of telemedicine networks

This paper proposes a thorough framework for the economic evaluation of telemedicine networks. A standard cost analysis methodology was used as the initial base, similar to the evaluation method currently being applied to telemedicine, and to which we suggest adding subsequent stages that enhance the scope and sophistication of the analytical methodology. We completed the methodology with a longitudinal and stakeholder analysis, followed by the calculation of a break-even threshold, a calculation of the economic outcome based on net present value (NPV), an estimate of the social gain through external effects, and an assessment of the probability of social benefits. In order to illustrate the advantages, constraints and limitations of the proposed framework, we tested it in a paediatric cardiology tele-expertise network. The results demonstrate that the project threshold was not reached after the 4 years of the study. Also, the calculation of the project's NPV remained negative. However, the additional analytical steps of the proposed framework allowed us to highlight alternatives that can make this service economically viable. These included: use over an extended period of time, extending the network to other telemedicine specialties, or including it in the services offered by other community hospitals. In sum, the results presented here demonstrate the usefulness of an economic evaluation framework as a way of offering decision makers the tools they need to make comprehensive evaluations of telemedicine networks.

THEORETICAL FRAMEWORK OF ECONOMIC EVALUATION OF AGRICULTURAL PROJECTS WITH EMPHASIS ON AQUACULTURE PROJECTS AND ITS ROLE TO ACHIEVE FOOD SECURITY

This research aims to investigate the theoretical framework ofeconomic evaluation agricultural projects with emphasis on aquaculture projects. The study showed the importance of agricultural project, andagricultural project cycle which can be divided to four stages: pre-investment,investment, operation stage, and evaluation stage.Assessment of the economic viability of aquaculture project requiresan interdisciplinary understanding of physical, social and economicrelationship. Quantitative or qualitative estimates of many relevant variablesare not readily available because aquaculture is in early stages of developmentin most areas of the world.The study comprised the outline aquaculture production-marketingconsideration which includes marketing, technical-environmentalbioeconomic, institutional, and social respects.The study showed that the, fish gap increased with annual rate ofgrowth with 1.5% during the period net ween (1995 and 2005).The most important fish production resources in Egypt is the seas,lacks and fish farms with 124 thousand ton, 188 thousand ton and 132thousand ton or about 23.14%, 35.18% and 24.65%, respectively from theannual average total of Egyptian fish production during the period (95-2000),and it increased to about 138 thousand ton, 196 thousand ton and about 328thousand ton or about 16.5%, 23.34%, and about 39.3% respectively from theannual average total of Egyptian fish production during the period (2001-2005).

Accounting for institutional change in health economic evaluation: A program to tackle HIV/AIDS and gender violence in Southern Africa

There has been growing interest in the application of institutionalist perspectives in the health economics literature. This paper investigates the institutionalist notion of social value and its use in economic evaluation with particular reference to a program to address HIV/AIDS and gender violence in Southern Africa (IMAGE). Institutions are the rules that govern the conduct between individuals, groups and organisations. Their social value stems from their capacity to reduce the uncertainty in human interactions thereby both reducing transaction costs and, importantly, enabling the initiation and sustainability of various activities (instrumental value). Furthermore, institutions tend to be formed around certain ethical positions and as a consequence, act in binding future decision making to these positions (intrinsic value). Incorporating such notions of social value within a conventional welfare-based measure of benefit is problematic as institutional development is not necessarily consistent with individual utility. An institutionalist approach allows for these additional domains to be factored into economic evaluation. IMAGE is an intervention to reduce gender violence and HIV through microfinance, health education and community development, and involves significant initial investment in institution-building activities, notably through training activities with program staff and community members. The key to employing an institutionalist approach to the evaluation of IMAGE is in understanding the nature of those actions that can be seen as institution-building and determining: (1) the instrumental value of follow-up activities by appropriate amortisation of transaction costs over an horizon that reflects the economies gained from the intervention; and (2) the intrinsic value of any transformation in the community through a cost-consequences approach informed by an a priori conceptual model. This case study highlights how health sector interventions can effect institutional changes and how these are captured within a theory-based economic evaluation framework.

