National Fee Research Articles

Cost-effectiveness analysis of CTZ/TAZ for the treatment of ventilated hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia in Japan

BackgroundResistant bacterial infections, particularly those caused by gram-negative pathogens, are associated with high mortality and economic burdens. Ceftolozane/tazobactam demonstrated efficacy comparable to meropenem in patients with ventilated hospital-acquired bacterial pneumonia in the ASPECT-NP study. One cost-effectiveness analysis in the United States revealed that ceftolozane/tazobactam was cost effective, but no Japanese studies have been conducted. Therefore, the objective of this study was to assess the cost-effectiveness of ceftolozane/tazobactam compared to meropenem for patients with ventilated hospital-acquired bacterial pneumonia/ventilator-associated bacterial pneumonia from a health care payer perspective.MethodsA hybrid decision-tree Markov decision-analytic model with a 5-year time horizon were developed to estimate costs and quality-adjusted life-years and to calculate the incremental cost-effectiveness ratio associated with ceftolozane/tazobactam and meropenem in the treatment of patients with ventilated hospital-acquired bacterial pneumonia/ventilator-associated bacterial pneumonia. Clinical outcomes were based on the ASPECT-NP study, costs were based on the national fee schedule of 2022, and utilities were based on published data. One-way sensitivity analysis and probabilistic sensitivity analysis were also conducted to assess the robustness of our modeled estimates.ResultsAccording to our base-case analysis, compared with meropenem, ceftolozane/tazobactam increased the total costs by 424,731.22 yen (£2,626.96) and increased the quality-adjusted life-years by 0.17, resulting in an incremental cost-effectiveness ratio of 2,548,738 yen (£15,763.94) per quality-adjusted life-year gained for ceftolozane/tazobactam compared with meropenem. One-way sensitivity analysis showed that although the incremental cost-effectiveness ratio remained below 5,000,000 yen (£30,925) for most of the parameters, the incremental net monetary benefit may have been less than 0 depending on the treatment efficacy outcome, especially the cure rate and mortality rate for MEPM and mortality rate for CTZ/TAZ. 53.4% of the PSA simulations demonstrated that CTZ/TAZ was more cost-effective than MEPM was.ConclusionAlthough incremental cost-effectiveness ratio was below ￥5,000,000 in base-case analysis, whether ceftolozane/tazobactam is a cost-effective alternative to meropenem for ventilated hospital-acquired bacterial pneumonia/ventilator-associated bacterial pneumonia in Japan remains uncertain. Future research should examine the unobserved heterogeneity across patient subgroups and decision-making settings, to characterise decision uncertainty and its consequences so as to assess whether additional research is required.

The impact of changes in a physician fee schedule on medical expenditures, fees, and volume of services. Evidence from a national fee schedule reform in Australia

We examine the impact of changes to a national physician fee schedule on total medical expenditures, the volume of services, and fees charged. In our context, changes to the fee schedule were designed to promote value-based health care, and so included different types of changes to subsidised medical services, including changes to fees. Using claims data from a sample of doctors linked to a physician survey, we use difference-in-difference methods with a staggered adoption design to compare medical services which were affected with those which were not. We show that medical expenditures and the volume of affected services fell, though there is uncertainty about the magnitude of the fall. For GPs, we find evidence of increases in expenditures and fees and an increase in fees for some services provided by specialists.

Cost-effectiveness of preventive aspirin use and intensive downstaging polypectomy in patients with familial adenomatous polyposis: A microsimulation modeling study.

