ACM Curriculum Reports: A Pedagogic Perspective

In this paper, we illuminate themes that emerged in interviews with participants in the major curriculum recommendation efforts: we characterize the way the computing community interacts with and influences these reports and introduce the term “pedagogic projection” to describe implicit assumptions of how these reports will be used in practice. We then illuminate how this perceived use has changed over time and may affect future reports

Opportunities for improving the efficiency of paediatric HIV treatment programmes

Objectives: To conduct two economic analyses addressing whether to: routinely monitor HIV-infected children on antiretroviral therapy (ART) clinically or with laboratory tests; continue or stop cotrimoxazole prophylaxis when children become stabilized on ART. Design and methods: The ARROW randomized trial investigated alternative strategies to deliver paediatric ART and cotrimoxazole prophylaxis in 1206 Ugandan/Zimbabwean children. Incremental cost-effectiveness and value of implementation analyses were undertaken. Scenario analyses investigated whether laboratory monitoring (CD4 tests for efficacy monitoring; haematology/biochemistry for toxicity) could be tailored and targeted to be delivered cost-effectively. Cotrimoxazole use was examined in malaria-endemic and non-endemic settings. Results: Using all trial data, clinical monitoring delivered similar health outcomes to routine laboratory monitoring, but at a reduced cost, so was cost-effective. Continuing cotrimoxazole improved health outcomes at reduced costs. Restricting routine CD4+ monitoring to after 52 weeks following ART initiation and removing toxicity testing was associated with an incremental cost-effectiveness ratio of $6084 per quality-adjusted life-year (QALY) across all age groups, but was much lower for older children (12+ years at initiation; incremental cost-effectiveness ratio =$769/QALY). Committing resources to improve cotrimoxazole implementation appears cost-effective. A healthcare system that could pay $600/QALY should be willing to spend up to$12.0 per patient-year to ensure continued provision of cotrimoxazole. Conclusion: Clinically driven monitoring of ART is cost-effective in most circumstances. Routine laboratory monitoring is generally not cost-effective at current prices, except possibly CD4 testing amongst adolescents initiating ART. Committing resources to ensure continued provision of cotrimoxazole in health facilities is more likely to represent an efficient use of resources

A note on the estimation of confidence intervals for cost-effectiveness when costs and effects are censored

<i>Background</i>. The relation between methodological advances in estimation of confidence intervals (CIs) for incremental cost-effectiveness ratios (ICER) and estimation of cost effectiveness in the presence of censoring has not been explored. The authors address the joint problem of estimating ICER precision in the presence of censoring. <i>Methods</i>. Using patient-level data (n = 168) on cost and survival from a published placebo-controlled trial, the authors compared 2 methods of measuring uncertainty with censored data: 1)Bootstrap with censor adjustment (BCA); 2) Fieller’s method with censor adjustment (FCA). The authors estimate the FCA over all possible values for the correlation (p) between costs and effects (range= –1 to +1) and also examine the use of the correlation between cases without censoring adjustment (i.e., simple time-on-study) for costs and effects as an approximation for. <i>Results</i>. Using time-on-study, which considers all censored observations as responders (deaths), yields 0.64 life-years gained at an additional cost of 87.9 for a cost per life-year of 137 (95% CI by bootstrap –5.9 to 392). Censoring adjustment corrects for the bias in the time-on-study approach and reduces the cost per life-year estimate to 132 (=72/0.54). Confidence intervals with censor adjustment were approximately 40% wider than the base-case without adjustment. Using the Fieller method with an approximation of based on the uncensored cost and effect correlation provides a 95% CI of (–48 to 529), which is very close to the BCA interval of (–52 to 504). <i>Conclusions</i>. Adjustment for censoring is necessary in cost-effectiveness studies to obtain unbiased estimates of ICER with appropriate uncertainty limits. In this study, BCA and FCA methods, the latter with approximated covariance, are simple to compute and give similar confidence intervals

