The death of cost-minimization analysis?

Four different types of evaluation methods, cost-benefit analysis (CBA), cost-utility analysis (CUA), cost-effectiveness analysis (CEA) and cost-minimization analysis (CMA), are usually distinguished. In this note, we pronounce the (near) death of CMA by showing the rare circumstances under which CMA is an appropriate method of analysis. We argue that it is inappropriate for separate and sequential hypothesis tests on differences in effects and costs to determine whether incremental cost-effectiveness (or cost-utility) should be estimated. We further argue that the analytic focus should be on the estimation of the joint density of cost and effect differences, the quantification of uncertainty surrounding the incremental cost-effectiveness ratio and the presentation of such data as cost-effectiveness acceptability curves. Two examples from recently published CEA are employed to illustrate the issues. The first shows a situation where analysts might be tempted (inappropriately) to employ CMA rather than CEA. The second illustrates one of the rare circumstances in which CMA may be justified as a legitimate form of analysis

Mode-coupling and nonlinear Landau damping effects in auroral Farley-Buneman turbulence

The fundamental problem of Farley-Buneman turbulence in the auroral $E$-region has been discussed and debated extensively in the past two decades. In the present paper we intend to clarify the different steps that the auroral $E$-region plasma has to undergo before reaching a steady state. The mode-coupling calculation, for Farley-Buneman turbulence, is developed in order to place it in perspective and to estimate its magnitude relative to the anomalous effects which arise through the nonlinear wave-particle interaction. This nonlinear effect, known as nonlinear ``Landau damping'' is due to the coupling of waves which produces other waves which in turn lose energy to the bulk of the particles by Landau damping. This leads to a decay of the wave energy and consequently a heating of the plasma. An equation governing the evolution of the field spectrum is derived and a physical interpration for each of its terms is provided

Accounting for Timing when Assessing Health-Related Policies

The primary focus of this paper is to offer guidance on the analysis of time streams of effects that a project may have so that they can be discounted appropriately. This requires a framework that identifies the common parameters that need to be assessed, whether conducting cost-effectiveness or benefit-cost analysis. The quantification and conversion of the time streams of different effects into their equivalent health, health care cost or consumption effects avoids embedding multiple arguments in discounting policies. This helps to identify where parameters are likely to differ in particular contexts, what type of evidence would be relevant, what is currently known and how this evidence might be strengthened. The current evidence available to support the assessment of the key parameters is discussed and possible estimates and default assumptions are suggested. Reporting the results in an extensive way is recommended. This makes the assessments required explicit so the impact of alternative assumptions can be explored and analysis updated as better estimates evolve. Some projects will have effects across different countries where some or all of these parameters will differ. Therefore, the net present value of a project will be the sum of the country specific net present values rather than the sum of effects across countries discounted at some common rate

Exploring the costs and outcomes of sexually transmitted infection (STI) screening interventions targeting men in football club settings: preliminary cost-consequence analysis of the SPORTSMART pilot randomised controlled trial

Background: The objective of this study was to compare the costs and outcomes of two sexually transmitted infection (STI) screening interventions targeted at men in football club settings in England, including screening promoted by team captains. Methods: A comparison of costs and outcomes was undertaken alongside a pilot cluster randomised control trial involving three trial arms: (1) captain-led and poster STI screening promotion; (2) sexual health advisor-led and poster STI screening promotion and (3) poster-only STI screening promotion (control/comparator). For all study arms, resource use and cost data were collected prospectively. Results: There was considerable variation in uptake rates between clubs, but results were broadly comparable across study arms with 50% of men accepting the screening offer in the captain-led arm, 67% in the sexual health advisor-led arm and 61% in the poster-only control arm. The overall costs associated with the intervention arms were similar. The average cost per player tested was comparable, with the average cost per player tested for the captain-led promotion estimated to be £88.99 compared with £88.33 for the sexual health advisor-led promotion and £81.87 for the poster-only (control) arm. Conclusions: Costs and outcomes were similar across intervention arms. The target sample size was not achieved, and we found a greater than anticipated variability between clubs in the acceptability of screening, which limited our ability to estimate acceptability for intervention arms. Further evidence is needed about the public health benefits associated with screening interventions in non-clinical settings so that their cost-effectiveness can be fully evaluated