Although there is increasing evidence to suggest the cost-effectiveness of aspirin use to prevent colorectal cancer (CRC) in the general population, no study has assessed cost-effectiveness in patients with familial adenomatous polyposis (FAP), who are at high risk of developing CRC. We examined the cost-effectiveness of preventive use of low-dose aspirin in FAP patients who had undergone polypectomy in comparison with current treatment practice. We developed a microsimulation model that simulates a hypothetical cohort of the Japanese population with FAP for 40 years. Three scenarios were created based on three intervention strategies for comparison with no intervention, namely intensive downstaging polypectomy (IDP) of colorectal polyps at least 5.0 mm in diameter, IDP combined with low-dose aspirin, and total proctocolectomy with ileal pouch-anal anastomosis (IPAA). Cost-effective strategies were identified using a willingness-to-pay threshold of USD 50,000 per QALY gained. Compared with no intervention, all strategies resulted in extended QALYs (21.01-21.43 QALYs per individual) and showed considerably reduced colorectal cancer mortality (23.35-53.62 CRC deaths per 1000 individuals). Based on the willingness-to-pay threshold, IDP with low-dose aspirin was more cost-effective than the other strategies, with an incremental cost-effectiveness ratio of $57 compared with no preventive intervention. These findings were confirmed in both one-way sensitivity analyses and probabilistic sensitivity analyses. This study suggests that the strategy of low-dose aspirin with IDP may be cost-effective compared with IDP-only or IPAA under the national fee schedule of Japan.

Recommendations for Cost-Conscious Treatment of Basal Cell Carcinoma.

Basal cell carcinoma (BCC) affects 3.3 million Americans annually. Treatment modalities for BCC include many surgical and nonsurgical options. The cost of BCC treatment can pose a substantial burden to patients and the healthcare system. Cost can be an important consideration in BCC treatment planning. We present an approach to the management of BCC when cost reduction is a priority. A PubMed literature search identified studies on effectiveness of current BCC therapies. Treatment prices were obtained from the Medicare National Fee Schedule, GoodRx, and pharmaceutical companies. The American Academy of Dermatology's (AAD) guidelines for treating BCC were used to develop recommendations for cost-reductive treatment. The cost of treating a primary superficial BCC < 0.5cm arising on Area M (cheeks, forehead, scalp, neck, jawline, pretibial surface) was $143 with curettage and electrodesiccation (C&E), $143 with cryosurgery, $210 with standard excision and simple reconstruction (SE), $1221 with Mohs Micrographic Surgery (MMS) and simple reconstruction, $472 with imiquimod, $186 with 5-fluorouracil (5-FU), and $354-$371 for photodynamic therapy (PDT). The cost of treating a primary nodular BCC 1.1-2cm arising on Area L (trunk and extremities, excluding pretibial surface, hands, feet, nail units and ankles) was $183 with C&E, $183 with cryosurgery, $251 with SE and simple reconstruction, $1163-1351 with MMS and simple reconstruction, $472 with imiquimod, $186 with 5-FU, and $354-$371 for photodynamic therapy (PDT). The cost of treating a giant BCC (BCC > 10cm with aggressive behavior) was $465-3311 with radiation, $139,560 with vismodegib, $144,452 with sonidegib, ~ $44.5 with cisplatin (medication cost only), and at least $184,836 with cemiplimab-rwlc. For a primary superficial BCC < 0.5cm arising on Area M, the cost-conscious algorithm prioritizes C&E or cryosurgery. For a primary nodular BCC 1.1-2cm arising on Area L, the cost-conscious algorithm prioritizes C&E, cryosurgery, or 5-FU. For a giant BCC, the cost-conscious algorithm identifies superficial radiation therapy as first line.

Implant or tooth? – A cost-time analysis of managing “unrestorable” teeth✰

ObjectivesRetaining and restoring severely compromised teeth with subcrestal defect extensions or removing and replacing them using implant-supported crowns (ISC) remains controversial, and economic analyses comparing both strategies remain scarce. We performed a cost-time analysis, comparing the expenditures for retaining “unrestorable” teeth using forced orthodontic extrusion and restoration (FOE) versus extraction and ISC, in a clinical prospective cohort study. MethodsForty-two patients (n = 21 per group) were enrolled from clinical routine at a university into this study. Direct medical and indirect costs (opportunity costs) were assessed for all relevant steps (initial care, active care, restorative care, supportive care) using the private payer's perspective in German healthcare based on a micro-costing approach and/or national fee items. Statistical comparison was performed with Mann-Whitney-U test. ResultsPatients were followed up for at least one year after initial treatment (n = 40). The drop-out rate was 5% (n = 2). Total direct medical costs were higher for ISC (median: 3439.05€) than FOE (median: 1601.46€) with p<0.001. We observed a higher number of appointments (p = 0.002) for ISC (median: 14.5) in comparison to FOE (median: 12), while cumulatively, FOE patients spent more time in treatment (median: 402.5 min) in comparison to ISC (median: 250 min) with p<0.001, resulting in comparable opportunity costs for both treatment groups (FOE: 304.50€; ISC: 328.98€). ConclusionsISC generated higher costs than FOE. More in-depth and long-term exploration of cost-effectiveness is warranted. Clinical SignificanceISCs were associated with higher initial medical costs and required more appointments than the restoration of severely compromised teeth after FOE. Treatment time was higher for patients with FOE, resulting in similar opportunity costs for both treatment approaches. Future research needs to investigate long-term cost-effectiveness.

