Mind the gap! A multilevel analysis of factors related to variation in published cost-effectiveness estimates within and between countries

Background. Published cost-effectiveness estimates can vary considerably, both within and between countries. Despite extensive discussion, little is known empirically about factors relating to these variations. Objectives. To use multilevel statistical modeling to integrate cost-effectiveness estimates from published economic evaluations to investigate potential causes of variation. Methods. Cost-effectiveness studies of statins for cardiovascular disease prevention were identified by systematic review. Estimates of incremental costs and effects were extracted from reported base case, sensitivity, and subgroup analyses, with estimates grouped in studies and in countries. Three bivariate models were developed: a cross-classified model to accommodate data from multinational studies, a hierarchical model with multinational data allocated to a single category at country level, and a hierarchical model excluding multinational data. Covariates at different levels were drawn from a long list of factors suggested in the literature. Results. We found 67 studies reporting 2094 cost-effectiveness estimates relating to 23 countries (6 studies reporting for more than 1 country). Data and study-level covariates included patient characteristics, intervention and comparator cost, and some study methods (e.g., discount rates and time horizon). After adjusting for these factors, the proportion of variation attributable to countries was negligible in the cross-classified model but moderate in the hierarchical models (14%−19% of total variance). Country-level variables that improved the fit of the hierarchical models included measures of income and health care finance, health care resources, and population risks. Conclusions. Our analysis suggested that variability in published cost-effectiveness estimates is related more to differences in study methods than to differences in national context. Multinational studies were associated with much lower country-level variation than single-country studies. These findings are for a single clinical question and may be atypical

Pensioner poverty over the next decade: what role for tax and benefit reform?

Recent falls in poverty amongst those aged 65 and over are unlikely to continue after 2007-08, even after the implementation of the proposals outlined in the Government's Pensions White Paper. This report looks at the prospects for pensioner poverty in England over the next decade. The authors find that that the proportion of those aged 65 and over living in poverty is set to remain at its current level - around one-in-five - between 2007-08 and 2017-18. This is despite the overall increase in the generosity of state pensions arising from the Pensions White Paper, and the fact that younger cohorts are expected to have more private pension income and higher employment rates at older ages than those preceding them

The Co-occurrence of child and intimate partner maltreatment in the family: characteristics of the violent perpetrators

This study considers the characteristics associated with mothers and fathers who maltreat their child and each other in comparison to parents who only maltreat their child. One hundred and sixty-two parents who had allegations of child maltreatment made against them were considered. The sample consisted of 43 fathers (Paternal Family—PF) and 23 mothers (Maternal Family—MF) who perpetrated both partner and child maltreatment, together with 23 fathers (Paternal Child—PC) and 26 mothers (Maternal Child—MC) who perpetrated child maltreatment only. In addition, 2 fathers (Paternal Victim—PV) and 23 mothers (Maternal Victim—MV) were victims of intimate partner maltreatment and perpetrators of child maltreatment and 7 fathers (Paternal Non-abusive Carer—PNC) and 15 mothers (Maternal Non-abusive Carer—MNC) did not maltreat the child but lived with an individual who did. Within their family unit, 40.7% of parents perpetrated both intimate partner and child maltreatment. However, fathers were significantly more likely to maltreat both their partner and child than mothers and mothers were significantly more likely to be victims of intimate partner violence than fathers. PF fathers conducted the highest amount of physical and/or sexual child maltreatment while MC and MV mothers perpetrated the highest amount of child neglect. Few significant differences between mothers were found. PF fathers had significantly more factors associated with development of a criminogenic lifestyle than PC fathers. Marked sex differences were demonstrated with PF fathers demonstrating significantly more antisocial characteristics, less mental health problems and fewer feelings of isolation than MF mothers. MC mothers had significantly more childhood abuse, mental health problems, parenting risk factors and were significantly more likely to be biologically related to the child than PC fathers. This study suggests that violent families should be assessed and treated in a holistic manner, considering the effects of partner violence upon all family members, rather than exclusively intervening with the violent man

VLA 8.4-GHz monitoring observations of the CLASS gravitational lens B1933+503

The complex ten-component gravitational lens system B1933+503 has been monitored with the VLA during the period February to June 1998 with a view to measuring the time delay between the four compact components and hence to determine the Hubble parameter. Here we present the results of an `A' configuration 8.4-GHz monitoring campaign which consists of 37 epochs with an average spacing of 2.8 days. The data have yielded light curves for the four flat-spectrum radio components (components 1, 3, 4 and 6). We observe only small flux density changes in the four flat-spectrum components which we do not believe are predominantly intrinsic to the source. Therefore the variations do not allow us to determine the independent time delays in this system. However, the data do allow us to accurately determine the flux density ratios between the four flat-spectrum components. These will prove important as modelling constraints and could prove crucial in future monitoring observations should these data show only a monotonic increase or decrease in the flux densities of the flat-spectrum components.Comment: Accepted for publication in MNRAS. 5 pages, 2 included PostScript figure

Fast linear-space computations of longest common subsequences

AbstractSpace saving techniques in computations of a longest common subsequence (LCS) of two strings are crucial in many applications, notably, in molecular sequence comparisons. For about ten years, however, the only linear-space LCS algorithm known required time quadratic in the length of the input, for all inputs. This paper reviews linear-space LCS computations in connection with two classical paradigms originally designed to take less than quadratic time in favorable circumstances. The objective is to achieve the space reduction without alteration of the asymptotic time complexity of the original algorithm. The first one of the resulting constructions takes time O(n(m−l)), and is thus suitable for cases where the LCS is expected to be close to the shortest input string. The second takes time O(ml log(min[s, m, 2nl])) and suits cases where one of the inputs is much shorter than the other. Here m and n (m⩽n) are the lengths of the two input strings, l is the length of the longest common subsequences and s is the size of the alphabet. Along the way, a very simple O(m(m−l)) time algorithm is also derived for the case of strings of equal length