Health Economic Assessment Research Articles

PM2.5 prediction and related health effects and economic cost assessments in 2020 and 2021: Case studies in Jing-Jin-Ji, China

Serious air pollution can result in adverse health effects and economic costs. In this study, PM2.5 predictions, their related health effects, and the resulting economic costs for 2020 and 2021 were performed. A novel grey model optimized using optimization algorithms was established to predict PM2.5 concentration, and PM2.5-related health effects and economic costs were estimated using exposure–response functions, data regarding health effects, and environmental value assessment methods. The experimental results show that (1) PM2.5 values of Beijing, Tianjin, and Shijiazhuang are predicted to decline in 2020 and 2021, showing a trend of improving air quality; (2) the estimates of outpatient services and diseases account for largest proportion of the total health effects; (3) the economic costs of deaths and acute bronchial issues account for most of the overall costs, which can be regarded as a major means of reducing of health-related economic costs; (4) compared with Tianjin and Shijiazhuang, Beijing is expected to suffer the biggest economic cost, approximately 6505.84 million yuan, accounting for approximately 0.17% of the GDP in 2020, and 5554.94 million yuan, accounting for about 0.13% of the GDP in 2021, at the C0=10μg/m3 level, and is expected to suffer the lowest economic cost with approximately 0 yuan in 2020 and 2021 at the C0=35μg/m3 level. Overall, the findings provide a scientific basis for implementing air quality standards based on their expected health benefits and provide a reference for managing environmental air quality and implementing air quality health warnings and prevention measures.

Assessing the economic benefits of active transport policy pathways: Opportunities from a local perspective

Combined with concerns about climate change, air pollution and human health, the COVID-19 pandemic has renewed the use of and policy interest in active transport (AT) modes, namely cycling and walking. However, we note a high degree of uncertainty and lack of assessments addressing the economic benefits of AT policies; particularly when they are used as a mix of policies at the local level. This study aims to address this knowledge gap. We use the city of Oxford as a case study and apply the WHO Health Economic Assessment Tool and different baselines to assess four policy packages promoting a mode shift to AT for the 2030–2050 period. In total, 312 policy scenarios were produced and analysed. Results show that a policy mix that maximises economic benefits entails bike-sharing, cycle parking, training and education, low traffic neighbourhoods, e-bike grants, a workplace parking levy and increased use of a ‘cycle-to-work’ Scheme. Considering the health impacts from increased physical activity and avoided CO2 emissions, benefits are estimated in the range of: 62–256 prevented premature deaths; 18–50 million tonnes of avoided CO2e emissions; resulting in a total gross benefit of €3.45–11.28 billion. These impacts remain high and robust when key input parameters are tested via a sensitivity analysis. We conclude that investing in AT policy measures represents a multi-faceted low-carbon opportunity that should not be missed by policymakers.

Outpatient parenteral antimicrobial therapy (OPAT) versus inpatient care in the UK: a health economic assessment for six key diagnoses

ObjectivesTo compare costs associated with different models of outpatient parenteral antimicrobial therapy (OPAT) delivery with costs of inpatient (IP) care across key infection groups managed via OPAT in the UK.DesignA...

Mortality Implications of Increased Active Mobility for a Proposed Regional Transportation Emission Cap-and-Invest Program

BACKGROUND AND AIM: The transportation sector is now the primary contributor to greenhouse gas emissions in the USA. The Transportation Climate Initiative (TCI), a partnership of 12 states and the District of Columbia currently under development, would implement a cap-and-invest program to reduce transportation sector emissions across the Northeast and Mid-Atlantic region, including substantial investment in cycling and pedestrian infrastructure. The health impacts from investing in active mobility could be substantial. METHODS: Using outputs from an investment scenario model and the World Health Organization Health Economic Assessment Tool methodology, we estimate the mortality implications of increased active mobility and their monetized value for three different investment allocation scenarios considered by policymakers. We conduct these analyses for all 378 counties in the region, accounting for potential increased traffic fatalities. RESULTS:We find that even for the scenario with the smallest investment in active mobility, when it is fully implemented, the Transportation Climate Initiative could result in hundreds of fewer deaths per year across the region, with monetized benefits in the billions of dollars annually. Under all scenarios considered, the monetized benefits from deaths avoided substantially exceed the direct infrastructure costs of investment. These potential mortality benefits are like to be highly concentrated in urban areas. CONCLUSIONS:We conclude that investing proceeds in active mobility infrastructure is a cost-effective way of reducing mortality, especially in urban areas, providing a strong motivation for investment in modernization of the transportation system and further evidence of the health co-benefits of climate action. KEYWORDS: physical activity, transportation, active mobility, urban policy

Health-Related Quality of Life in Patients with Health Conditions in Lebanese Community Setting.