Complexity and reflexivity: Two important issues for economic evaluation in health care

Economic evaluations are analytic techniques to assess the relative costs and consequences of health care programmes and technologies. Their role is to provide rigorous data to inform the health care decision-making process. Economic evaluation may oversimplify complex health care decisions. These analyses often ignore important health consequences, contextual elements, relationships or other relevant modifying factors, which might not be appropriate in a multi-objective, multi-stakeholder issue. One solution would be to develop a new paradigm based on the issues of perspective and context. Complexity theory may provide a useful conceptual framework for economic evaluation in health care. Complexity thinking develops an awareness of issues including uncertainty, contextual issues, multiple perspectives, broader societal involvement, and transdisciplinarity. This points the economic evaluation field towards an accountability and epistemology based on pluralism and uncertainty, requiring new forms of lay-expert engagement and roles of lay knowledge into decision-making processes. This highlights the issue of reflexivity in economic evaluation in health care. A reflexive approach would allow economic evaluators to analyze how objective structures and subjective elements influence their practices. In return, this would point increase the integrity and reliability of economic evaluations. Reflexivity provides opportunities for critically thinking about the organization and activities of the intellectual field, and perhaps the potential of moving in new, creative directions. This paper argues for economic evaluators to have a less positivist attitude towards what is useful knowledge, and to use more imagination about the data and methodologies they use.

Pharmacoeconomic modelling in schizophrenia

Pharmacoeconomic evaluations are important elements in the decision making process, and decision tree analyses are statistical models that analyse both clinical and economic consequences of medical actions. Using one theoretic model, key confounding variables were identified that constituted a standardised framework for economic evaluation of schizophrenia management. The extent to which they were included in several previously published schizophrenia models was appraised. Five different models were developed, and a systematic review of schizophrenia modelling studies was conducted. Results indicate that atypical antipsychotics may be more or less cost-effective depending upon whether key confounding variables were taken into account, but vigilance is warranted when assessing data because serious discrepancies can occur between different methods of analysis. A need for standardised schizophrenia pharmacoeconomic models exists. Additionally, social rehabilitation should be considered because this may also influence outcomes. Standardising modelling techniques will facilitate adherence to guidelines issued by decision makers.

Comprehensive Assessment of Regional Circular Economy Development Based on Efficiency of Resource & Environment: A Case Study of Jiangsu Province

Abstract In the first, the paper gave a retrospective analysis on the comprehensive assessment of circular economic development. According to the requirement of improving resource & environment efficiency, the paper designed an analytical framework for a comprehensive assessment of regional circular economic growth, which consists of the goal, object and technical line of the comprehensive assessment of regional circular economic development. Given that, the paper discussed the criterion for choosing the assessment index, the approaches of index's weighing determination, the means of data standardization, and the reference system of assessment index value and so on. According to the framework of regional circular economic development evaluation, the paper made a comprehensive evaluation of Jiangsu Province's circular economic development. The result shows that from temporal change, Jiangsu Province's circular economic development had different stages; from the spatial comparison, there is variance among different regions, which could be divided into different types according to the spatial variance and the relation between the development of circular economy and the aggregative index number. There was a remarkable correlation between circular economic development level and GDP or the 2nd industry GDP. Finally, the paper gives some suggestions on how to promote the development of circular economy in Jiangsu Province.

Methodological design for economic evaluation in Public Access Defibrillation (PAD) trial

Our objective is to describe the rationale and methods for the economic analysis of the PAD trial. The objective of this analysis is to assess whether automated external defibrillators (AEDs) use by lay responders is good value for money. Design. This economic evaluation is being conducted concurrently with a randomized trial of (a) control--training to recognize arrest, access 911, and administer cardiopulmonary resuscitation (CPR) while awaiting arrival of emergency medical services providers versus (b) intervention--training to recognize arrest, access 911, administer CPR, and use an AED while awaiting emergency medical services providers. Lay responders in either group were trained to deliver the study intervention. Population. Participating sites identified distinct units with a population of at least 250 people aged > or = 50 years. Outcome. The primary economic outcome is the incremental cost-effectiveness ratio of intervention versus control. Nine hundred ninety-three units including 1260 public and residential locations were randomized. There were 30 survivors in the intervention group and 15 in the control group (P = .03). Sampling will identify program and health care costs. A societal perspective will be adopted. Incremental cost effectiveness will be estimated by using bootstrapping and decision analytic modeling. The study will demonstrate whether defibrillation by lay responders improves outcomes at reasonable cost. If so, then the thousands of lives will be improved annually. If not, then limited resources can be invested in other interventions. Our methods also provide a framework for economic evaluations of other interventions for acute cardiovascular events.

