Clinical Guidelines : a NICE Way to Introduce Cost-effectiveness Considerations?

The National Institute for Health and Care Excellence (NICE) in the United Kingdom initiated its clinical guidelines program in 2001 and more than 200 guidelines have been produced to date. As with most of NICE’s other programs, the clinical guidelines program also must take into account the relative costs and benefits of interventions when deciding whether to recommend them. The three main advantages of the program are that 1) it represents an important collaboration with the medical profession, thereby increasing the likelihood of recommendations being adopted; 2) the guidelines provide an opportunity to review all aspects of the clinical pathway, rather than focusing on only the adoption of a new technology; and 3) the guidelines offer the potential to discuss disinvestment as well as new investment. All the guidelines contain a systematic review of the relevant economic evaluation literature, and the 12 guidelines published from January 1 to August 31, 2015, contain 28 de novo economic analyses. The main challenges encountered in the guidelines program are that 1) there is an inevitable tension in advising on the quality of care that individual patients could expect while recognizing the broader public health objectives of equity, fairness, and efficiency; 2) the impact of economics is sometimes lessened because of the lack of time to conduct de novo analyses; and 3) unlike NICE’s technology appraisal program, the adoption of recommendations is not mandatory for the UK National Health Service

MP759: Grower Survey of Organic Pest Management Practices for Wild Blueberries in Maine with Case Studies

This report describes the results of a survey of all known organic blueberry growers in Maine conducted in December 2006. The survey included questions ranging from acreage owned and/or managed to market outlets to pruning techniques to educa­tion level of grower to methods of learning new information and was part of a larger, interdisciplinary project addressing organic pest-management strategies for lowbush blueber­ries.https://digitalcommons.library.umaine.edu/aes_miscpubs/1021/thumbnail.jp

TB198: Economic Analysis of Organic Pest Management Strategies for Lowbush Blueberries Using Enterprise Budgeting

Enterprise budgets were developed for the 12 different pest management treatments of a large-plot organic blueberry transitions project in Maine, covering two prune/harvest cycles (2004–2005 and 2006–2007). Regression analysis of the plot-level yield results for the aggregate of the two prune/harvest cycles indicated that burning fields as compared to mow­ing fields significantly increased blueberry yields over the aggregate of two prune/harvest cycles. Similarly, adding 1,000 lbs of sulfur before the first prune/harvest cycle significantly increased blueberry yields over the aggregate of two prune/harvest cycles as compared to no addition of sulfur. The addition of fertilizer had no significant impact on blueberry yields.https://digitalcommons.library.umaine.edu/aes_techbulletin/1003/thumbnail.jp

B852: Organic Wild Blueberry Production

Recent research carried out under the auspices of a USDA organic transition grant resulted in a better understanding of the interaction of wild blueberry production tactics such as pruning method, soil pH reduction by sulfur (S) application, and organic fertilizer rates on wild blueberry growth, development, and yield. This bulletin is the product of what we have learned over the past four years of this research project.https://digitalcommons.library.umaine.edu/aes_bulletin/1002/thumbnail.jp

Twenty Years of Using Economic Evaluations for Reimbursement Decisions : What Have We Achieved?

The objective of this paper is to examine the impact of economic evaluation on the reimbursement process for pharmaceuticals. Before the introduction of economic evaluation, a range of arrangements existed across different jurisdictions, varying from reimbursement based on clinical criteria alone and price controls, to a total absence of controls over price or reimbursement. The changes in the structure of reimbursement policies necessary to incorporate economic evaluation have been accomplished without major difficulty in most jurisdictions. However, several methodological differences in international guidelines for economic evaluation exist, only some of which can easily be justified. A number of beneficial changes in reimbursement processes have also been observed, such as a trend towards requiring the measurement of more meaningful clinical endpoints and increased engagement between manufacturers, drug regulators and payers. A consistent finding in studies of reimbursement decisions is that economic considerations have been influential, second only to the strength of the clinical evidence for the drug of interest. The impact of economic evaluation on the allocation of healthcare resources is hard to ascertain because of the difficulties in specifying the counterfactual and the fact that little is known about the extent to which reimbursement decisions actually lead to changes in healthcare practice. However, there is evidence that economic evaluation has assisted price negotiations and enabled reimbursement agencies to target drugs to those patients who will benefit the most. In publicly financed healthcare systems, an evidence-based system of pricing and reimbursement for drugs, considering societal willingness-to pay, is a reasonable policy objective to pursue