Background: The measurement of health-related quality of life (HRQoL) provides utility scores that could be used for health economics assessment. The aim of this study was to measure HRQoL in Lebanese patients with certain medical conditions, and to determine demographic and medical factors affecting such health utility scores. Method: This was a prospective cross-sectional pilot study conducted to gather information on the socioeconomic status, health condition and quality of life of participants with common diseases during their community pharmacy visit. The EuroQol-5-Dimension instrument was used to measure utility scores and SPSS v26 was used to perform the statistical analysis. Results: Participants (n = 102) gave an average of 6.8 and 7.4 out of 10 for their current health and for their satisfaction with their treatment, respectively. The mean utility score was 0.762 (SD 0.202). The number of prescribed medications per respondent indicated a significant impact on HRQoL (p = 0.002). On average, the utility scores were low for participants who were 75 years or older (0.15, p < 0.001), and those who were hospitalized in the past 12 months (0.111, p < 0.001). For every unit increase in treatment satisfaction, the quality-of-life score increased by 0.036 unit (p = 0.001). Conclusion: This pilot study measured health utility scores and factors influencing HRQoL in the Lebanese population. Further studies are needed to confirm our findings and to develop and validate tools helping to measure health related quality of life in the population in Lebanon.

Health economic value of CT scan based robotic assisted UKA: a systematic review of comparative studies

The aim of this systematic review was to compare relevant health economic consequences of the CT-based robotic-arm-assisted system versus conventional Uni-compartmental Knee Arthroplasty (UKA). In November 2020, A PRISMA systematic review was conducted using four databases (Pubmed, Scopus, Cochrane and Google Scholar) to identify all comparative studies reporting health economic assessments, such as robotic system costs, consumable costs, surgical revision rate, operating time, length of stay, and inpatient care costs. A total of nine comparative studies published between 2014 and 2020 were included in this systematic review. There was a moderate risk of bias as assessed using the ROBINS-I Tool. The CT-based robotic-arm-assisted system seemed to be associated with a lower risk of revision, decreased analgesia requirements during hospitalization, a shorter length of stay, and lower inpatient care costs compared to a conventional technique. CT-based robotic-arm-assisted system for UKA appears to be an economically viable solution with a positive health economic impact as it tends to decrease revision rate compared to conventional UKA, improve post-operative rehabilitation and analgesia management. Post-operative inpatient care costs seem lower with the robotic-assisted system but depend on institutional case volume and differ among health systems. More studies are needed to confirm cost-effectiveness of CT-based robotic-arm-assisted system based on different health systems. Systematic review, Level IV.

A health economic assessment of air pollution effects under climate neutral vehicle fleet scenarios in Stockholm, Sweden

IntroductionElectric vehicles (EVs) are heavily promoted as beneficial for climate and health. In most studies, it is assumed that EVs contribution to urban air pollution is zero due to no tailpipe emissions, ignoring the contribution of non-exhaust particles (brake, tire and road wear), which are unregulated in EU. This study of Stockholm, Sweden, aims to 1) assess how a future vehicle fleet impacts concentrations of particles of size less than 2.5 μm (PM2.5) and evaluate the expected health outcomes economically and 2) compare this with CO2 savings. MethodsSource specific dispersion models of exhaust and non-exhaust PM2.5 was used to estimate the population weighted concentrations. Thereafter exposure differences within a business as usual (BAU2035) and a fossil free fuel (FFF2035) scenario were used to assess expected health and economic impacts. The assessment considered both exhaust and non-exhaust emissions, considering the vehicle weight and the proportion of vehicles using studded winter tires. Health economic costs were retrieved from the literature and societal willingness to pay was used to value quality-adjusted life-years lost due to morbidity and mortality. ResultsThe mean population weighted exhaust PM2.5 concentration decreased 0.012 μg/m3 (39%) in FFF2035 as compared to BAU2035. Assuming 50% higher road and tire wear PM2.5 emission because of higher weight among EVs and 30% less brake wear emissions, the estimated decrease in wear particle exposures were 0.152 (22%) and 0.014 μg/m3 (1.9%) for 0 and 30% use on studded winter tires, respectively. The resulting health economic costs were estimated to €217M and €32M, respectively. An increase by 0.079 μg/m3 (11%) was however estimated for 50% use of studded winter tires, corresponding to an €89M increase in health costs. ConclusionConsidering both exhaust and wear generated particles, it is not straight forward that an increase of EVs will decrease the negative health impacts.