A Bayesian approach to stochastic cost-effectiveness analysis

The aim of this paper is to discuss the use of Bayesian methods in cost-effectiveness analysis (CEA) and the common ground between Bayesian and traditional frequentist approaches. A further aim is to explore the use of the net benefit statistic and its advantages over the incremental cost-effectiveness ratio (ICER) statistic. In particular, the use of cost-effectiveness acceptability curves is examined as a device for presenting the implications of uncertainty in a CEA to decision makers. Although it is argued that the interpretation of such curves as the probability that an intervention is cost-effective given the data requires a Bayesian approach, this should generate no misgivings for the frequentist. Furthermore, cost-effectiveness acceptability curves estimated using the net benefit statistic are exactly equivalent to those estimated from an appropriate analysis of ICERs on the cost-effectiveness plane. The principles examined in this paper are illustrated by application to the cost-effectiveness of blood pressure control in the U.K. Prospective Diabetes Study (UKPDS 40). Due to a lack of good-quality prior information on the cost and effectiveness of blood pressure control in diabetes, a Bayesian analysis assuming an uninformative prior is argued to be most appropriate. This generates exactly the same cost-effectiveness results as a standard frequentist analysis

Towards a transparent, credible, evidence-based decision-making process of new drug listing on the Hong Kong Hospital Authority Drug Formulary: challenges and suggestions

The aim of this article is to describe the process, evaluation criteria, and possible outcomes of decision-making for new drugs listed in the Hong Kong Hospital Authority Drug Formulary in comparison to the health technology assessment (HTA) policy overseas. Details of decision-making processes including the new drug listing submission, Drug Advisory Committee (DAC) meeting, and procedures prior to and following the meeting, were extracted from the official Hong Kong Hospital Authority drug formulary management website and manual. Publicly-available information related to the new drug decision-making process for five HTA agencies [the National Institute of Health and Care Excellence (NICE), the Scottish Medicines Consortium (SMC), the Australia Pharmaceutical Benefits Advisory Committee (PBAC), the Canadian Agency for Drugs and Technologies in Health (CADTH), and the New Zealand Pharmaceutical Management Agency (PHARMAC)] were reviewed and retrieved from official documents from public domains. The DAC is in charge of systemically and critically appraising new drugs before they are listed on the formulary, reviewing submitted applications, and making the decision to list the drug based on scientific evidence to which safety, efficacy, and cost-effectiveness are the primary considerations. When compared with other HTA agencies, transparency of the decision-making process of the DAC, the relevance of clinical and health economic evidence, and the lack of health economic and methodological input of submissions are the major challenges to the new-drug listing policy in Hong Kong. Despite these challenges, this review provides suggestions for the establishment of a more transparent, credible, and evidence-based decision-making process in the Hong Kong Hospital Authority Drug Formulary. Proposals for improvement in the listing of new drugs in the formulary should be a priority of healthcare reforms

Bio-Based Renewable Additives for Anti-Icing Applications (Phase II)

The performance and impacts of several agro-based anti-icers along with a traditional chloride-based anti-icer (salt brine) were evaluated. A statistical design of experiments (central composite design) was employed for developing anti-icing liquids consisting of cost-competitive chemicals such as agro-based compounds (e.g., Concord grape extract and glycerin), sodium chloride, sodium metasilicate, and sodium formate. The following experimentally obtained parameters were examined as a function of the formulation design: ice-melting capacity at 25°F (−3.9°C), splitting strength of Portland cement mortar samples after 10 freeze-thaw/deicer cycles, corrosion rate of C1010 carbon steel after 24-hour immersion, and impact on asphalt binder stiffness and m-value. One viable formula (“best performer”) was tested for thermal properties by measuring its differential scanning calorimetry (DSC) thermograms, the friction coefficient of asphalt pavement treated by this anti-icing formulation (vs. 23 wt.% NaCl and beet juice blend) at 25°F after being applied at 30 gallons per lane mile (1 hour after simulated trafficking and plowing), and other properties (pH, oxygen demand in COD). Laboratory data shed light on the selection and formulation of innovative agro-based snow- and ice-control chemicals that can significantly reduce the costs of winter maintenance operations

