Cost-effectiveness acceptability curves in the dock: case not proven?

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Cost-effectiveness acceptability curves - facts, fallacies and frequently asked questions

Cost-effectiveness acceptability curves (CEACs) have been widely adopted as a method to quantify and graphically represent uncertainty in economic evaluation studies of health-care technologies. However, there remain some common fallacies regarding the nature and shape of CEACs that largely result from the textbook illustration of the CEAC. This textbook CEAC shows a smooth curve starting at probability 0, with an asymptote to 1 for higher money values of the health outcome (). But this familiar ogive shape which makes the textbook CEAC look like a cumulative distribution function is just one special case of the CEAC. The reality is that the CEAC can take many shapes and turns because it is a graphic transformation from the cost-effectiveness plane, where the joint density of incremental costs and effects may straddle quadrants with attendant discontinuities and asymptotes. In fact CEACs: (i) do not have to cut the y-axis at 0; (ii) do not have to asymptote to 1; (iii) are not always monotonically increasing in ; and (iv) do not represent cumulative distribution functions (cdfs). Within this paper we present a gallery of CEACs in order to identify the fallacies and illustrate the facts surrounding the CEAC. The aim of the paper is to serve as a reference tool to accompany the increased use of CEACs within major medical journals

POGO Instabilities Suppression Evaluation

A dynamic (frequency response) analysis was made of a liquid oxygen feed system consisting of a low-speed inducer, a high-speed main pump and a positive displacement pulser utilized for simulating pogo induced pressure oscillations. Based on the results of the analysis, an active control system for suppression of pulser generated pressure oscillations was designed, fabricated and tested. The test results verified that the suppressor was effective in attenuating the generated pressure oscillations over the frequency range from 10 to 30 Hz

Pre-operative optimisation employing dopexamine or adrenaline for patients undergoing major elective surgery: a cost-effectiveness analysis

<b>Objective</b>: To compare the cost and cost-effectiveness of a policy of pre-operative optimisation of oxygen delivery (using either adrenaline or dopexamine) to reduce the risk associated with major elective surgery, in high-risk patients. <b>Methods</b>: A cost-effectiveness analysis using data from a randomised controlled trial (RCT). In the RCT 138 patients undergoing major elective surgery were allocated to receive pre-operative optimisation employing either adrenaline or dopexamine (assigned randomly), or to receive routine peri-operative care. Differential health service costs were based on trial data on the number and cause of hospital in-patient days and the utilisation of health care resources. These were costed using unit costs from a UK hospital. The cost-effectiveness analysis related differential costs to differential life-years during a 2 year trial follow-up. <b>Results</b>: The mean number of in-patient days was 16 in the pre-optimised groups (19 adrenaline; 13 dopexamine) and 22 in the standard care group. The number (%) of deaths, over a 2 year follow-up, was 24 (26%) in the pre-optimised groups and 15 (33%) in the standard care group. The mean total costs were EUR 11,310 in the pre-optimised groups and EUR 16,965 in the standard care group. Life-years were 1.68 in the pre-optimised groups and 1.46 in the standard care group. The probability that pre-operative optimisation is less costly than standard care is 98%. The probability that it dominates standard care is 93%. Conclusions: Based on resource use and effectiveness data collected in the trial, pre-operative optimisation of high-risk surgical patients undergoing major elective surgery is cost-effective compared with standard treatment

Space Shuttle Main Engine (SSME) Pogo testing and results

To effectively assess the Pogo stability of the space shuttle vehicle, it was necessary to characterize the structural, propellant, and propulsion dynamics subsystems. Extensive analyses and comprehensive testing programs were established early in the project as an implementation of management philosophy of Pogo prevention for space shuttle. The role of the space shuttle main engine (SSMF) in the Pogo prevention plans, the results obtained from engine ground testing with analysis, and measured data from STS-1 flight are discussed

Non-conventional charge transport in organic semiconductors: magnetoresistance and thermoelectricity

Magnetoresistance and thermoelectricity require additional properties of materials beyond their ability to transport charge, namely a large resistive response to a magnetic field, or in the case of thermoelectrics a large Seebeck coefficient combined with low thermal conductivity.</p

Double trouble: the impact of multimorbidity and deprivation on preference-weighted health related quality of life - a cross sectional analysis of the Scottish Health Survey