Quantifying the health and economic benefits of active commuting in scotland

BackgroundDespite the substantial evidence base for the health and economic benefits of walking and cycling, there remains a lack of published findings on the levels and benefits of active commuting at a national level. This study aimed to quantify the proportion of active commuters who met a daily equivalent of weekly physical activity recommendations through their commuting journeys, and the economic value of health benefits associated with active commuting in Scotland. MethodsA repeat cross-sectional analysis of the 2001 and 2011 waves of the Scottish Census was conducted. We analysed data from approximately 250,000 respondents aged 16–74 at each time-point who selected walking or cycling for their usual journey to work. A count was taken of walkers and cyclists whose daily commuting time was at least 30 min. The Health Economic Assessment Tool was used to estimate the number of deaths averted by active commuting, and the associated economic value of walking and cycling annually and over a 10-year period. ResultsActive modes of commuting accounted for a modal share of 13.5% (n = 244,009) in 2001, and 14.5% (n = 286,145) in 2011. In 2001, 46.5% of all active commuters met a daily target of 30 min of moderate intensity activity rising to 50.2% in 2011. In Scotland, the annual health economic benefit of commuting to work by walking was estimated to be approximately EUR 700.2 million, and EUR 79.8 million for cycling to work. ConclusionThis study provides clear evidence of the substantial health and economic benefits that active commuting makes at a population level. These findings support the case for further investment to increase levels of walking and cycling.

A novel hybrid fine particulate matter (PM2.5) forecasting and its further application system: Case studies in China

AbstractAir pollution has received more attention from many countries and scientists due to its high threat to human health. However, air pollution prediction remains a challenging task because of its nonstationarity, randomness, and nonlinearity. In this research, a novel hybrid system is successfully developed for PM2.5 concentration prediction and its application in health effects and economic loss assessment. First, an efficient data mining method is adopted to capture and extract the primary characteristic of PM2.5 dataset and alleviate the noises' adverse effects. Second, Harris hawks optimization algorithm is introduced to tune the extreme learning machine model with high prediction accuracy, then the optimized extreme learning machine can be established to obtain the forecasting values of PM2.5 series. Next, PM2.5‐related health effects and economic costs was estimated based on the predicted PM2.5 values, the related health effects, and environmental value assessment methods. Several experiments are designed using three daily PM2.5 datasets from Beijing, Tianjin, and Shijiazhuang. Lastly, the corresponding experimental results showed that this proposed system can not only provide early warning information for environmental management, assist in the formulation of effective measures to reduce air pollutant emissions, and prevent health problems but also help for further research and application in different fields, such as health issues due to PM2.5 pollutant.

Health economic evaluations of medical tests: Translating laboratory information into value - A case study example.

Health-care providers and funders are focused on identifying value in all their services and that includes laboratories. This means that in order to gain a share of scarce resources, laboratory professionals must also understand and assess the value of tests and that includes their economic impact. This can be assessed using health economic modelling tools which, when used in conjunction with a detailed value proposition for the test, can translate laboratory information into value. While a variety of health economic assessment tools are available, this review will focus on the use of decision analytic models which essentially compare the outcomes from pathways with and without the new test, the value of which is being assessed. A step-by-step framework is provided to guide laboratory professionals through the essential steps of conducting the evaluation. Initial steps include mapping the clinical pathway, understanding the goal of the evaluation, identifying the key stakeholders and their needs and determining a suitable analytical model. Following collection of the actual data, the validity of the model must be checked, and the robustness of the outcomes tested through sensitivity analysis. The last step is to translate the findings into measures of value which can then inform appropriate decisions by the stakeholders. This review of basic health economic modelling should enable laboratory professionals to have an understanding of how modelling can be applied to tests in their own environment and help deliver their potential value.