Transcatheter aortic valve implantation against conventional aortic valve replacement surgery in high-risk patients with aortic stenosis; a cost-effectiveness analysis

BackgroundAortic stenosis is a prevalent heart valvular disorder in Iran. Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR) are two common procedures for treating the disease in the current clinical pathway. However, TAVI is an expensive procedure, and for Iran with severe limitations in financial resources, it is crucial to investigate the cost-effectiveness of the technology against other competing alternatives with the same purpose. This study aims to analyse the cost-effectiveness of TAVI vs SAVR in elderly patients who are at a higher risk of surgery.MethodsThis study is a decision economic evaluation modeling, with a lifetime horizon and a healthcare payer (health insurer) perspective. The utility values are from a previous study, transitional probabilities come from an established clinical trial called PARTNER-1, and the unit costs are from Iran’s national fee schedule for medical services. The probabilistic and one-way sensitivity analyses have been performed to mitigate the uncertainty.ResultsThe incremental cost, effectiveness, and cost-effectiveness ratio for the base case were: 368,180,101 Iranian Rial, (US$ 1,473), 0.37 QALY-per-patient, and, 995,081,354 Iranian Rial (US$ 3,980), respectively. The probabilistic sensitivity analysis yielded 981,765,302 I.R.I Rials (US$ 3,927) per patient for the ICER. The probability of being cost-effective at one and three times the country’s Gross Domestic Production (GDP) is 0.31 and 0.83, respectively.ConclusionsTAVI does not seem a cost-effective procedure in comparison with SAVR at the current willingness to pay thresholds of the country. However, by increasing the WTP threshold to 3 times the GDP per capita the probability of being cost-effective will raise to 83%.

Economic Incentives in Stormwater Management: A Study of Practice Gaps in Poland

Sustainable rainwater management is made possible, among others, by nationwide and local policies and regulations that create economic incentives. This article analyzes how existing economic instruments in Poland motivate property owners to make investments that manage rainwater on their own properties. Two types of investments were analyzed: bioswales as one of the lowest-cost green infrastructure measures in construction and operation, and the rainwater harvesting solution that uses rainwater to irrigate greenery. Simulation of this type of investment was undertaken in response to existing economic incentives—obtainable discounts of national and municipal rainwater drainage fees and municipal subsidy programs for rainwater management from three cities of different sizes selected from the Greater Poland province. Analyses were carried out for three types of development: different intensity, sealing of the land, and number of residents. The financial profitability of the investment was evaluated by determining the payback period, NPV, and benefit–cost ratio, taking into account the possible discounts in fees and investment subsidies in the variant analyses. It was shown that the incentive function of national fees for rainwater drainage is low, and that the incentive function of municipal fees and subsidies is higher, depending on the design of the fee (rates and discounts) and subsidy (directions and level of subsidies) systems.

