Economic evaluation of the impact of the privatisation policy on animal health delivery services in africa: a case study of Zimbabwe

In many countries in Africa, the delivery of animal health services, especially in rural areas, is far from adequate. These services therefore need restructuring. An analysis of these systems indicates that the development of an appropriate analytical framework for evaluating them would prove to be extremely valuable. Such a framework should be able to identify, qualify and quantify, the various segments of the population, their spatial distribution, and specific health care needs, as well as permit the prediction and evaluation of the socio-economic impact of policies and interventions on the delivery system. In order to develop such a framework, a project was undertaken using the concept of Precision Service Delivery (PSD), with the objective of developing a robust analytical framework which is universally applicable to all health care delivery systems. PSD is aimed at adjusting and "fine-tuning" the delivery of services, so as to meet the specific health care needs of the different segments of the population, in the context of their geographical location. The animal health care delivery system in Zimbabwe was used as a case study. The PSD framework was used in this study, to analyse the economic and social impact of different scenarios of the current privatisation oriented policy reforms. This involved the use of statistical techniques, a geo-spatial modelling technique and Linear Programming mathematical models. A questionnaire survey of 145 livestock producers was conducted with representation from all four livestock production systems in Zimbabwe. The objective was to evaluate the socio-economic and health care variables that characterise the production systems. From fourteen putative variables identified, eight were extracted using Principal Component Analysis, as a bases for characterising the existing livestock production systems. Using Multiple Discriminant Analysis, the validity of the different production systems as distinct classes was confirmed

Local Government Autonomy: A Veritable Tool for Redressing Usurpation of Powers of Local Governments by the State Governments in Nigeria

The local councils can hardly be developmental, just as they are practically tied to the apron strings of the state by the constitution. They are in fact political structures that have increasingly become sad and forceful reminders of the systematic disempowerment that has become the lot of the grassroots in Nigeria. This paper examined the utility of the local government autonomy as a vehicle for redressing the overbearing powers of the state governments over local governments’ affairs in Nigeria. The paper contended that the growing demand for an autonomous local government system holds great promise in this direction in that, it will help to strengthen the powers of local governments and make them focus on grassroots politics than being a stooge to the state; a situation which was driven by long period of state governments tricks to ensure that the third tier government remains under their apron strings. The paper further argued that, in spite of the useful potentials of local government autonomy, the need to check against the inordinate usurpation of powers of local governments by state governments demands a multi-faceted approach in its implementation as it affects both tiers of governments in Nigeria. To this end, the paper suggested additional ways of facilitating the achievement of this objective. Keywords: Autonomy, Local Government, State encroachment, Power, Constitutio

Students’ Union–Management relations and conflict resolution mechanisms in Obafemi Awolowo University, Nigeria

Conflict is inevitable in any human relationship. The situation is the same in the university system where several groups with diverse interests exist.While scholarly attention has focused on conf lict and conf lict resolution in the larger human society, less attention has been directed towards conf lict and its resolution between and among various groups within a university. This article empirically examines the relations between the Students’ Union (the body representing the students) and the management of Obafemi Awolowo University (OAU), and the conf lict resolution mechanismsavailable to the groups. The article adopts secondary and primary data sourced from semi-structured interviews, and analyses the data using descriptive and content analysis methods. Findings show that the relations between the Students’ Union and the management of OAU are mixed, largely depending on the strategies adopted by the union leaders and the university administrators; that conf licts are mostly triggered by issues bordering on students’ welfare; and that mechanisms such as mediation, negotiation, and consultation are some of the conf lict resolution  mechanisms between OAU students and management. The article concludes that the central issue between the Students’ Union and management of OAU is student welfare, and that to avert future conf licts, student welfare must be management’s priority at all times. Keywords: Students’ Union, Management, conf lict, conf lict resolution, relations, Obafemi Awolowo Universit

A Systematic Review of Clinical Efficacy Associated with use of Protease-Modulating Interventions with Diabetic Foot Ulcer or Venous Leg Ulcer

