Economic Evaluation Techniques Research Articles

Cost-utility analysis of lumbar disc herniation: Surgery versus conservative treatment*

ABSTRACT Objective: This study aimed to compare surgical and conservative treatment applied to patients diagnosed with lumbar disc herniation in terms of both cost and value derived from the treatments. Methods: Cost-utility analysis was chosen as an economic evaluation technique and made from the perspective of the reimbursement agency. The sample of the study consisted of 96 patients with lumbar disc herniation. The cost data of the study were obtained from the automation system of Ordu University Training and Research Hospital and the effectiveness data were obtained by applying the EQ-5D-5L Health Questionnaire to the patients. The data were evaluated using decision tree analysis, cost-utility analysis, sensitivity analysis, and budget analysis. Results: As a result of the analysis, it was noted that surgical treatment in lumbar disc herniation is very cost-effective compared to conservative treatment. Conclusions: The surgical method is recommended for the treatment of lumbar disc herniation within the framework of medical requirements.

Adapting Economic Evaluation Methods to Shifting Global Health Priorities: Assessing the Value of Health System Inputs

ObjectivesWe highlight the importance of undertaking value assessments for health system inputs if allocative efficiency is to be achieve with health sector resources, with a focus on low- and middle-income countries. However, methodological challenges complicated the application of current economic evaluation techniques to health system input investments. MethodsWe undertake a review of the literature to examine how assessments of investments in health system inputs have been considered to date, highlighting several studies that have suggested ways to address the methodological issues. Additionally, we surveyed how empirical economic evaluations of health system inputs have approached these issues. Finally, we highlight the steps required to move toward a comprehensive standardized framework for undertaking economic evaluations to make value assessments for investments in health systems. ResultsAlthough the methodological challenges have been illustrated, a comprehensive framework for value assessments of health system inputs, guiding the evidence required, does not exist. The applied literature of economic evaluations of health system inputs has largely ignored the issues, likely resulting in inaccurate assessments of cost-effectiveness. ConclusionsA majority of health sector budgets are spent on health system inputs, facilitating the provision of healthcare interventions. Although economic evaluation methods are a key component in priority setting for healthcare interventions, such methods are less commonly applied to decision making for investments in health system inputs. Given the growing agenda for investments in health systems, a framework will be increasingly required to guide governments and development partners in prioritizing investments in scarce health sector budgets.

A systematic literature review of economic evaluation studies of interventions impacting antimicrobial resistance

BackgroundAntimicrobial resistance (AMR) is accelerated by widespread and inappropriate use of antimicrobials. Many countries, including those in low- and middle- income contexts, have started implementing interventions to tackle AMR. However, for many interventions there is little or no economic evidence with respect to their cost-effectiveness. To help better understand the scale of this evidence gap, we conducted a systematic literature review to provide a comprehensive summary on the value for money of different interventions affecting AMR.MethodsA systematic literature review was conducted of economic evaluations on interventions addressing AMR. a narrative synthesis of findings was produced. Systematic searches for relevant studies were performed across relevant databases and grey literature sources such as unpublished studies, reports, and other relevant documents. All identified economic evaluation studies were included provided that they reported an economic outcome and stated that the analysed intervention aimed to affect AMR or antimicrobial use in the abstract. Studies that reported clinical endpoints alone were excluded. Selection for final inclusion and data extraction was performed by two independent reviewers. A quality assessment of the evidence used in the included studies was also conducted.Results28,597 articles were screened and 35 articles were identified that satisfied the inclusion criteria. The review attempted to answer the following questions: (1) What interventions to address AMR have been the subject of an economic evaluation? (2) In what types of setting (e.g. high-income, low-income, regions etc.) have these economic evaluations been focused? (3) Which interventions have been estimated to be cost-effective, and has this result been replicated in other settings/contexts? (4) What economic evaluation methods or techniques have been used to evaluate these interventions? (5) What kind and quality of data has been used in conducting economic evaluations for these interventions?DiscussionThe review is one of the first of its kind, and the most recent, to systematically review the literature on the cost-effectiveness of AMR interventions. This review addresses an important evidence gap in the economics of AMR and can assist AMR researchers’ understanding of the state of the economic evaluation literature, and therefore inform future research.Systematic review registration PROSPERO (CRD42020190310).