ВІДОБРАЖЕННЯ СПРОЩЕНОЇ СИСТЕМИ ОПОДАТКУВАННЯ У ПРОГРАМНОМУ ПРОДУКТІ BAS

Introduction. The introduction of a single tax rate of 2% under martial law conditions led to the emergence of new requirements for the software's ability to reflect the above changes introduced by the Tax Code of Ukraine. Today, the use of software products by business entities for the purpose of displaying accrued taxes and fees in the accounting system outlines new horizons in terms of their capabilities. Transforming the capabilities of software products to meet today's changing requirements aims to automate those areas of accounting that primarily relate to the payment and calculation of relevant national and local taxes and fees. Such a software product can be «BAS Accounting» (hereinafter – BAS) from the developer of Business automation software. Purpose. The purpose of the article is to provide practical recommendations for displaying the simplified taxation system in the BAS software product. Results. As a result of the conducted research, we can come to the conclusion that we considered the procedure for displaying the simplified taxation system in the BAS software product, namely, the payer of the single tax of the third group (2%). The above-mentioned software product enables business entities to adapt the proper display of single tax calculations in the accounting system, and therefore can be recommended for use by all single tax payers, both individuals and legal entities. Discussion. In further scientific research, it is suggested to focus attention on the debate on the abolition of the simplified taxation system, and especially on the third group of single tax payers, who are taxed at the rate of 2%, because such a taxation system significantly reduces income to the state budget in the form of income tax, as well as income tax added value, and this, in turn, leads to an increase in the country's state budget deficit.

The Impact of Changes in a Physician Fee Schedule on Medical Expenditures, Fees, and Volume of Services: Evidence from a National Fee Schedule Reform in Australia

The Impact of Changes in a Physician Fee Schedule on Medical Expenditures, Fees, and Volume of Services: Evidence from a National Fee Schedule Reform in Australia

POSA145 Budget Impact of Zanubrutinib to Treat Relapsed or Refractory Marginal Zone Lymphoma from a Payer Perspective in the United States

Marginal zone lymphoma (MZL) is a heterogeneous, rare non-Hodgkin lymphoma that follows a prolonged remitting and relapsing course. The pivotal Phase 2 MAGNOLIA trial suggests that zanubrutinib had high response rates and durable disease control with a favorable safety profile in patients with relapsed/refractory (r/r) MZL. This study aimed to assess the budget impact of zanubrutinib treating adult patients with r/r MZL who had previously received ≥1 prior anti-CD20–based regimens. A 3-year Excel-based model was developed to estimate the budget impact of adding zanubrutinib to the formulary of a 1 million (M) member health plan from a US payer perspective. Comparators included ibrutinib, bendamustine-rituximab, rituximab/cyclophosphamide/doxorubicin/vincristine/prednisone (RCHOP), rituximab-monotherapy, and lenalidomide. Dosing and treatment schedules were obtained from clinical trial publications. Costs of drug acquisition, administration, monitoring, and AE management costs (2020 US$) were obtained from RED BOOK, Centers for Medicare & Medicaid Services fee schedules, National Fee Analyzer, and Healthcare Cost and Utilization Project, respectively. Projected market shares were applied to estimate the number of patients treated with each regimen with and without zanubrutinib. Model outputs include annual budget impact and per member per month cost (PMPM) differences. Sensitivity analyses tested the impact of input uncertainty on modeled outcomes. In a hypothetical 1M members health plan, 11 patients (0.001%) were estimated to have at least 1 prior therapy and initiate treatment for r/r MZL. Adding zanubrutinib is associated with an average incremental budget impact of $45,018 ($0.004 PMPM), $67,527 ($0.006 PMPM), and $90,036 ($0.008 PMPM) in year 1, year 2, and year 3 respectively. Model results were most sensitive to zanubrutinib wholesale acquisition cost. Zanubrutinib offers an important treatment option for treating r/r MZL. Providing access to zanubrutinib for patients with r/r MZL is associated with minimal budget impact to a US health plan.