TB203: Recent Advances in the Biology and Genetics of Lowbush Blueberry

For lowbush blueberries, this publication presents an in-depth look at the biology and genetics of lowbush blueberry. The authors provide details on its genetic composition and the outline the usefulness of various biochemical, genomic, and other markers in studying the plants genetic structure. The authors also provide an overview of the plant’s economic value to Maine, nutritional value, and its life history.https://digitalcommons.library.umaine.edu/aes_techbulletin/1008/thumbnail.jp

Using Peer Discussion Facilitated by Clicker Questions in an Informal Education Setting : Enhancing Farmer Learning of Science

PLoS ONE, Vol. 7, No. 10Blueberry growers in Maine attend annual Cooperative Extension presentations given by university faculty members. These presentations cover topics, such as, how to prevent plant disease and monitor for insect pests. In 2012, in order to make the sessions more interactive and promote learning, clicker questions and peer discussion were incorporated into the presentations. Similar to what has been shown at the undergraduate level, after peer discussion, more blueberry growers gave correct answers to multiple-choice questions than when answering independently. Furthermore, because blueberry growers are characterized by diverse levels of education, experience in the field etc., we were able to determine whether demographic factors were associated with changes in performance after peer discussion. Taken together, our results suggest that clicker questions and peer discussion work equally well with adults from a variety of demographic backgrounds without disadvantaging a subset of the population and provide an important learning opportunity to the least formally educated members. Our results also indicate that clicker questions with peer discussion were viewed as a positive addition to university-related informal science education sessions

Homopterans and an invasive red ant, Myrmica rubra (L.), in Maine

Myrmica rubra (L.), is an invasive ant that is spreading across eastern North America. It is presently found in over 40 communities in Maine and areas in Vermont, New Hampshire, Massachusetts, New York, and several provinces in the Canadian Maritimes and Ontario. In addition to disrupting native ant faunas, invasive ants also have been shown to influence homopteran abundance and species composition. We conducted surveys of Homoptera in infested and noninfested sites and conducted manipulative experiments to quantify the effects of M. rubra on homopteran abundance and composition in the summers of 2003, 2006, and 2007 on Mount Desert Island, ME. In 2003, Homoptera family-level richness was higher in infested sites compared with noninfested sites with two out of three sampling methods. Homopteran abundance in infested compared with noninfested sites depended upon the site. The sites with the highest population of M. rubra were associated with significant differences in Homoptera population abundance. In 2006 and 2007, two out of three host plants sampled had significantly higher abundances of the aphids, Aphis spiraephila Patch and Prociphilus tessellatus Fitch. An ant exclusion field experiment on the native plant, meadowsweet (Spiraea alba Du Roi), resulted in higher abundances of A. spiraephila with M. rubra tending compared with native ant tending. A predator exclusion field experiment was conducted on meadowsweet using adult ladybeetles, Hippodamia convergens Guérin-Méneville, larval green lacewings, Chyrsoperla carnea Stephens, and no predators. Predator impacts on aphid populations were reduced in the presence of M. rubra with C. carnea and moderately reduced with H. convergens.We thank Bruce Hazen-Connery and David Manski, biologists with the National Park Service at Acadia National Park, for their support and assistance with the logistics of conducting research in Acadia National Park. In addition, we want to thank two anonymous reviewers for their invaluable comments. This research was supported by several entities: the Maine Agriculture and Forestry Experiment Station, the University of Maine Graduate School, the National Park Service at Acadia National Park, and the L.L. Bean Acadia Research Fellowship Program run by the Friends of Acadia. This is Maine Agricultural and Forestry Experiment Station journal article no. 3245.http://www.entsoc.org/nf201