Constraining Ceres' interior from its Rotational Motion

Context. Ceres is the most massive body of the asteroid belt and contains about 25 wt.% (weight percent) of water. Understanding its thermal evolution and assessing its current state are major goals of the Dawn Mission. Constraints on internal structure can be inferred from various observations. Especially, detailed knowledge of the rotational motion can help constrain the mass distribution inside the body, which in turn can lead to information on its geophysical history. Aims. We investigate the signature of the interior on the rotational motion of Ceres and discuss possible future measurements performed by the spacecraft Dawn that will help to constrain Ceres' internal structure. Methods. We compute the polar motion, precession-nutation, and length-of-day variations. We estimate the amplitudes of the rigid and non-rigid response for these various motions for models of Ceres interior constrained by recent shape data and surface properties. Results. As a general result, the amplitudes of oscillations in the rotation appear to be small, and their determination from spaceborne techniques will be challenging. For example, the amplitudes of the semi-annual and annual nutations are around ~364 and ~140 milli-arcseconds, and they show little variation within the parametric space of interior models envisioned for Ceres. This, combined with the very long-period of the precession motion, requires very precise measurements. We also estimate the timescale for Ceres' orientation to relax to a generalized Cassini State, and we find that the tidal dissipation within that object was probably too small to drive any significant damping of its obliquity since formation. However, combining the shape and gravity observations by Dawn offers the prospect to identify departures of non-hydrostaticity at the global and regional scale, which will be instrumental in constraining Ceres' past and current thermal state. We also discuss the existence of a possible Chandler mode in the rotational motion of Ceres, whose potential excitation by endogenic and/or exogenic processes may help detect the presence of liquid reservoirs within the asteroid.Comment: submitted to Astronomy and Astrophysic

Follow-up of breast cancer in primary care vs specialist care: results of an economic evaluation

A randomized controlled trial (RCT) comparing primary-care-centred follow-up of breast cancer patients with the current standard practice of specialist-centred follow-up showed no increase in delay in diagnosing recurrence, and no increase in anxiety or deterioration in health-related quality of life. An economic evaluation of the two schemes of follow-up was conducted concurrent with the RCT. Because the RCT found no difference in the primary clinical outcomes, a cost minimization analysis was conducted. Process measures of the quality of care such as frequency and length of visits were superior in primary care. Costs to patients and to the health service were lower in primary care. There was no difference in total costs of diagnostic tests, with particular tests being performed more frequently in primary care than in specialist care. Data are provided on the average frequency and length of visits, and frequency of diagnostic testing for breast cancer patients during the follow-up period. © 1999 Cancer Research Campaig

Assertive Community Treatment for People With Alcohol Dependence: A Pilot Randomized Controlled Trial

Aims: A pilot randomized controlled trial (RCT) to assess the feasibility and potential efficacy of assertive community treatment (ACT) in adults with alcohol dependence. Methods: Single blind, individually randomized, pilot RCT of 12 months of ACT plus treatment as usual (TAU) versus TAU alone in adults (age 18+ years) with alcohol dependence and a history of previous unsuccessful alcohol treatment attending specialist community alcohol treatment services. ACT aimed to actively engage participants for 12 months with assertive, regular, minimum weekly contact. ACT was combined with TAU. TAU comprised access to the full range of services provided by the community teams. Primary outcome is mean drinks per drinking day and percent days abstinent at 12 months follow up. Analysis of covariance was conducted using 80% confidence intervals, appropriate in the context of a pilot trial. Results: A total of 94 participants were randomized, 45 in ACT and 49 in TAU. Follow-up was achieved with 98 and 88%, respectively at 12 months. Those in ACT had better treatment engagement, and were more often seen in their homes or local community than TAU participants. At 12 months the ACT group had more problems related to drinking and lower quality of life than TAU but no differences in drinking measures. The ACT group had a higher percentage of days abstinent but lower quality of life at 6 months. The ACT group had less unplanned healthcare use than TAU. Conclusions: An trial of ACT was feasible to implement in an alcohol dependent treatment population. Trial registration: ISRCTN2277553

Statistical Survey of Type III Radio Bursts at Long Wavelengths Observed by the Solar TErrestrial RElations Observatory (STEREO)/Waves Instruments: Radio Flux Density Variations with Frequency

We have performed a statistical study of $152$ Type III radio bursts observed by Solar TErrestrial RElations Observatory (STEREO)/Waves between May 2007 and February 2013. We have investigated the flux density between $125$kHz and $16$MHz. Both high- and low-frequency cutoffs have been observed in $60\,$ of events suggesting an important role of propagation. As already reported by previous authors, we observed that the maximum flux density occurs at $1$MHz on both spacecraft. We have developed a simplified analytical model of the flux density as a function of radial distance and compared it to the STEREO/Waves data.Comment: published in Solar Physic

Occupational therapy for adults with problems in activities of daily living after stroke

No abstract available