Tax system: features of conceptual apparatus

Problem setting. The definition of the tax system of Ukraine, given in para. 6.3 of Article 6 of the Tax Code of Ukraine (hereinafter - the TC of Ukraine), as a set of national and local taxes and fees, which are managed in the procedure established by this Code [9], does not cover a number of relations regulated by tax legislation. Appeal to the provisions of para. 1 part 2 of Article 92 of the Constitution of Ukraine [4] further "reinforces" our position. According to the abovementioned norm of the Basic Law of Ukraine, only the laws of Ukraine establish a system of taxation, taxes and fees. That is, at the level of the Constitution of Ukraine, the system of taxation and taxes and fees are divided. And there remains space for considerations, which is meant both by the tax system and by taxes and fees. Analysis of recent research. The tax system is a fundamental category of tax law. Various aspects of the tax system have been studied by many scientists. Here it should be noted D. Getmantsev, M. Kucheryavenko, N. Pryshva and others. Among the latest comprehensive legal studies of the tax system should be noted the dissertation of O. Barin "Legal foundations of the tax system of Ukraine: current state, basic elements, principles". The purpose of the article is to study the content and conceptual apparatus of the tax system. Article’s main body. The article is devoted to the peculiarities of the conceptual apparatus used in determining the tax system of Ukraine. The definition of the tax system as a set of national and local taxes and fees in the procedure established by the Tax Code of Ukraine leaves a number of issues of both theoretical and practical nature. Attention is focused on the fact that there is no military fee in the list of state taxes and fees fixed in Article 9 of the TC of Ukraine [9]. It is not clear for what reasons the regulation of its payment is carried out by p. 16-1 of subdivision 10 Section XX of the Tax Code of Ukraine [9]. With this approach, there is a situation when the military fee in the tax system of Ukraine seems not to have. Although the military fee is actually paid. We can’t mention that the name of this tax payment does not correspond to the provisions of clauses 6.1 and 6.2 of Article 6 of the TC of Ukraine [9], where the definition of tax and fee is provided. According to its legal mechanism, the military tax fee, because the main feature of the fee - individual repayment - is absent. That is, the military payer does not receive individual special benefits. Conclusions. The conceptual apparatus used in the Tax Code of Ukraine in determining the tax system of Ukraine has a number of contradictions. The case here is not only in legal technique. The lawmaker's approach to determining the tax system as a set of national and local taxes and fees in the procedure established by the TC of Ukraine leaves a number of issues of both theoretical and practical nature. This attitude to the fundamental principles of legal regulation of the tax sphere can have negative consequences for both taxpayers and budgets of different levels. Bringing the conceptual apparatus into logical compliance will be able to lay down the necessary guarantees of compliance with the rights of taxpayers and will be able to ensure stable receipt of taxes and fees to budgets.

Women\u2019s decision-making power in a context of free reproductive healthcare and family planning in rural Burkina Faso

BackgroundIn 2016, the national user fee exemption policy for women and children under five was introduced in Burkina Faso. It covers most reproductive healthcare services for women including prenatal care, delivery, and postnatal care. In subsequent years, the policy was gradually extended to include family planning. While studies have shown that user fee abolition policies increase visits to health centers and improve access to reproductive healthcare and family planning, there are also indications that other barriers remain, notably women’s lack of decision-making power. The objective of the study is to investigate women’s decision-making power regarding access to reproductive health and family planning in a context of free healthcare in rural Burkina Faso.MethodsA descriptive qualitative study was carried out in rural areas of the Cascades and Center-West regions. Qualitative data were collected using individual semi-structured interviews (n = 20 participants) and focus groups (n = 15 participants) with Burkinabe women of childbearing age, their husbands, and key informants in the community. Data was analyzed using thematic analysis.ResultsA conceptual framework describing women’s participation in the decision-making process was built from the analysis. Results show that the user fee exemption policy contributes to improving access to reproductive care and family planning by facilitating the negotiation processes between women and their families within households. However, social norms and gender inequalities still limit women’s decision-making power.ConclusionIn light of these results, courses of action that go beyond the user fee exemption policy should be considered to improve women’s decision-making power in matters of health, particularly with regard to family planning. Interventions that involve men and community members may be necessary to challenge the social norms, which act as determinants of women’s health and empowerment.

The SRU Law, twenty years later: evaluating the legacy of France’s most important social housing program

Twenty years ago, in December 2000, the SRU Law (Loi Solidarité et Renouvellement Urbain) was passed in France, requiring selected municipalities to devote 25% of their local stock to social housing, in order to curb growing trends of segregation. Almost twenty years later, the balance is striking: still 1,222 municipalities targeted by the program do not comply with the set quota of 25% social housing units per municipality. Out of these non-complying municipalities, 269 had to pay an increased fee in 2017, based on the Article 55 clause included in the SRU Law. The total fee that these ‘outlaw municipalities’ had to pay for not providing enough social housing represented a total of € 77 million in 2017, and helped finance the national rental social housing fund for housing. In this paper, I ask what impact the Article 55 fee clause designed to enforce SRU Law objectives has had on the rebalancing of social housing stocks for municipalities not complying with set quotas. To answer such a question, I conduct a Difference-in-Differences study that measures changes in social housing stocks before and after the passage of the law. The treatment group comprises municipalities not complying with quota requirements and subject to the Article 55 fee, while the control group consists of municipalities not complying with quota requirements, but exempt from the fee. Findings underscore how after the passage of the Article 55 fee, municipalities that were subject to the fee have built less social housing than municipalities that are exempt, relative to before the enactment of the law. They corroborate my conceptual framework, which states that beyond the adoption of a national fee for noncompliant municipalities, social housing production trends are impacted by the types of land use ideologies in place in municipalities, be they pro-social housing or exclusionary Twenty years later, these findings bring a new perspective to current debates taking place in policy circles around the effectiveness of one of France’s most important social housing policy programs.