How consistent are cost-effectiveness estimates of a cardiovascular polypill strategy for the secondary prevention of cardiovascular disease across different cardiovascular risk equations?

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Ferre Internacional Background Risk equations (RE) are crucial to individualise estimates and properly adjust preventive treatments in patients with previous cardiovascular (CV) disease. RE are also routinely incorporated into health economic assessments but it is unknown if the cost-effectiveness results vary according to the RE applied. Purpose To determine the cost-effectiveness of a CV polypill (ASA 100mg, atorvastatin 20/40mg and ramipril 2.5/5/10mg) strategy compared to usual practice of combining monocomponents in the prevention of recurrent events in patients with previous coronary heart disease (CHD) or stroke applying two different CV RE: SMART and FRAMINGHAM, respectively. Methods A Markov cost-effectiveness model (1-year cycles; 4 health states: stable disease, subsequent CHD, subsequent stroke; death; payer perspective; direct medical costs; lifetime horizon; 4% discount rate) was developed for Portugal. Transition probability between health states was based on the SMART RE and an adaptation for secondary CV prevention of the FRAMINGHAM RE, respectively. Cost-effectiveness was calculated for a mixed cohort of secondary prevention patients (weighed post-CHD: 57.9%; post-stroke: 42.1%). Systematic literature reviews, Portuguese registries, mortality tables and official reports ware used to identify effectiveness, epidemiological, costs and utility data. Outcomes were costs (€, 2020) per life year (LY) and Quality Adjusted Life Year (QALY) gained. One-way (OWA) and probabilistic (PSA) sensitivity analyses tested the consistency of results. Assumptions were validated by experts. Results Applying the SMART RE, the incremental cost-effectiveness ratio (ICER) is 1,555€/LY gained and the incremental cost-utility ratio (ICUR) is 1,785€/QALY gained for the polypill strategy. The incremental costs of adopting the polypill strategy are 171,378€. Recurrent CV events (550.68 vs 642.13) and CV deaths (106.05 vs 122.81) are also less frequent with the polypill strategy compared with monocomponents. Assuming a willingness-to-pay (WTP) threshold of 30.000 €/QALY gained, there is a 77.80% probability for the polypill strategy to be cost-effective and 43.00% chances to be costs saving when used in a mixed cardiovascular and cerebrovascular disease population. Applying the FRAMINGHAM RE, the ICER is 998€/LY gained and the ICUR is 1,242€/QALY. The incremental costs amount 175,122€. Recurrent CV events (452.66 vs 563.48) and CV deaths (104.77 vs 127.32) are less frequent with the polypill strategy. The PSA shows a 99.5% probability for the polypill strategy to be cost-effective and 46.8% chances to be costs saving. Conclusion Both risk equations result in comparable results on the cost-effectiveness of interventions for the secondary prevention of CV disease. The polypill strategy remains cost-effective compared to the common practice of using individual monocomponents concomitantly, reducing recurrent CV events at a moderately higher cost.

The price of precision: trade-offs between usability and validity in the World Health Organization Health Economic Assessment Tool for walking and cycling

ObjectivesThe widely used World Health Organization (WHO) Health Economic Assessment Tool (HEAT) for walking and cycling quantifies health impacts in terms of premature deaths avoided or caused as a result of changes in active transport. This article attempts to assess the effect of incorporating ‘life-years’ as an impact measure to increase the precision of the model and assess the effect on the tool's usability. Study designThis article is a methods paper, using simulation to estimate the effect of a methodological change to the HEAT 4.2 physical activity module. MethodsWe use the widely used WHO HEAT for walking and cycling as a case study. HEAT currently quantifies health impacts in terms of premature deaths avoided or caused as a result of changes in active transport. We assess the effect of incorporating “duration of life gained” as an impact measure to increase the precision of the model without substantially affecting usability or increasing data requirements. ResultsCompared with the existing tool (HEAT version 4.2), which values premature deaths avoided, estimates derived by valuing life-years gained are more sensitive to the age of the population affected by an intervention, with results for older and younger age groups being markedly different between the two methods. This is likely to improve the precision of the tool, especially where it is applied to interventions that affect age groups differentially. The life-years method requires additional background data (obtained and used in this analysis) and minimal additional user inputs; however, this may also make the tool harder to explain to users. ConclusionsMethodological improvements in the precision of widely used tools, such as the HEAT, may also inadvertently reduce their practical usability. It is therefore important to consider the overall impact on the tool's value to stakeholders and explore ways of mitigating potential reductions in usability.