OBJECTIVES: Diabetic foot ulcers (DFUs) or leg ulcers (LUs) of venous, arterial or mixed origin can cause a considerable burden to a patient and healthcare provider, taking a long time to heal and requiring frequent interventions. Dressings are a mainstay of treatment with countless options for a Healthcare Provider. Protease-modulating matrix (PMM) interventions are an alternative to basic or other advanced dressings. A systematic review was undertaken to assess the clinical effectiveness of PMM interventions for DFUs and LUs. METHODS: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. An online database search, and consultation with experts and manufacturers identified the literature. Databases searched included: Centre Reviews and Dissemination (CRD) York Database, Cochrane Library, Medline (PubMed), National Institute for Health and Clinical Excellence Evidence Search, Science Direct/Scopus. Two researchers performed data extraction with a third consulted in case of any discrepancies. A narrative synthesis of results and critical appraisal of included studies was performed. RESULTS: A total of 283 records were identified by literature searching. After initial screening of titles and abstracts, 215 full text articles were judged against pre-defined inclusion and exclusion criteria. Six randomised controlled trials and 2 observational studies were included in the review. A total of 1310 patients were included in this study. The three VLU RCTs included a total of 377 patients, and the DFU studies included 933 patients. Healing was the most frequently reported outcome, followed by wound area reduction. A meta-analysis was not possible given the heterogeneity of the included studies. CONCLUSIONS: This review provides some evidence that PMM interventions have a clinical benefit on wound healing outcomes; however, there were several methodological issues with the studies included. New evidence shows promising results for the treatment of DFUs involving protease modulation by sucrose octasulfate dressings

Deriving health state utilities for the numerical pain rating scale

Background The use of patient reported outcome measures within cost-effectiveness analysis has become commonplace. However, specific measures are required that produce values, referred to as 'utilities', that are capable of generating quality adjusted life years. One such measure - the EQ-5D - has come under criticism due to the inherent limitations of its three-level response scales. In evaluations of chronic pain, the numerical pain rating scale (NPRS) which has eleven levels is routinely used which has a greater measurement range, but which can not be used in cost-effetiveness analyses. This study derived utility values for a series of EQ-5D health states that replace the pain dimensions with the NPRS, thereby allowing a potentially greater range of pain intensities to be captured and included in economic analyses. Methods Interviews were undertaken with 100 member of the general population. Health state valuations were elicited using the time trade-off approach with a ten year time horizon. Additionally, respondents were asked where the EQ-5D response scale descriptors of moderate and extreme pain lay on the 11-point NPRS scale. Results 625 valuations were undertaken across the study sample with the crude mean health state utilities showing a negative non-linear relationship with respect to increasing pain intensity. Relative to a NPRS of zero (NPRS0), the successive pain levels (NPRS1-10) had mean decrements in utility of 0.034, 0.043, 0.061, 0.121, 0.144, 0.252, 0.404, 0.575, 0.771 and 0.793, respectively. When respondents were asked to mark on the NPRS scale the EQ-5D pain descriptors of moderate and extreme pain, the median responses were '4' and '8', respectively. Conclusions These results demonstrate the potential floor effect of the EQ-5D with respect to pain and provide estimates of health reduction associated with pain intensity described by the NPRS. These estimates are in excess of the decrements produced by an application of the EQ-5D scoring tariff for both the United States and the United Kingdom

A Systematic Review of Economic Outcomes Associated with use of Topical Interventions for Treatment of Chronic Wounds

OBJECTIVES: A combination of interventions may be appropriate for a patient with a chronic wound. However, standard care varies by aetiology, geographical location and clinician discipline. A systematic review was undertaken to examine the economic impact of topical interventions for chronic wounds and variance associated with standard care. METHODS: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches of: Science Direct, National Institute for Health and Clinical Excellence Evidence search, Medline (PubMed), Centre of Reviews and Dissemination (University of York), Cochrane Database and discussion with experts and manufacturers identified the literature. Two researchers performed data extraction, with a third consulted where there were disagreements. Economic endpoints including: incremental cost-effectiveness ratio, cost-per Quality Adjusted Life Year and disease related resource use were extracted. A narrative synthesis of results and critical appraisal using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement were performed. RESULTS: 3422 records identified. After screening, 817 full text articles were judged versus inclusion and exclusion criteria. 15 studies were included: 6 economic analysis along clinical trials, and 9 modelling studies.10 studies focused on VLUs, 3 studies on DFUs and 1 on Pressure Ulcers and 1 on Chronic Wounds. Data tables for methods, results and appraisal using the CHEERS statement were completed. Quality scores ranged from 10 – 15 with a mean of 12.9. CONCLUSIONS: This review provides some evidence that topical interventions can offer cost-effective solutions for treating chronic wounds compared with standard care. Current evidence predominantly uses the endpoint of wound area reduction; evaluations using complete wound closure as primary endpoint could be more useful. This review informs decision makers and clinicians that more expensive wound care products can be cost-effective in the management of chronic wounds; in opposition to current NICE guidance to use the ‘least costly’ dressing

Conceptualisation and role of market access in pharmaceutical industry: a scoping review