Role of National Taxes and Fees in the System of Mandatory Payments

The provisions of the Tax Code of Ukraine, which determine the national taxes and fees within the system of mandatory payments, have been studied. It has been determined that the main purpose of national taxes and fees is the formation and saturation of the State budget’s revenues. The influence of national taxes and fees on the regulation of production and consumption has been clarified. It has been stated that national taxes and fees have a general impact on each person, obliging him or her to pay taxes established by the Tax Code. It has been determined that the studied taxes and fees are a lever for regulating and preventing negative tendencies in the economy and are the part of the mechanism that ensures the relationship between national interests and the interests of local business entities. The role of national taxes and fees within the system of mandatory payments as a source of revenues of the State budget (given their stability) also determines the policy of formation of all other types of revenues. The role of national taxes and fees in the formation of local budgets in Ukraine has been analyzed, namely such instruments of budget regulation as interest deductions from national taxes and revenues, budget transfers (budget subsidies, subsidies and subventions, withdrawals to the State Budget of Ukraine, intergovernmental settlements) and budget loans.&#x0D; It has been offered that the share of national taxes, which should be fixed in local budgets, is defined in proportion to the amount of the relevant national tax collected in a particular community. An important criterion for the VAT distribution between centeral and regional budgets should be the population of the region. It has been noted that national taxes are distributed between different levels of the budget system in accordance with the norms of deductions.

UTILITY OF THREE-DIMENSIONAL ULTRASOUND (3D-US) IN WOMEN WITH ARCUATE UTERI SCHEDULED FOR INVITRO-FERTILIZATION (IVF): A SCENARIO ECONOMIC ANALYSIS

Subtle septae have been reported in women with hysterosalpingography (HSG) diagnosis of arcuate uterus who had prior failed IVF. The optimal diagnostic tool and definition for arcuate uterus diagnosis, that behaves benignly from implantation perspective, is an area of debate. This study is a scenario economic analysis to determine whether implementation of 3D-US after HSG to screen for subtle septae in women with arcuate uterus anomaly prior to IVF treatment could be cost-effective. A decision-analytic-model A decision-analytic-model was developed to compare 2 screening strategies utilized in daily practice. Modeled women were 100 infertile women, indicated for IVF with HSG diagnosis of arcuate uterus. The first strategy (3D strategy) offers 3D-US screening of subtle septum in IVF women with arcuate uterus diagnosis based on initial HSG. The second strategy (NO-3D strategy) is the reference standard that adopts proceeding to IVF without 3D-US screening in similar cohort; widely practiced in low resource settings. ASRM-2016 defining criteria for uterine septum were followed to categorize modeled women. Model endpoints were cumulative costs and live birth (LB) after 3 successive IVF cycles. The incremental cost-effectiveness ratio (ICER) was calculated. Baseline input probability data were obtained utilizing the best available evidence concerning the effect of uterine septum incision before IVF therapy and the prevalence of missed septum in a population of arcuate uterus. Medicare 2019 National Fee Estimates were considered for costs assumptions. Costs were reported in US dollars. USA population based LB for year 2017 was also used. For modeling and analysis, we used TreeAge Pro Healthcare 2020 software. Sensitivity analysis was conducted. Base-case analysis revealed that 3D-US screening strategy prior to IVF was more cost effective than NO-3D strategy. After 3 IVF cycles, 3D-US screening resulted in cumulative LB of 73.2% with $ 2,203,250 total costs compared to 58.9 % cumulative LB and $ 2,255,000 total costs in NO-3D strategy. 3D-US implementation would cause initial costs of $142,250 for diagnosis of missed septae and their accompanying metroplasty procedure; however, this would yield cost saving of $ 3620 per live birth gained after 3 IVF cycles. Even in the worst-case-scenario of sensitivity analysis, when low probability of missed septate was evaluated, 3D strategy was still cost effective with extra-costs and more benefits (ICER: $1160 per LB) utilizing $50,000/QALY willingness-to-pay threshold. The higher the probability of missed septum detection in arcuate IVF population and the higher the increase in LB after septum resection, the more would be the cost effectiveness of 3D-startegy. Sensitivity analyses were robust. Adoption of 3D-US prior to IVF, to reevaluate arcuate uteri initially diagnosed by HSG, could minimize the financial burden due to failed cycle caused by missed septum. This strategy may be helpful, since randomized controlled trials in IVF women with uterine septum face recruitment challenges.