Application of health economics assessment techniques in the prevention and control of important infectious diseases: a review

Due to the relative shortage of health resources, rational allocation and utilization of health resources is critical to achieving the maximum economic benefits in developing countries, which requires a health economic assessment to meet the needs to balance the competitive requirements of cost reduction and effectiveness enhancement. This review describes the advances in applications of health economic assessment techniques in four major infectious diseases, including AIDS, tuberculosis, hepatitis B and schistosomiasis. Currently, there is no standard economic assessment in the prevention and control of infectious diseases, and notably, the transparency of cost research is limited, which may affect the popularization of the study conclusions. Further health economic assessments of infectious diseases are required to improve the quality, standard and transparency of the economic evaluation through formulating strategies, to improve the standardization of studies, to improve the popularization of the study conclusions and to improve the applicability of the economic evaluation for policies.

Immunoglobulin Replacement Therapy is critical and cost-effective in increasing life expectancy and quality of life in patients suffering from Common Variable Immunodeficiency Disorders (CVID): A health-economic assessment.

Common variable immunodeficiency disorders (CVID), the most common form of primary antibody deficiency, are rare conditions associated with considerable morbidity and mortality. The clinical benefit of immunoglobulin replacement therapy (IgGRT) is substantial: timely treatment with appropriate doses significantly reduces mortality and the incidence of CVID-complications such as major infections and bronchiectasis. Unfortunately, CVID-patients still face a median diagnostic delay of 4 years. Their disease burden, expressed in annual loss of disability-adjusted life years, is 3-fold higher than in the general population. Hurdles to treatment access and reimbursement by healthcare payers may exist because the value of IgGRT is poorly documented. This paper aims to demonstrate cost-effectiveness and cost-utility (on life expectancy and quality) of IgGRT in CVID. With input from a literature search, we built a health-economic model for cost-effectiveness and cost-utility assessment of IgGRT in CVID. We compared a mean literature-based dose (≥450mg/kg/4wks) to a zero-or-low dose (0 to ≤100 mg/kg/4wks) in a simulated cohort of adult patients from time of diagnosis until death; we also estimated the economic impact of diagnostic delay in this simulated cohort. Compared to no or minimal treatment, IgGRT showed an incremental benefit of 17 life-years (LYs) and 11 quality-adjusted life-years (QALYs), resulting in an incremental cost-effectiveness ratio (ICER) of €29,296/LY and €46,717/QALY. These results were robust in a sensitivity analysis. Reducing diagnostic delay by 4 years provided an incremental benefit of six LYs and four QALYs compared to simulated patients with delayed IgGRT initiation, resulting in an ICER of €30,374/LY and €47,495/QALY. The health-economic model suggests that early initiation of IgGRT compared to no or delayed IgGRT is highly cost-effective. CVID-patients' access to IgGRT should be facilitated, not only because of proven clinical efficacy, but also due to the now demonstrated cost-effectiveness.

Better Breathlessness Services for Older People with Advanced Diseases: A Multicentre Discrete Choice Experiment and Economic Modelling (OPRBreathe)

