International comparability of reference unit costs of education services: when harmonizing methodology is not enough (PECUNIA project)

Background: Health problems can lead to costs in the education sector. However, these costs are rarely incorporated in health economic evaluations due to the lack of reference unit costs (RUCs), cost per unit of service, of education services and of validated methods to obtain them. In this study, a standardized unit cost calculation tool developed in the PECUNIA project, the PECUNIA RUC Template for services, was applied to calculate the RUCs of selected education services in five European countries. Methods: The RUCs of special education services and of educational therapy were calculated using the information collected via an exploratory gray literature search and contact with service providers. Results: The RUCs of special education services ranged from €55 to €189 per school day. The RUCs of educational therapy ranged from €6 to €25 per contact and from €5 to €35 per day. Variation was observed in the type of input data and measurement unit, among other. Discussion: The tool helped reduce variability in the RUCs related to costing methodology and gain insights into other aspects that contribute to the variability (e.g. data availability). Further research and efforts to generate high quality input data are required to reduce the variability of the RUCs

The Relative Importance of Education and Criminal Justice Costs and Benefits in Economic Evaluations

Objectives Mental and behavioural disorders (MBDs) and interventions targeting MBDs lead to costs and cost savings in the healthcare sector, but also in other sectors. The latter are referred to as intersectoral costs and benefits (ICBs). Interventions targeting MBDs often lead to ICBs in the education and criminal justice sectors, yet these are rarely included in economic evaluations. This study aimed to investigate the attitudes held by health economists and health technology assessment experts towards education and criminal justice ICBs in economic evaluations and to quantify the relative importance of these ICBs in the context of MBDs. Methods An online survey containing open-ended questions and two best–worst scaling object case studies was conducted in order to prioritise a list of 20 education ICBs and 20 criminal justice ICBs. Mean relative importance scores for each ICB were generated using hierarchical Bayes analysis. Results Thirty-nine experts completed the survey. The majority of the respondents (68%) reported that ICBs were relevant, but only a few (32%) included them in economic evaluations. The most important education ICBs were “special education school attendance”, “absenteeism from school”, and “reduced school attainment”. The most important criminal justice ICBs were “decreased chance of committing a crime as a consequence/effect of mental health programmes/interventions”, “jail and prison expenditures”, and “long-term pain and suffering of victims/victimisation”. Conclusions This study identified the most important education and criminal justice ICBs for economic evaluations of interventions targeting MBDs and suggests that it could be relevant to include these ICBs in economic evaluations

Relationship between trust and patient involvement in medical decision-making: A cross-sectional study

INTRODUCTION: Patients vary in their preferences regarding involvement in medical decision-making. Current research does not provide complete explanation for this observed variation. Patient involvement in medical decision-making has been found to be influenced by various mechanisms, one of which could be patients’ trust in physicians. The aim of this study was to examine whether trust in physicians fosters or impairs patient involvement in medical decision-making. This study also aimed to determine to what extent the relationship between trust and preferences regarding decision-making roles was influenced by the sociodemographic characteristics of the patients. We hypothesised that trust can both foster and impair patient involvement in medical decision-making. MATERIALS AND METHODS: A survey was sent out to members of the Nivel Dutch Health Care Consumer Panel in February 2016 (response rate = 47%, N = 703). The Wake Forest Physician Trust Scale was used to measure trust. Patient involvement was measured using two items based on the study published by Flynn and colleagues in 2006. Multiple regression analysis was used to analyse the relationship between trust and patient involvement. RESULTS: We found a negative relationship between trust and patient involvement in medical decision-making in men. Women with high trust reported to be more involved in medical decision-making compared to men with high trust. CONCLUSION: The results suggest that trust impairs involvement in medical decision-making for men but not for women. Further research could provide a more comprehensive explanation of the variation in patient preferences regarding involvement in medical decision-making to further elucidate which underlying mechanisms could enhance patient participation

Do Costs in the Education Sector Matter? A Systematic Literature Review of the Economic Impact of Psychosocial Problems on the Education Sector