A Simplified Facility Management Tool for Condition Assessment through Economic Evaluation and Data Centralization: Branch to Core

The field of facility management, especially concerning condition assessment, is affected by two main issues: one is the incompleteness and heterogeneity of information transfer between the involved subjects; the other is the frequent lack of specific advanced skills needed for technically complex tools. The immediate consequences of this process inefficiency fall on economic and environmental aspects: the unavailability or incorrect structuring of data related to building conditions does not allow for making optimal choices concerning interventions on components. This paper attempts to provide a solution in this framework by presenting a methodology for simplified condition assessment, in which the evaluation of decay parameters draws from economic evaluation techniques, and which optimizes data collection, systematization, and elaboration, also integrating it with a mobile app for automatic data upload and centralization. The research underlying its development draws from decay evaluation criteria and national standards for the analysis and breakdown of buildings. The methodology was tested on a case study of the Cloister of Santa Croce in Florence, which also served as the client of the tool. The proposed methodology stands as an easily implementable integration to condition assessment for maintenance planning and building inspection activities.

Real options approach: Case study applied to a nursery to produce Eucalyptus forest seedlings in Brazil

Aim of study: We checked if an infrastructure investment project for a nursery to produce Eucalyptus forest seedlings using the real options approach was economically viable, in order to verify the influence of the deferral, expansion and abandonment options on the investment project value, as well as their concatenation.
 Area of study: Our study was based on technical-economic coefficients of a nursery infrastructure to be installed in the São Paulo’s state Midwest region, Brazil.
 Material and methods: The investment was assessed by addressing the uncertainties inherent in the investment project. We used the dynamic model for real option approach and, to determine the volatility of the project, we applied the Monte Carlo simulation method. As real options for the project, we employed deferral, expansion, and abandonment.
 Main results: Using the traditional valuation methodology, we obtained a negative static net present value of USD 50,957. When incorporating the real options of the abandonment, deferral and expansion in the form of managerial flexibility to forest managers, we obtained the expanded net present value of USD 216,498, that is, 524.8% of valuation. The traditional method of investment evaluation undervalues the project in infrastructures to produce Eucalyptus forest seedlings nursery, and the increase in managerial flexibility, through the real options for deferral, expansion and abandonment, promotes value to forest managers and enables the feasibility of the project.
 Research highlights: Infrastructure investment project for a nursery to produce Eucalyptus forest seedlings is not economically viable through the traditional economic evaluation techniques. However, by incorporating managerial flexibilities, through real options, the investment project was valued and it became economically viable.

The Performance Evaluation Model of Hotel Green Human Resources Based on Internet of Things and Fuzzy Theory

The Internet of Things (IoT) is influencing national centers of excellence as well as businesses’ approaches to development and how they generate and exploit opportunities in day-to-day hotel activities. The IoT is revolutionary and will transform how human resources are created and managed, necessitating a fresh and adaptable strategy for human resource development. The promise of the IoT is that each device will have a unique means of identifying itself and will be addressable, allowing any object to be connected. This will present a new difficulty to how green human resource development in hotels is conducted. Besides, environmental protection has emerged as the most pressing problem in world politics. Green problems are widely acknowledged as a fundamental source of development. Due to increased customer awareness, the hotel service sector has advanced in terms of quality of services as green marketing has evolved into a crucial instrument for sustainable business approaches. Green marketing strategies are being implemented by businesses to improve company success. In order to improve the adaptive performance assessment capacity of hotel green human resources, this research proposes a performance evaluation model of hotel green human resources based on the Internet of Things and fuzzy theory. It develops a large data analysis model of hotel green human resource performance by statistically quantitatively assessing the constraint parameters of hotel green human resource performance assessment. It extracts the entropy characteristic amount of hotel green human resource performance big data to make the best choice and assessment of hotel green human resource performance by green hotel maximum economic benefit evaluation and fuzzy decision technique. Furthermore, it builds an expert system analysis model for evaluating the hotel green human resource performance. Adaptive optimization of hotel green human resource performance evaluation is carried out by the fuzzy theory adaptive learning algorithm, and the optimization strategy of the hotel green human supply performance evaluation model is realized by similarity characteristic parameter estimation and fuzzy multidimensional parameter constraint. The simulation results show that the performance evaluation of hotel green human resources with this method has high accuracy and good confidence level, which improves the performance evaluation efficiency of hotel green human resources.