Background: In advanced respiratory disease, breathlessness becomes severe, increasing health services use. Breathlessness Services (BSs) demonstrate effectiveness in trials and meta-analyses but lack health economic assessment and modelling of their impacts on care services. Methods: We conducted a discrete choice experiment (DCE), followed by cost-effectiveness analysis modelling. The DCE comprised face to face interviews with older patients with chronic breathlessness and their carers across eight UK centres. Regression analysis of DCE data determined the preferences (or not, indicated by negative β coefficients) of service attributes for patients. Economic modelling estimated costs and quality adjusted life years (QALYs) over five years. Findings: We recruited 190 patients, 68 carers. Offering BSs from GP surgeries was not preferred (β =-0.30, 95% CI -0.40 to -0.21); hospital outpatient clinics (0.16, 0.06 to 0.25) or via home visits (0.15, 0.06 to 0.24) were preferred. BSs with comprehensive treatment review (0.15, 0.07 to 0.21) and holistic support (0.19, 0.07 to 0.31) were preferred to usual services. Cost-effectiveness analysis found the most and the least preferred models of BSs were cost-effective compared to usual care. The most preferred BSs had £5,719 lower costs and 0.004 QALY benefit per patient. Uptake was higher when attributes were tailored to individual preferences (86% versus 40%). Interpretation: BSs are cost-effective compared to usual care for health and social care, giving cost savings and better quality of life. Uptake of BSs is higher when service attributes are individually tailored. Funding: This study was funding by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0815-20026). Declaration of Interest: All authors have nothing to disclose. Ethical Approval: This study received ethical approval from the West of Scotland Research Ethics Service (Ref. 17/WS/0083).

СИСТЕМАТИЧЕСКИЙ ОБЗОР ЭКОНОМИЧЕСКИХ ОЦЕНОК ПРОФИЛАКТИКИ КАРИЕСА МОЛОЧНЫХ ЗУБОВ У ДЕТЕЙ ДОШКОЛЬНОГО ВОЗРАСТ

Caries of baby teeth is the most common disease among preschool children in the practice of a dentist. This is why it is so important to take into account a number of preventive measures at an early stage. This study is devoted to evaluating the cost-effectiveness of prevention of dental caries in preschool children. In the course of the study, the materials of the past years of the main literature reviews were studied, in which full and partial economic efficiency was calculated using popular statistical models. We also took into account the initial clinical cases and calculated the full cost-effectiveness based on school practice for the prevention of dental diseases and dental education among parents and preschool children. The economic status was assessed using a checklist of consolidated reporting standards for health economic assessment. Thus, the economic efficiency and profitability in the prevention of dental diseases in preschool children are shown. Based on the data obtained, a direct relationship was revealed in the economic significance and frequency of occurrence of caries of baby teeth, as well as the profitability of prevention of caries and its complications.

Quarterly PM2.5 prediction using a novel seasonal grey model and its further application in health effects and economic loss assessment: evidences from Shanghai and Tianjin, China

Previous research only focused on PM2.5 prediction without considering its further application or just evaluated the past years' health effects and economic losses caused by PM2.5 without studying the future scenarios. Thus, a novel hybrid system using a seasonal grey model with the fractional order accumulation, called SFGM (1, 1), and health economic loss assessment model was developed in this study, which can not only perform quarterly PM2.5 prediction, but also estimate its health effects and economic losses. The results indicated that (1) the designed SFGM (1, 1) can not only reflect the seasonal fluctuation, but also predict the seasonal PM2.5 concentrations with higher prediction accuracy in both out-and-in-samples than comparison models. (2) The total economic losses in 2020 of Shanghai and Tianjin will be 6867.25 million yuan (95% CI: 3072.34–10704.47) and 4869.20 million yuan (95% CI: 2194.50–7532.00), respectively, showing that Shanghai will suffer bigger economic losses than Tianjin. (3) The economic loss caused by the premature deaths attributable to PM2.5 is the largest, accounting for more than 70% of the total economic loss. Finally, the findings can help policymakers to formulate more policies and take effective measures to improve public awareness of environmental protection.

An economic analysis of the health-related benefits associated with bicycle infrastructure investment in three Canadian cities