Evaluating a remote patient monitoring program for automated peritoneal dialysis

The benefits of automated peritoneal dialysis (APD) have been established, but patient adherence to treatment remains a concern. Remote patient monitoring (RPM) programs are a potential solution; however, the cost implications are not well established. This study modeled, from the payer perspective, expected net costs and clinical consequences of a novel RPM program in Colombia. Amarkov model was used to project costs and clinical outcomes for APD patients with and without RPM. Clinical inputs were directly estimated from Renal Care Services data or taken from the literature. Dialysis costs were estimated from national fees. Inpatient costs were obtained from a recent Colombian study. The model projected overall direct costs and several clinical outcomes. Deterministic and probabilistic sensitivity analyses (DSA and PSA) were also conducted to characterize uncertainty in the results. The model projected that the implementation of an RPM program costing US$35 per month in a cohort of 100 APD patients over 1 year would save US$121,233. The model also projected 31 additional months free of complications, 27 fewer hospitalizations, 518 fewer hospitalization days, and 6 fewer peritonitis episodes. In the DSA, results were most sensitive to hospitalization rates and days of hospitalization, but cost savings were robust. The PSA found there was a 91% chance for the RPM program to be cost saving. The results of the model suggest that RPM is cost-effective in APD patients which should be verified by a rigorous prospective cost analysis.

Budget impact of implementing platelet pathogen reduction into the Italian blood transfusion system.

Despite improvements in blood donor selection and screening procedures, transfusion recipients can still develop complications related to infections by known and emerging pathogens. Pathogen reduction technologies (PRT) have been developed to reduce such risks. The present study, developed whithin a wider health technology assessment (HTA) process, was undertaken to estimate the costs of the continuing increase in the use of platelet PRT in Italy. A multidisciplinary team was established to perform the HTA and conduct a budget impact analysis. Quantitative data on platelet use were derived from the 2015 national blood transfusion report and from the Italian Platelets Transfusion Assessment Study (IPTAS). The current national fee of 60 Euro per platelet PRT procedure was used to quantify the costs to the Italian National Health Service (INHS). The analysis adopts a 3-year time-frame. In order to identify the impact on budget we compared a scenario representing an increased use of PRT platelets over time with a control scenario in which standard platelets are used. Progressive implementation of PRT for 20%, 40% and 66% of annual adult platelet doses could generate an increase in annual costs for the INHS amounting to approximately 7, 14 and 23 million Euros, respectively. Use of kits and devices suitable for the treatment of multiple adult platelet doses in one PRT procedure could lower costs. In order to fully evaluate the societal perspective of implementing platelet PRT, the increase in costs must be balanced against the expected benefits (prevention of transfusion-transmissible infections, white cell inactivation, extension of platelet storage, discontinuation of pathogen detection testing). Further studies based on actual numbers of platelet transfusion complications and their societal cost at a local level are needed to see the full cost to benefit ratio of platelet PRT implementation in Italy, and to promote equal treatment for all citizens.