&lt;b&gt;Objective&lt;/b&gt; To investigate the association between multimorbidity and Preference_Weighted Health Related Quality of Life (PW_HRQoL), a score that combines physical and mental functioning, and how this varies by socioeconomic deprivation and age.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Design&lt;/b&gt; The Scottish Health Survey (SHeS) is a cross-sectional representative survey of the general population which included the SF-12, a survey of HRQoL, for individuals 20 years and over.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Methods&lt;/b&gt; For 7,054 participants we generated PW_HRQoL scores by running SF-12 responses through the SF-6D algorithm. The resulting scores ranged from 0.29 (worst health) to 1 (perfect health). Using ordinary least squares, we first investigated associations between scores and increasing counts of longstanding conditions, and then repeated for multimorbidity (2+ conditions). Estimates were made for the general population and quintiles of socioeconomic deprivation. For multimorbidity, the analyses were repeated stratifying the population by age group (20--44, 45--64, 65+).&lt;p&gt;&lt;/p&gt; &lt;b&gt;Results&lt;/b&gt; 45% of participants reported a longstanding condition and 18% reported multimorbidity. The presence of 1, 2, or 3+ longstanding conditions were associated with average reductions in PW_HRQoL scores of 0.081, 0.151 and 0.212 respectively. Reduction in scores associated with multimorbidity was 33% greater in the most deprived quintile compared to the least deprived quintile, with the biggest difference (80%) in the 20--44 age groups. There were no significant gender differences.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Conclusions&lt;/b&gt; PW_HRQoL decreases markedly with multimorbidity, and is exacerbated by higher deprivation and younger age. There is a need to prioritise interventions to improve the HRQoL for (especially younger) adults with multimorbidity in deprived areas

The Electiiic Illumination of the Bladder as a Means of Diagnosis of Obscuee Vesico-Ukethhal Diseases:

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Association between body mass index and mental health among Scottish adult population: a cross-sectional study of 37,272 participants

&lt;b&gt;Background:&lt;/b&gt; The evidence is conflicting as to whether body mass index (BMI) is associated with mental health and, if so, to what extent it varies by sex and age. We studied mental health across the full spectrum of BMI among the general population, and conducted subgroup analyses by sex and age.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Method:&lt;/b&gt; We undertook a cross-sectional study of a representative sample of the Scottish adult population. The Scottish Health Survey provided data on mental health, measured by the General Health Questionnaire-12 (GHQ), BMI, demographic and life-style information. Good mental health was defined as a GHQ score &#60;4, and poor mental health as a GHQ score ≥4. Logistic regression models were applied. Results Of the 37 272 participants, 5739 (15.4%) had poor mental health. Overall, overweight participants had better mental health than the normal-weight group [adjusted odds ratio (OR) 0.93, 95% confidence interval (CI) 0.87–0.99, p = 0.049], and individuals who were underweight, class II or class III obese had poorer mental health (class III obese group: adjusted OR 1.26, 95% CI 1.05–1.51, p = 0.013). There were significant interactions of BMI with sex (p = 0.013) and with age (p &#60; 0.001). Being overweight was associated with significantly better mental health in middle-aged men only. In contrast, being underweight at all ages or obese at a young age was associated with significantly poorer mental health in women only.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Conclusions:&lt;/b&gt; The adverse associations between adiposity and mental health are specific to women. Underweight women and young women who are obese have poorer mental health. In contrast, middle-aged overweight men have better mental health.&lt;p&gt;&lt;/p&gt

Transverse waves in a post-flare supra-arcade

Observations of propagating transverse waves in an open magnetic field structure with the Transition Region And Coronal Explorer (TRACE) are presented. Waves associated with dark tadpole-like sunward moving structures in the post-flare supra-arcade of NOAA active region 9906 on the 21st of April 2002 are analysed. They are seen as quasi-periodic transverse displacements of the dark tadpole tails, with periods in the range of 90–220 s. Their phase speeds and displacement amplitudes decrease as they propagate sunwards. At heights of 90 and 60 Mm above the post-flare loop footpoints the phase speeds are in the ranges 200–700 km s −1 and 90–200 km s −1 respectively. Furthermore, for consecutive tadpoles the phase speeds decrease and periods increase as a function of time. The waves are interpreted as propagating fast magnetoacoustic kink waves guided by a vertical, evolving, open structure