Decision-makers are increasingly requesting economic analyses on transportation-related interventions, but health is often excluded as a determinant of value. We assess the health-related economic impact of bicycle infrastructure investments in three Canadian cities (Victoria, Kelowna and Halifax), comparing a baseline reference year (2016) with the future infrastructure build-out (2020). The World Health Organization's Health Economic Assessment Tool (HEAT; version 4.2) was used to quantify the economic value of health benefits associated with increased bicycling, using a 10-year time horizon. Outputs comprise premature deaths prevented, carbon emissions avoided, and a benefit:cost ratio. For 2016-2020, we derived cost estimates for bicycle infrastructure investments (including verification from city partners) and modelled three scenarios for changes in bicycling mode share: 'no change', 'moderate change' (a 2% increase), and 'major change' (a 5% increase). Further sensitivity analyses (32 per city) examined how robust the moderate scenario findings were to variation in parameter inputs. Planned bicycle infrastructure investments between 2016 and 2020 ranged from $28-69 million (CAD; in 2016 prices). The moderate scenario benefit:cost ratios were between 1.7:1 (Victoria) and 2.1:1 (Halifax), with the benefit estimate incorporating 9-18 premature deaths prevented and a reduction of 87-142 thousand tonnes of carbon over the 10-year time horizon. The major scenario benefit:cost ratios were between 3.9:1 (Victoria) and 4.9:1 (Halifax), with 19-43 premature deaths prevented and 209-349 thousand tonnes of carbon averted. Sensitivity analyses showed the ratio estimates to be sensitive to the time horizon, investment cost and value of a statistical life inputs. Within the assessment framework permitted by HEAT, the dollar value of health-related benefits exceeded the cost of planned infrastructure investments in bicycling in the three study cities. Depending on the decision problem, complementary analyses may be required to address broader questions relevant to decision makers in the public sector.

Utility Index and Patient-Reported Outcome Measures in Glaucomatous Patients Comparing with Normal Participants.

PurposeUtility index is a significant outcome in terms of health economics assessment while patient-reported outcome measure (PROMs) evaluates quality of life (QOL) from patient’s perspective. Our objective was to evaluate both utility indices and PROMs using generic and eye specific QOL in glaucomatous patients compared with normal population.MethodsThis is a case-control study. We interviewed normal and glaucomatous participants with the European Quality of Life questionnaire (EQ-5D-5L), the European visual analogue scale (EQ-VAS) and the visual function questionnaire 28 (Thai version) (VFQ-28). The visual function questionnaire utility index (VFQ-UI) and generic utility index from EQ-5D-5L were calculated.ResultsThere were 47 normal and 127 glaucomatous participants in this study. Amongst glaucoma group, 35 participants were in the early stage of the disease, 43 were in the moderate stage, 30 normal vision participants were in the severe stage, 14 participants had blindness one eye, and 5 had blindness both eyes. The mean age of the participants in both groups was statistically similar (63.78±6.84 vs 66.30±8.93 years old, respectively, p=0.062). Underlying diseases between groups were also comparable. The EQ-5D-5L utility index score and the EQ-VAS score were not statistically different between normal and glaucomatous groups, respectively (EQ-5D-5L: 0.874±0.122 vs 0.837±0.191, p=0.215; EQ VAS: 76.06±15.07 vs 74.02 ±15.10, p=0.43). By contrast, VFQ-UI of the glaucomatous group was significantly lower than that of the normal group, (VFQ-UI: 0.833±0.147 vs 0.895±0.070, accordingly, p<0.05).ConclusionsUtility index from the VFQ-UI was a relevant PROMs for evaluating the QOL of glaucomatous patients in terms of visual function specificity and acceptable validity.

Impact Assessment on Cycle Super Highway Schemes

Recently, Seoul has been pushing for eco-friendly transportation policies to reduce emission and improve environment, including restrictions on the use of cars and the introduction of shared bicycles. The government introduced the shared bicycles, of which the demand has been steadily increasing. The government is planning to introduce Cycling Rapid Transit (CRT) for the enhancement of the shared bicycle program. However, by applying the standard feasibility assessment, it is difficult to secure the feasibility of many eco-friendly measures, such as CRT. This research intends to promote the eco-friendly transportation by reflecting other benefit indicators represented by the wider impact parameters, such as health benefits. Based on the Origin/Destination data of the shared bicycles users, this study conducted a demand forecast estimation for various scenario considering the conversion of existing means to short-distance traffic, and analysed the benefits reflecting the wider impact. The study considered cycling's health benefits, which are estimated by the HEAT (Health Economic Assessment Tool) and the SART (The Sickness Absence Reduction Tool) used by WHO. The CRT introduction analysis was conducted on three sites, and the analysis showed that if human life value is not reflected, B/C is found to be at a minimum of 0.47 and the feasibility of the project cannot be secured with the existing methodology. When wider impact was applied, B/C was shown up to 3.29. Through this study, an efficient and more adequate feasibility methodology for evaluating the eco-friendly transportation policies was suggested, as the research intended to present the development direction for the analysis of health benefits suitable for domestic analysis and the selection of reference values.