Economic assessment of molecular imaging in the oncology treatment process

The development towards targeted treatments in oncology has been accompanied by significant improvements in molecular imaging. Yet, broad application of novel imaging techniques has partly been slowed down due to economical considerations. Building on the broad positive evidence of its diagnostic accuracy, modelling of effects on long-term costs and effectiveness may help to foster a broader application and acceptance of comprehensive molecular imaging techniques, such as PET/MRI.In this article, common economic evaluation techniques and cost-effectiveness analysis (CEA) evaluation methods will be introduced including Markov models and incremental cost-effectiveness ratios (ICER). This is complemented with a review of literature on recently published cost-effectiveness of molecular imaging.Additionally, the strategic relevance of CEAs for the molecular imaging community is discussed and combined with a global outlook.

A review of public health economic modelling in the National Institute for Health and Care Excellence (NICE)

Background: The National Institute for Health and Care Excellence (NICE) use economic modelling to inform judgements whenever further insight is required for decision-making. Doing so for public health guidance poses several challenges. The study’s objective was to investigate the level of heterogeneity in NICE’s public health economic models with regards to economic evaluation techniques, perspectives on outcomes and the measurement of non-health benefits. Methods: A review of all economic modelling reports published by NICE’s Centre for Public Health (CPH) as part of their guidance. Results: The review identified 56 eligible pieces of public health over the relevant period. Of these, 43 used economic modelling and 13 used no formal economic model. In total 61 economic models were used. Though the CPH specifies a reference case, in practice there is a large amount of variability from one model to the next. The most common perspective used for evaluations was that of the National Health Service (NHS); the most common economic evaluation approach was cost-utility analysis (CUA). 23 of the 56 topics used other combinations of perspective and technique, which allowed them to incorporate non-health effects, such as productivity, the effect on taxes raised and benefits spending, costs to the criminal justice sector, the effect on educational attainment and general wellbeing. Conclusions: NICE regularly updates its reference case, and non-CUA evaluation techniques have become more prominent in recent years. The results highlight the genuine advantages of having a variety of economic evaluation techniques available, which can be matched with the given topic. While it is always necessary to be wary of the possibility of gamesmanship and cherry picking, there is a surprising alignment between many approaches in certain circumstances.

A systematic review on modelling approaches for economic losses studies caused by parasites and their associated diseases in cattle.

Parasites reside inside or outside their hosts and get host nutrition and blood. Here, we have emphasized economic losses in cattle caused by parasitic diseases due to ecto- and endo- parasites (flies, ticks, mites and helminths). We have outlined different methods/models including economic evaluation techniques and dynamic analysis as a major class, used for the calculation of economic losses caused by parasites in cattle. According to already conducted studies, a decrease in production is mentioned in quantity and percentage while financial losses are expressed in the form of account with respect to per head, herd or for the specific study area. The parasites cause the reduced production and financial losses due to control, treatment and mortality costs. We calculated the average decrease in milk production and organ condemnation as 1.16 L animal-1 day-1 and 12.95%, respectively, from overall cattle parasitic infections. Moreover, the average calculated financial and percentage losses were US$ 50.67 animal-1 year-1 and 17.94%, respectively. Economically important parasitic diseases mentioned here are caused by specific spp. of protozoans and helminths according to data collected from the literature. Protozoan diseases include tick-borne diseases, coccidiosis, neosporosis, trypanosomiasis and cryptosporidiosis. Losses due to tick-borne infections were encountered for decreased milk production, mortality, treatment and control. Losses from coccidiosis were due to decreased weight gain, treatment costs and mortality. While abortion losses were encountered in neosporosis. Trypanosomiasis caused losses due to a decrease in milk yield. Moreover, only diagnostic (conventional or molecular techniques) cost was taken into account for cryptosporidiosis. Economically important nematode parasites are Oesophagostomum spp., Cooperia spp., Trichostrongylus spp., Strongyloides spp., Ostertagia spp. and Haemonchus placei. Due to the zoonotic importance of echinococcosis, Echinococcus granulosus is the most economically important cestode parasite. Losses caused by echinococcosis were due to organ condemnation, carcass weight loss and decreases hide value, milk production and fecundity. While, fascioliasis is one of the most economically important trematodal disease, which causes cirrhosis of the liver due to parasite migration, and thus, the organ becomes inedible. So, it would be helpful for farmers and researchers to approach these methods/models for calculation of parasitic losses and should adopt suitable measures to avoid long-term economic losses.

