A systematic review of health economic models of opioid agonist therapies in maintenance treatment of non-prescription opioid dependence

Background: Opioid dependence is a chronic condition with substantial health, economic and social costs. The study objective was to conduct a systematic review of published health-economic models of opioid agonist therapy for non-prescription opioid dependence, to review the different modelling approaches identified, and to inform future modelling studies. Methods: Literature searches were conducted in March 2015 in eight electronic databases, supplemented by hand-searching reference lists and searches on six National Health Technology Assessment Agency websites. Studies were included if they: investigated populations that were dependent on non-prescription opioids and were receiving opioid agonist or maintenance therapy; compared any pharmacological maintenance intervention with any other maintenance regimen (including placebo or no treatment); and were health-economic models of any type. Results: A total of 18 unique models were included. These used a range of modelling approaches, including Markov models (n = 4), decision tree with Monte Carlo simulations (n = 3), decision analysis (n = 3), dynamic transmission models (n = 3), decision tree (n = 1), cohort simulation (n = 1), Bayesian (n = 1), and Monte Carlo simulations (n = 2). Time horizons ranged from 6 months to lifetime. The most common evaluation was cost-utility analysis reporting cost per quality-adjusted life-year (n = 11), followed by cost-effectiveness analysis (n = 4), budget-impact analysis/cost comparison (n = 2) and cost-benefit analysis (n = 1). Most studies took the healthcare provider’s perspective. Only a few models included some wider societal costs, such as productivity loss or costs of drug-related crime, disorder and antisocial behaviour. Costs to individuals and impacts on family and social networks were not included in any model. Conclusion: A relatively small number of studies of varying quality were found. Strengths and weaknesses relating to model structure, inputs and approach were identified across all the studies. There was no indication of a single standard emerging as a preferred approach. Most studies omitted societal costs, an important issue since the implications of drug abuse extend widely beyond healthcare services. Nevertheless, elements from previous models could together form a framework for future economic evaluations in opioid agonist therapy including all relevant costs and outcomes. This could more adequately support decision-making and policy development for treatment of non-prescription opioid dependence

The Evaluation of Route Guidance Systems

BACKGROUND We were commissioned by the Transport and Road Research Laboratory to: "collaborate with the German government and their representatives who are responsible for conducting the LISB trial in Berlin in order to produce an agreed methodology, which is acceptable in both Germany and the UK, for assessing the automatic route guidance systems which will be provided in Berlin and London." The brief suggested a number of aspects to be included, and required detailed proposals, timescales and costs for implementation in London. 1.1.2 The background to the brief lies in decisions to introduce pilot automatic route guidance systems in the two cities. The principles of the systems are similar, and have been described in detail elsewhere (Jeffery, 1987). In brief, they involve : (i) a central computer which retains information on a specified road network, which is updated using real time information from the equipment users; (ii) infra red beacons at selected junctions which transmit information to equipped vehicles and receive information from those vehicles; (iii) in-vehicle equipment which includes a dead-reckoning system for position finding, a device for requesting guidance and specifying the destination, a micro-computer which selects the optimal route, and a display which indicates when a turn is required on the main network, and the compass direction and distance to the final destination; iv) transmission from the equipped vehicles of origin, requested destination, links used since passing the last beacon and, for each link, the time of entry and departure and time spent delayed. It is this travel time information which is used to update the central computer's knowledge of the best routes. (Continues..

Assessing and augmenting SCADA cyber security: a survey of techniques

SCADA systems monitor and control critical infrastructures of national importance such as power generation and distribution, water supply, transportation networks, and manufacturing facilities. The pervasiveness, miniaturisations and declining costs of internet connectivity have transformed these systems from strictly isolated to highly interconnected networks. The connectivity provides immense benefits such as reliability, scalability and remote connectivity, but at the same time exposes an otherwise isolated and secure system, to global cyber security threats. This inevitable transformation to highly connected systems thus necessitates effective security safeguards to be in place as any compromise or downtime of SCADA systems can have severe economic, safety and security ramifications. One way to ensure vital asset protection is to adopt a viewpoint similar to an attacker to determine weaknesses and loopholes in defences. Such mind sets help to identify and fix potential breaches before their exploitation. This paper surveys tools and techniques to uncover SCADA system vulnerabilities. A comprehensive review of the selected approaches is provided along with their applicability

How do diabetes models measure up? A review of diabetes economic models and ADA guidelines