Background Psychosocial (e.g., anxiety or behavior) problems lead to costs not only in the healthcare sector but also in education and other sectors. As psychosocial problems develop during the critical period of establishing educational trajectories, education costs are particularly relevant in the context of psychosocial problems among children and adolescents. Objectives This study aimed to gain insights into the methods used for the inclusion of education costs in health economics studies and into the proportion of the education costs in relation to the total costs associated with a condition or an intervention. Methods We systematically searched the PubMed, Embase, SSCI, CINAHL, PsycINFO, ERIC, and Econlit databases in August 2019 for economic evaluations of mental health, psychosocial and educational interventions, and cost-of-illness studies of mental, behavioral, and neurodevelopmental disorders conducted from a societal perspective in populations of children and adolescents. An additional search was conducted in February 2021 to update the review. Results In total, 49 articles were included in the analysis. The most common cost items were special education, school absenteeism, and various educational professionals (educational psychologist). A variety of methods were employed for the identification, measurement, and/or valuation of education costs. The proportion of education costs to the total costs of condition/intervention ranged from 0 to 67%, with the mean being 18.5%. Discussion Since education costs can constitute a significant proportion of the total costs of an intervention or condition, including them in health economics studies might be important in informing optimal resource allocation decisions. Although various methods are available for including education costs in health economics studies, further research is needed to develop evidence-based methods for producing comparable estimates

The broader societal impacts of COVID-19 and the growing importance of capturing these in health economic analyses

The rapid spread of the current COVID-19 pandemic has affected societies worldwide, leading to excess mortality, long-lasting health consequences, strained healthcare systems, and additional strains and spillover effects on other sectors outside health (i.e., intersectoral costs and benefits). In this perspective piece, we demonstrate the broader societal impacts of COVID-19 on other sectors outside the health sector and the growing importance of capturing these in health economic analyses. These broader impacts include, for instance, the effects on the labor market and productivity, education, criminal justice, housing, consumption, and environment. The current pandemic highlights the importance of adopting a societal perspective to consider these broader impacts of public health issues and interventions and only omit these where it can be clearly justified as appropriate to do so. Furthermore, we explain how the COVID-19 pandemic exposed and exacerbated existing deep-rooted structural inequalities that contribute to the wider societal impacts of the pandemic

Preparation of Carbon-Copper-Silicon Nanocomposite Materials and Coatings Owing to Abrasive-Reactive Wear

We will focus on the important aspect of mechanical activation by grinding in a mill, namely, nanoscale wear of the treated substances and of the milling tools. A new technology called abrasive-reactive wear has been developed that utilizes wear debris as an integral component of the reaction system rather than treating it as a harmful impurity. This technology is applied to the processing of low-grade diamond and silicon by cupric milling tools. Abnormal influence of graphite on abrasive wear degree is established

Metasomatism in lithospheric mantle roots: Constraints from whole-rock and mineral chemical composition of deformed peridotite xenoliths from kimberlite pipe Udachnaya

International audienceWe report new data on the geochemical evolution, metasomatic and deformation processes in the lower layers of cratonic lithospheric mantle based on a detailed study of extraordinarily fresh and large deformed peridotite xenoliths from the Udachnaya kimberlite pipe, Siberia. Based on our T-P estimates, the deformed peridotites are localized in a depth range of 170 to 220 km near the base of cratonic mantle. The degree of deformation is not correlated with the depth and equilibration temperatures of the xenoliths. The deformed peridotites are depleted in magmaphile major elements indicating their residual nature, but are enriched in incompatible trace elements, Fe and K. The deformed peridotites experienced a complex evolution, i.e., they were formed initially as high-degree melt extraction residues and later were subjected to three main stages of metasomatic modification. (1) An old, mostly cryptic metasomatism by melt/fluid of carbonatitic composition, which formed garnets with sinusoidal REE patterns (Smn/Ern > 1). (2) Silicate metasomatism, which led to the most significant changes in mineralogical and chemical composition of the deformed peridotites. (3) Fe and Ti metasomatism just before the entrainment of the deformed rocks into kimberlite magma. Enrichment of the peridotites in large-ion lithophile elements (K, Rb, Ba) is related to the formation of kelyphitic rims around garnet. The nature of the metasomatic agent of silicate metasomatism was evaluated from mass-balance of measured and calculated whole-rock compositions, ratios of highly incompatible elements (D < 0.1) and fractional crystallization modeling. All this evidence indicates that the agent of silicate metasomatism had a composition intermediate between that of kimberlites and HIMU OIB. The metasomatic processes responsible for the formation of deformed peridotites and precipitation of megacryst suites cannot be widespread at the base of the cratonic mantle. Rather, they are local features only existing in the cratonic mantle below kimberlite fields and localized along the metasomatic vein system