Health technology assessment: A primer for ophthalmology.

Rising healthcare costs and increasing demands for health care require techniques to choose between competing uses and even rationing of health care. Economic evaluations and health technology assessments are increasingly a means to assess the cost effectiveness of healthcare interventions so as to inform such resource allocation decisions. To date, the adoption of health technology assessments, as a way of assessing cost effectiveness, in ophthalmology has been slower, relative to their implementation in other specialities. Nevertheless, demands for eye services are increasing due to an ageing population. The prevalence of conditions such as glaucoma, cataract, diabetic eye disease and age-related macular degeneration increases with age, and it is predicted that global blindness will triple by 2050. So there is a challenge for ophthalmologists to ensure that they can contribute to, interpret, critically evaluate, and use findings from economic evaluations in their clinical practice. To aid this, this article serves as a primer on the use of health technology assessments to assess cost effectiveness using economic evaluation techniques for ophthalmologists. Healthcare systems face many challenges worldwide - changing demographics and evolution of new technologies are only going to intensify. With this in mind, ophthalmology needs to be ready and able to engage with health economists to prepare, interpret, critically evaluate and use findings of economic evaluations and health technology assessments.

Techno‐economic optimization model for “sustainable” insulation material developed for energy efficiency

AbstractRenewable insulation materials are produced within the scope of this study using clay, fly ash, expanded perlite, epoxidized hemp oil, and hemp fiber. Density, thermal conductivity, and compressive‐tensile strength of the produced materials are analyzed. Economic and environmental analysis of the best sample with the most appropriate characteristics for an insulation material is conducted using a hybrid mathematical model developed for this study. Mathematical formulas of an economic evaluation technique of P1‐P2 method is integrated into Simulated Annealing Algorithm as one of the metaheuristic optimization approaches. Applicability of the proposed material for externally insulated walls is tested. For this purpose, optimum insulation thickness, payback period, energy savings for 10 years of lifetime, and CO2‐SO2 emissions were calculated for 5 types of energy sources along with a sensitivity analysis. This method is developed and coded in a software platform and used for the first time for the optimization of insulation material thickness. The experimental results obtained from evaluation of the sample H36 indicate that using this material for insulation purposes in the buildings have the potential of making significant contribution for energy efficiency along with various environmental benefits.

Comprehensive study of land transportation external costs (Iran)

This research is a comprehensive study of land transportation external costs that influence on the national economy. It includes detailed analysis of various land transportation costs by using the best available data. It provides monetized estimate approaches for estimate external costs. There are many efforts to get these external costs from consumers and producers. External costs are much expanded that this report is going to present a lot of information about the external costs of land transportation and different ways of estimating them in financial terms. So this study has an economical approach to turn the externalities into the monetized and it can help to assess the planning and policies in Iran. This work is done due to the people and society’s decision for choosing policies, according to benefits and social costs that it’s known as a good approach in the world. Environmental economists discover some new methods to account these effects as financial facts, in order to change the view point of traditional cost benefit analysis and instead of that, replace marginal social cost and marginal social benefit. External effects are a general expression that includes costs and benefits which can’t reflect the market’s prices. The costs and benefits are so important for planning of land transportation. It is one of the most comprehensive studies in Iran, including many costs categories that are often overlooked. It is help to apply economic evaluation techniques. The costs that are in the attention of the past studies and recognition of land transportation divided to 20 groups. In this study after study economic evaluation techniques Hedonic approach that depends on the real exchanges of market can have more real results. Hedonic is better than the others approach. The avoid cost and controlling costs are not the same with real costs. The contingent valuation method not based on the market exchanges and people reveal their willingness to pay. Due to limited time and resources when decisions have to be made, it’s offered to use the benefits transfer method for Iran. The benefits transfer method is a way that we can use the studies of external costs and we also use them in a reasonable way and in some more places.