The effect of PD-L1 testing on the cost-effectiveness and economic impact of immune checkpoint inhibitors for the second-line treatment of NSCLC

Background: Immune checkpoint inhibitors improve outcomes compared with chemotherapy in lung cancer. Tumor PD-L1 receptor expression is being studied as a predictive biomarker. The objective of this study was to assess the cost-effectiveness and economic impact of second-line treatment with nivolumab, pembrolizumab, and atezolizumab with and without the use of PD-L1 testing for patient selection. Design: We developed a decision-analytic model to determine the cost-effectiveness of PD-L1 assessment and second-line immunotherapy versus docetaxel. The model used outcomes data from randomized clinical trials (RCTs) and drug acquisition costs from the United States. Thereafter, we used epidemiologic data to estimate the economic impact of the treatment. Results: We included four RCTs (2 with nivolumab, 1 with pembrolizumab, and 1 with atezolizumab). The incremental quality-adjusted life year (QALY) for nivolumab was 0.417 among squamous tumors and 0.287 among non-squamous tumors and the incremental cost-effectiveness ratio (ICER) were $155 605 and$187 685, respectively. The QALY gain in the base case for atezolizumab was 0.354 and the ICER was $215 802. Compared with treating all patients, the selection of patients by PD-L1 expression improved incremental QALY by up to 183$98 421. Patient selection also reduced the budget impact of immunotherapy. Conclusion: The use of PD-L1 expression as a biomarker increases cost-effectiveness of immunotherapy but also diminishes the number of potential life-years saved.info:eu-repo/semantics/publishedVersio

Effectiveness of Thermal-Pneumatic Airfoil-Ice-Protection System

Icing and drag investigations were conducted in the NACA Lewis icing research tunnel employing a combination thermal-pneumatic de-icer mounted on a 42-inch-chord NACA 0018 airfoil. The de-icer consisted of a 3-inch-wide electrically heated strip symmetrically located about the leading edge with inflatable tubes on the upper and lower airfoil surfaces aft of the heated area. The entire de-icer extended to approximately 25 percent of chord. A maximum power density of 9.25 watts per square inch was required for marginal ice protection on the airfoil leading edge at an air temperature of 00 F and an airspeed of 300 miles per hour. Drag measurements indicated, that without icing, the de-icer installation increased the section drag to approximately 140 percent of that of the bare airfoil; with the tubes inflated, this value increased to a maximum of approximately 620 percent. A 2-minute tube-inflation cycle prevented excessive ice formation on the inflatable area although small scattered residual Ice formations remained after inflation and were removed intermittently during later cycles. Effects of the time lag of heater temperatures after initial application of power and the insulating effect of ice formations on heater temperatures were also determined

Evaluating Value-Based Frameworks Used for Relapsed or Refractory Multiple Myeloma Regimens: ICER Report, ASCO Value Framework, and NCCN Evidence Blocks