Governance Based on Cost Analysis (Unit Cost Analysis for Vocational Schools)

&lt;p class="Abstract"&gt;This study aims to calculate unit cost to produce one middle-level vocational school graduate (in Indonesian terms known as "Sekolah Menengah Kejuruan” abbreviated as SMK). The calculation is required because operational grant funds (in Indonesian terms known as antuan Operasional Sekolah abbreviated as BOS) are distributed so far to the same extent in all areas of Indonesia and for all majors. This is most likely less than optimal because in fact there are very basic characteristics differences including; Economic capacity of each region, the cost standard for each region, and the type of department in the school. Based on this, the researcher assumed that cost analysis should be done by considering these things as a basis to provide BOS funds tailored to specific characteristics. The data to be analyzed in this research is North Sumatra province data. This research is conducted in two stages, which in this report only completed the first phase which is a survey in North Sumatra region. Stages of survey to obtain data which then analyzed with related data such as community income, learning outcomes through the value of national examinations, tuition fee, and conditions of learning facilities. The research is funded by the ministries of research, technology and higher education through competing grant schemes for fiscal year 2017 and 2018. The result of correlation analysis between the variables shows that there is a strong relationship between the average income with average tuition paid by the community and between average tuition paid by the community with Quality Level of Education Facilities. The result of correlation analysis also shows a moderate relationship between the average tuition with learning outcomes measured through average national exam and relationship between quality level of education facilities with average national exam. While the relationship between average income with average national exam does not have a strong relationship. The result of correlation analysis concludes that further research is required to calculate unit cost. The results of these calculations can be used as a recommendation for policy makers to evaluate the funding system boss funds to pay attention to the characteristics as mentioned above.&lt;/p&gt;

Cost-effectiveness of the Aerobika* oscillating positive expiratory pressure device in the management of COPD exacerbations.

IntroductionCOPD places a huge clinical and economic burden on the US health care system, with acute exacerbations representing a key driver of direct medical costs. Current treatments, although effective in reducing symptoms and limiting exacerbations, do not adequately target the underlying disease processes that drive exacerbation development. The Aerobika* oscillating positive expiratory pressure (OPEP) device has been shown in a real-world effectiveness study to lower the frequency of moderate-to-severe exacerbations during a 30-day post-exacerbation period. This study sought to determine the impact on exacerbations and costs and to determine the cost-effectiveness of the Aerobika* device.MethodsData from published literature and national fee schedules were used to model the cost-effectiveness of the Aerobika* device in patients who had experienced an exacerbation in the previous month, or a post-exacerbation care population. Exacerbation trends and the impact of the Aerobika* device on reducing exacerbation frequency were modeled using a one-year Markov model with monthly cycles and three health states: (i) no exacerbation, (ii) exacerbation, and (iii) death. Scenario analysis and one-way sensitivity analysis (OWSA) were also performed.ResultsWhen the effect of Aerobika* device was assumed to last 30 days, use of the device resulted in cost-savings ($553 per patient) and improved outcomes (ie, six fewer exacerbations per 100 patients per year) compared to no OPEP/positive expiratory pressure therapy. When the effect of the Aerobika* device was assumed to extend beyond the conservative 30-day time frame, the Aerobika* device remained the dominant strategy (21 fewer exacerbations per 100 patients per year; cost savings of $1,952 per patient). Consistency in findings after performing OWSAs indicates the robustness of results.ConclusionThe Aerobika* device is a cost-effective treatment option that provides clinical benefit and results in direct medical cost savings in a post-exacerbation care COPD population.

Pictures, Protests and Politics: Mapping Twitter Images during South Africa’s Fees Must Fall Campaign

ABSTRACTNews media have often been criticised for framing social protests in negative ways, particular through photojournalism. While news photographs can shape the public's understanding of social and political events, research has shown that journalists often portray dramatic, violent or sensationalist images. This paper shifts the focus from mainstream news media, to explore how citizens themselves visually frame protests. The paper provides results from a qualitative analysis of the images shared by Twitter users during the national Fees Must Fall (FMF) student protests in South Africa, which began in October 2015. The paper analyses the representational strategies of the protest images tweeted, questioning how these visual images produce accounts of the social world, and further, how those accounts are constructed as “truthful” via their circulation in social media. Moreover, this analysis of the images circulated on Twitter and labelled using the hashtag Fees Must Fall (#FMF), explores the role played by images in strategic online communication within the campaign. An examination of this specific case contributes toward an understanding of social protest in an African context, particularly with respect to how new technologies and social media are increasingly being used as tools for political mobilisation.