Bonding of Plywood Using Hot Melt Adhesives

The paper presents the strength tests results of joints made by use of two hot melt adhesives. The tests were carried out according to the modified standard CSN EN 1465 (66 8510) and CSN EN 205 (66 8508). For bonding the three-layer plywood of 4 mm thickness was used. The test samples of 100 x 25 mm size were cut out from a semi-product in the direction of its longer side, in the oblique direction and in the direction of its shorter side. The specimen pairs were bonded using the hot melt glue gun. All assemblies were loaded up to their destruction. The destructive force and the destruction type were registered. From the results of carried out tests evaluation it follows that hot melt adhesives can be recommended for bonding plywood. The bonding strength of bonded joint is comparable to the strength of the bonded material. Finally the technical-economical evaluation of the experiments was carried out.

Cost-effectiveness analysis for decision making in health care-concept, relevance and methodological challenges

With continuous rise in health spending among countries, the need to make use of limited resources in health systems has become crucial. Health policy makers in countries strive to identify the interventions which can contribute to improving health outcomes. Techniques of economic evaluation, especially cost effectiveness analysis (CEA) have been widely applied in health sector to identify interventions that are more effective in terms of resources utilization. An understanding of CEA will not only help policy makers to take appropriate decisions in health sector but also in judicious spending of scarce resources. However, CEA studies have been flaunted with series of methodological challenges and practicability issues. This paper provides an introduction to CEA as one of the techniques of economic evaluation of health interventions and its relevance in making decisions in health sector. The paper also discusses some of the practical issues that arise while doing a CEA study in the health sector.

Abrasive wear resistance of selected woods

In this contribution, the results of the wear resistance study of 10 sorts of wood (apple, aspen, beech, hornbeam, horse-chestnut, London plane, mahogany, silver fir, sour cherry and sweet cherry) are published. The laboratory tests were carried out using the pin-on-disk machine when the abrasive clothes of three different grits (240, 120 and 60) were used. The wear intensity was assessed by the volume, weight and length losses of the tested samples. From the results of the carried out tests it follows that the wear resistance of different woods is different. It was proved that the wear resistance of different woods depends on the abrasive particles size, too. Also the technical-economical evaluation was part of the carried out tests. It was univocally proved that at the intensive abrasive wear using the abrasive cloth the best results were shown by hard woods, e.g. apple, beech or mahogany. Soft woods, e.g. horse-chestnut, silver fir or sweet cherry, are cheap, but their wear is bigger compared to hard woods.

154: A PHARMACOECONOMIC EVALUATION TO MAKE DECISION: IS THE USE OF SIMVASTATIN 10 MG AS AN OTC MEDICATION COST-EFFECTIVE FOR THE PRIMARY PREVENTION OF STROKE AMONGST WOMEN IN IRAN?

Background and aims:Cardiovascular disease (CVD) is one of the most important causes of death and disability in Iran. Stroke is a serious cardiovascular situation which poses many problems for both...

Evaluación de técnicas de deshidratación de etanol aplicando la simulación

Se evaluaron tres técnicas de deshidratación de etanol: la destilación azeotrópica con benceno, la pervaporación y la adsorción con tamices moleculares. Para la simulación de las técnicas se utilizó el simulador de procesos HYSYS v3.2 y para su comparación se estableció un mismo flujo molar de etanol en la mezcla etanol-agua de 216,5 kmol/h. En todos los casos se obtuvo una composición molar de etanol anhidro mayor de 99,7%. Se determinó la influencia de los parámetros de operación en la eficiencia de las tecnologías simuladas analizando tres casos de estudios. Se analizaron los perfiles de temperatura, flujos molares de líquido y vapor y las composiciones en las columnas presentes en cada proceso. Según la evaluación económica de las técnicas, todas las alternativas analizadas son económicamente ventajosas y en todas se logran ganancias netas, pero los mayores beneficios se obtienen en la adsorción con tamices moleculares al reportar la mayor tasa de rendimiento actualizada.