Square Pegs and Round Holes? A Review of Economic Evaluation in Complementary and Alternative Medicine

Economic evaluation, linking the costs and consequences of an intervention to indicate the potential benefits of alternative interventions, is becoming established as one of the core tools for decision making in health care. As knowledge of the safety and effectiveness of complementary and alternative medicine (CAM) interventions increases, economic evaluation within CAM has a heightened significance. To explore whether the present framework for economic evaluation fits CAM and what modifications if any are needed for its application. Systematic review. A comprehensive search of four databases was undertaken (NHS Economic Evaluation Database, AMED, MEDLINE, CINAHL). Studies were included if they took the form of a comparative analysis of costs and consequences of a CAM treatment and were written in English. Each study was reviewed using a set of methodological questions to judge their quality as economic evaluations. A total of 19 studies were identified, of which 9 were cost-effectiveness studies, 7 cost-consequence studies, 2 cost-minimization studies, and 1 cost-benefit analysis. Seventeen (17) of the studies involved CAM treatments being used alongside mainstream or conventional treatments. The majority of the treatments aimed to alleviate pain, including chronic pain, back pain, neck pain, and migraine. Only a small minority of studies addressed wider outcomes of particular relevance to CAM disciplines. Nine (9) adopted a service provider perspective only, 7 included wider sickness absence costs and 3 patient costs. Only 1 study included costs to relatives. The quality of the cost and benefit dimensions of the studies was mixed. A CAM sensitive approach to economic evaluation is required. This needs to include a focus on outcomes that explore the range of effects of CAM treatment, an exploration of the client's perspective and not just that of the service provider and study designs that facilitate the individualized practitioner approach so central to CAM treatment.

Do Interventions to Increase Income Improve the Health of the Poor in Developed Economies and Are Such Policies Cost Effective?

Health policy has shifted towards placing a greater emphasis on the role of lifestyle and life circumstances in improving health. The factors that are associated with poor health status are known, but the comparative effectiveness of specific policy interventions in improving health and reducing inequalities in health is unclear. For example, there is little evidence that specific policies aimed at providing income support or poverty eradication have any measurable impact on health. Two previous reviews have addressed the evidence in this area but in a fairly restrictive way. One considered only randomised trials and the other excluded non-cash benefits. This article builds on the previous reviews in three ways: a broader scope of study designs and types of intervention is considered; more recent literature is reviewed; and it considers the extent to which an economic evaluation framework has been applied. A systematic search of electronic databases was carried out for literature published since 1980 and in the English language. Each study was appraised in terms of its relevance to the question of interest, and the quality of the study design was appraised in terms of its capacity to provide robust answers. Few studies were found with health outcomes as their main focus. Most of the studies that used secondary data sources or survey data were of poor quality. Where economic evaluations were reported, these tended to be restricted to financial assessments. Different types of interventions were evaluated. In studies of cash benefits, there was limited evidence that they had a positive effect on some health domains, mainly psychosocial. Studies in welfare-to-work interventions produced mixed results in terms of impact on either income or health; there was no consistent relationship between income gains and health improvements. Five welfare-to-work studies included 'benefit-cost analysis', but these were essentially financial assessments. Studies of benefits in kind did not meet the quality criteria for inclusion in this article. Overall, we found no evidence of the potential cost effectiveness of income support or anti-poverty initiatives in improving health, nor is there a strong effectiveness literature on which to build such analysis. However, the hypothesis that increased income may improve health cannot be said to have been properly tested. Studies generally analyse the incremental effect of changes to the welfare system and do not estimate the health effects of current provisions. The production function for good health is complex. Increasing income may be a necessary, but not a sufficient, condition for the creation of better health in those with low incomes.