BACKGROUND: With the continuous rise in costs for oncology drugs, the Institute for Clinical and Economic Review (ICER), the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) have developed value-based frameworks (VBFs) to assist stakeholders in formulary and treatment decisionmaking. While emerging VBFs have the potential to significantly impact therapeutic options for patients, it is important to understand the differences associated with those VBFs within a therapeutic area. OBJECTIVE: To compare ICER, ASCO, and NCCN VBFs across three therapeutic options for relapsed or refractory multiple myeloma (RRMM). METHODS: The values of carfilzomib (CFZ), elotuzumab (ELO), and ixazomib (IX) were generated using ICER, ASCO, and NCCN VBFs. Those regimens, used for second or third line treatment of RRMM, were chosen because they share a common comparator in clinical trials, lenalidomide + dexamethasone (LEN + DEX). The ICER 2016 report of treatment options for RRMM was used to obtain results of the comparative clinical effectiveness and the cost effectiveness analysis for those regimens compared to LEN + DEX. ASCO’s 2016 VBF, which incorporates clinical benefit, toxicity and bonus points was used to generate a net health benefit (NHB) score without a scale along with the drug wholesale acquisition cost (WAC) for each regimen compared to LEN + DEX. The NCCN VBF uses a score ranging from 1 to 5, with 1 as the least favorable and 5 as the most favorable, for each of five evidence blocks: efficacy, safety, quality, consistency, and affordability. The 2016 Multiple Myeloma NCCN evidence blocks was used to obtain the value of CFZ, ELO, and IX. RESULTS: The ICER VBF suggested with moderate certainty that CFZ, ELO, and IX provide a better NHB in patients with RRMM compared to LEN + DEX. Second-line and third-line treatment costs per QALY for CFZ, ELO, and IX were $199,982,$427,607 and $433,794, and$238,560, $481,244, and$484,582, respectively. The ASCO VBF generated a total NHB of 28.8, 23.7 and 23.0 with a monthly WAC of $17,364,$16,032 and $20,607 for CFZ, ELO, and IX, respectively. The monthly cost of LEN + DEX was$11,616. The NCCN VBF had an efficacy score of 5, 3, and 4 for CFZ, ELO, IX, respectively. Safety, quality, consistency, and affordability scores of 3, 4, 4, and 1, respectively, were the same across regimens. CONCLUSIONS: ICER, ASCO and NCCN VBFs suggest CFZ may be the most valued treatment out of the three regimens. However, their applicability in stakeholder’s decision-making remains unclear due to uncertainty and challenges associated with them. SPONSORSHIP: None.https://jdc.jefferson.edu/jcphposters/1012/thumbnail.jp

Cost effectiveness of treatments for wet age-related macular degeneration

Age-related macular degeneration (AMD) is a leading cause of blindness in people aged >= 50 years. Wet AMD in particular has a major impact on patient quality of life and imposes substantial burdens on healthcare systems. This systematic review examined the cost-effectiveness data for current therapeutic options for wet AMD. PubMed and EMBASE databases were searched for all articles reporting original cost-effectiveness analyses of wet AMD treatments. The Centre for Reviews and Dissemination and Cochrane Library databases were searched for all wet AMD health technology assessments (HTAs). Overall, 44 publications were evaluated in full and included in this review. A broad range of cost-effectiveness analyses were identified for the most commonly used therapies for wet AMD (pegaptanib, ranibizumab and photodynamic therapy [PDT] with verteporfin). Three studies evaluated the cost effectiveness of bevacizumab in wet AMD. A small number of analyses of other treatments, such as laser photocoagulation and antioxidant vitamins, were also found. Ranibizumab was consistently shown to be cost effective for wet AMD in comparison with all the approved wet AMD therapies (four of the five studies identified showed ranibizumab was cost effective vs usual care, PDT or pegaptanib); however, there was considerable variation in the methodology for cost-effectiveness modelling between studies. Findings from the HTAs supported those from the PubMed and EM BASE searches; of the seven HTAs that included ranibizumab, six (including HTAs for Australia, Canada and the UK) concluded that ranibizumab was cost effective for the treatment of wet AMD; most compared ranibizumab with PDT and/or pegaptanib. By contrast, HTAs at best generally recommended pegaptanib or PDT for restricted use in subsets of patients with wet AMD. In the literature analyses, pegaptanib was found to be cost effective versus usual/best supportive care (including PDT) or no treatment in one of five studies; the other four studies found pegaptanib was of borderline cost effectiveness depending on the stage of disease and time horizon. PDT was shown to be cost effective versus usual/best supportive care or no treatment in five of nine studies; two studies showed that PDT was of borderline cost effectiveness depending on baseline visual acuity, and two showed that PDT was not cost effective. We identified no robust studies that properly evaluated the cost effectiveness of bevacizumab in wet AMD