Bonding of plywood

The contribution contains results of bonded joints strength tests. The tests were carried out according to the modified standard ČSN EN 1465 (66 8510):2009. The spruce three-ply wood of 4 mm thickness was used for bonding according to ČSN EN 636 (49 2419):2013. The test samples of 100 × 25 mm size were cut out from a semi-product of 2,440 × 1,220 mm size in the direction of its longer side (angle 0°), in the oblique direction (angle 45°) and in the direction of its shorter side (crosswise – angle 90°). The bonding was carried out using eight different domestic as well as foreign adhesives according to the technology prescribed by the producer. All used adhesives were designated for wood bonding. At the bonding the consumption of the adhesive was determined. After curing, the bonded assemblies were loaded using a universal tensile-strength testing machine up to the rupture. The rupture force and the rupture type were registered. Finally, the technical-economical evaluation of the experiments was carried out.

Economic evaluation of integrated new technologies for health and social care: Suggestions for policy makers, users and evaluators

With an ageing population there is a move towards the use of assisted living technologies (ALTs) to provide social care and health care services, and to improve service processes. These technologies are at the forefront of the integration of health and social care. However, economic evaluations of ALTs, and indeed economic evaluations of any interventions providing both health benefits and benefits beyond health are complex. This paper considers the challenges faced by evaluators and presents a method of economic evaluation for use with interventions where traditional methods may not be suitable for informing funders and decision makers. We propose a method, combining economic evaluation techniques, that can accommodate health outcomes and outcomes beyond health through the use of a common numeraire. Such economic evaluations can benefit both the public and private sector, firstly by ensuring the efficient allocation of resources. And secondly, by providing information for individuals who, in the market for ALTs, face consumption decisions that are infrequent and for which there may be no other sources of information. We consider these issues in the welfarist, extra-welfarist and capabilities frameworks, which we link to attributes in an individual production model. This approach allows for the valuation of the health component of any such intervention and the valuation of key social care attributes and processes. Finally, we present a set of considerations for evaluators highlighting the key issues that need to be considered in this type of economic evaluation.

Economic evaluation of health promotion for older people-methodological problems and challenges.

BackgroundThe support of health promotion activities for older people gains societal relevance in terms of enhancing the health and well-being of older people with a view to the efficient use of financial resources in the healthcare sector. Health economic evaluations have become an important instrument to support decision-making processes in many countries. Sound evidence on the cost-effectiveness of health promotion activities would encourage support for the implementation of health promotion activities for older people. This debate article discusses to what extent economic evaluation techniques are appropriate to support decision makers in the allocation of resources regarding health promotion activities for older people. We address the problem that the economic evaluation of these interventions is hampered by methodological obstacles that limit comparability, e.g. with economic evaluations of curative measures. Our central objective is to describe and discuss the specific problems and challenges entailed in the economic evaluation of health promotion activities especially for older people with regard to their usefulness for informing decision making processes.DiscussionBeyond general problems concerning the economic evaluation of health promotion, our discussion focusses on problems that pertain to the analysis of cost and outcomes of health promotion interventions for older people. With regard to costs these are general problems of economic evaluations, namely the actual implementation of a societal perspective, the appropriate measurement and valuation of informal caregiver time, the measurement and valuation of productivity costs and costs incurred in added years of life. The main problems concerning the identification and measurement of outcomes are related to the identification of outcome parameters that, firstly, adequately reflect the broad effects of health promotion interventions, especially social benefits that gain importance for older people, and secondly, ensure a comparability of effects across different age groups. In particular, the limitations of the widely used QALY for older people are discussed and recently developed alternatives are presented.ConclusionsThe key conclusion of the article is that a comparison of the effects of different health promotion initiatives between different age groups by means of economic evaluation is not recommendable. Taking into account the complex outcomes of health promotion interventions it has to be accepted that the outcomes of these interventions will often not be comparable with clinical interventions and have to be assessed differently.