Introduction: Economic models and computer simulation models have been used for assessing short-term cost-effectiveness of interventions and modelling long-term outcomes and costs. Several guidelines and checklists have been published to improve the methods and reporting. This article presents an overview of published diabetes models with a focus on how well the models are described in relation to the considerations described by the American Diabetes Association (ADA) guidelines. Methods: Relevant electronic databases and National Institute for Health and Care Excellence (NICE) guidelines were searched in December 2012. Studies were included in the review if they estimated lifetime outcomes for patients with type 1 or type 2 diabetes. Only unique models, and only the original papers were included in the review. If additional information was reported in subsequent or paired articles, then additional citations were included. References and forward citations of relevant articles, including the previous systematic reviews were searched using a similar method to pearl growing. Four principal areas were included in the ADA guidance reporting for models: transparency, validation, uncertainty, and diabetes specific criteria. Results: A total 19 models were included. Twelve models investigated type 2 diabetes, two developed type 1 models, two created separate models for type 1 and type 2, and three developed joint type 1 and type 2 models. Most models were developed in the United States, United Kingdom, Europe or Canada. Later models use data or methods from earlier models for development or validation. There are four main types of models: Markov-based cohort, Markov-based microsimulations, discrete-time microsimulations, and continuous time differential equations. All models were long-term diabetes models incorporating a wide range of compilations from various organ systems. In early diabetes modelling, before the ADA guidelines were published, most models did not include descriptions of all the diabetes specific components of the ADA guidelines but this improved significantly by 2004. Conclusion: A clear, descriptive short summary of the model was often lacking. Descriptions of model validation and uncertainty were the most poorly reported of the four main areas, but there exist conferences focussing specifically on the issue of validation. Interdependence between the complications was the least well incorporated or reported of the diabetes-specific criterion

Environmental impact of combined ITS traffic management strategies

Transport was responsible for 20% of the total greenhouse gas emissions in Europe during 2011 (European Environmental Agency 2013) with road transport being the key contributor. To tackle this, targets have been established in Europe and worldwide to curb transport emissions. This poses a significant challenge on Local Government and transport operators who need to identify a set of effective measures to reduce the environmental impact of road transport and at the same time keep the traffic smooth. Of the road transport pollutants, this paper considers NOx, CO2 and black carbon (BC). A particular focus is put on black carbon, which is formed through incomplete combustion of carboneous materials, as it has a significant impact on the Earth’s climate system. It absorbs solar radiation, influences cloud processes, and alters the melting of snow and ice cover (Bond et al. 2013). BC also causes serious health concerns: black carbon is associated with asthma and other respiratory problems, heart attacks and lung cancer (Sharma 2010; United States Environmental Protection Agency 2012). Since BC emissions are mainly produced during the decelerating and accelerating phases (Zhang et al. 2009), ITS actions able to reduce stop&go phases have the potential to reduce BC emissions. This paper investigates the effectiveness of combined ITS actions in urban context in reducing CO2 and BC emissions and improving traffic conditions

A comparative assessment of methodologies used to evaluate competition policy

Research by academics and competition agencies on evaluating competition policy has grown rapidly during the last two decades. This paper surveys the literature in order to (i) assess the fitness for purpose of the main quantitative methodologies employed, and (ii) identify the main undeveloped areas and unanswered questions for future research. It suggests that policy evaluation is necessarily an imprecise science and that all existing methodologies have strengths and limitations. The areas where the need is most pressing for further work include: understanding why Article 102 cases are only infrequently evaluated; the need to bring conscious discussion of the counterfactual firmly into the foreground; a wider definition of policy to include success in deterrence and detection. At the heart of the discussion is the impact of selection bias on most aspects of evaluation. These topics are the focus of ongoing work in the CCP

A sub-Nyquist co-prime sampling music spectral approach for natural frequency identification of white-noise excited structures

Motivated by practical needs to reduce data transmission payloads in wireless sensors for vibration-based monitoring of civil engineering structures, this paper proposes a novel approach for identifying resonant frequencies of white-noise excited structures using acceleration measurements acquired at rates significantly below the Nyquist rate. The approach adopts the deterministic co-prime sub-Nyquist sampling scheme, originally developed to facilitate telecommunication applications, to estimate the autocorrelation function of response acceleration time-histories of low-amplitude white-noise excited structures treated as realizations of a stationary stochastic process. This is achieved without posing any sparsity conditions to the signals. Next, the standard MUSIC algorithm is applied to the estimated autocorrelation function to derive a denoised super-resolution pseudo-spectrum in which natural frequencies are marked by prominent spikes. The accuracy and applicability of the proposed approach is numerically assessed using computer-generated noise-corrupted acceleration time-history data obtained by a simulation-based framework pertaining to a white-noise excited structural system with two closely-spaced modes of vibration carrying the same amount of energy, and a third isolated weakly excited vibrating mode. All three natural frequencies are accurately identified by sampling at as low as 78% below Nyquist rate for signal to noise ratio as low as 0dB (i.e., energy of additive white noise equal to the signal energy), suggesting that the proposed approach is robust and noise-immune while it can reduce data transmission requirements in acceleration wireless sensors for natural frequency identification of engineering structures