Background: Understanding the concept and dynamic process of the evolution of professional identity and roles of market access (MA) in the pharmaceutical industry (pharma) is critical to personal, interpersonal, and professional levels of development and impact. Objective: The aim was to carry out a scoping review of the conceptualisation of MA within pharma. Data Sources: BioMed Central, WorldCat.org, and Directory of Open Access Journals were searched from 2003 to 2023. Study Selection: All articles on concepts or definitions and other surrogate terms on MA in pharma were selected. Data Extraction: Keywords generated from an initial cursory literature search on MA in pharma were used in conjunction with AND/OR as search terms. Using the data charting method, key findings were mapped and summarised descriptively. inductive analysis was performed, allowing codes/themes that are relevant to the concept to emerge. Data Synthesis: Arskey and O’Malley’s six-stage framework and the PRISMA extension for scoping reviews extension checklist were used as the review and reporting templates. The databases search yielded 222 results. Following title and abstract screening, a total of 146 papers were screened, and 127 of them were excluded. Full-text review was conducted for 19 papers that were deemed by two reviewers to meet the eligibility criteria. One of the authors arbitrated on disputed papers for inclusion. Only 14 of the included papers were found to meet the criteria for the final analysis. Five conceptual dimensions of MA in pharma were identified as “right products”, “right patient”, “right price”, “right point” (time), and “right place” (setting). Conclusions: Market access in pharma is a process that commences with the development and availability of the right products that are proven to be efficacious and disease/condition-specific (including medications, medical devices, and vaccines); specifically produced for the right patients or end users who will maximise best clinical outcomes and economic value; delivered at the right point in a timely, sustained, and efficient manner, given at the right price (commercially viable or reimbursed price that represents good value); and conducted within the economic, policy, societal, and technological contexts, with the overarching goal of achieving the best patient outcomes and ensuring product profitability

Validation of the Patient Perception of Intensity of Urgency Scale in Patients with Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia

AbstractObjectiveTo assess the reliability and validity of scores derived from the Patient Perception of Intensity of Urgency Scale (PPIUS) in patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH).MethodsA post hoc analysis of the phase II Solifenacin and Tamsulosin in Males with Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia trial (NCT00510406), a 12-week clinical trial in men with LUTS associated with BPH, assessed the measurement properties of six PPIUS-derived scores: mean score; maximum urgency score; total urgency and frequency score (TUFS; average sum of urgency scores over 3 days); and numbers of urgency episodes, urgency episodes of grade 3 or 4, and urgency incontinence episodes. Test-retest reliability, presence of floor/ceiling effects, responsiveness to change, known-group validity, and concurrent validity were assessed for each score.ResultsA total of 901 patients had at least one valid PPIUS assessment after baseline. TUFS demonstrated good test-retest reliability (intraclass correlation coefficient >0.8), discriminated between groups defined based on International Prostate Symptom Score storage score severity (known-groups validity), had high concurrent validity, and had high responsiveness to change (Guyatt’s responsiveness statistic 0.88), with an absence of floor or ceiling effects. The psychometric properties of other PPIUS-derived scores were not as consistently robust and showed either low-to-moderate responsiveness, presence of a floor or ceiling effect, or low-to-moderate test-retest reliability.ConclusionsThis study shows that the PPIUS is reliable and valid in patients with LUTS associated with BPH. TUFS provided the best combination of psychometric properties of the six scores derived from the PPIUS and appeared to be an appropriate measure of urgency and frequency

Content validity and test-retest reliability of patient perception of intensity of urgency scale (PPIUS) for overactive bladder

BACKGROUND: The Patient Perception of Intensity of Urgency Scale (PPIUS) is a patient-reported outcome instrument intended to measure the intensity of urgency associated with each urinary or incontinence episode. The objectives of this study were to assess the content validity, test-retest reliability, and acclimation effect of the PPIUS in overactive bladder (OAB) patients. METHODS: Patients undergoing treatment for OAB were recruited to participate in a non-interventional study by completing a three-day micturition diary including the PPIUS for three consecutive weeks. Following completion of the three-week study, participants from two select sites also completed a cognitive interview to assess their comprehension of the PPIUS. RESULTS: Thirty-nine participants successfully completed the three-week test-retest study; twelve of these participants completed the cognitive interview. Test-retest reliability was high based on intra-class correlation coefficient of 0.95. Among stable patients, the difference between the mean ratings of any two weeks was non-significant. Among the twelve interview participants, nine found it simple to choose a PPIUS rating for each of their micturition episodes and most found the urgency rating definitions consistent with their urgency experiences. CONCLUSIONS: The results demonstrated content validity based on qualitative interviews, and excellent test-retest reliability among stable patients. In addition, no acclimation effect was observed among stable patients. These findings support the use of the PPIUS as a reliable measure of urgency in both clinical trial and real life settings. The validity of PPIUS could be further established with future studies investigating the relationship between discretely graded urgency and incontinence continuum

Cost-effectiveness analysis of fidaxomicin versus vancomycin in <i>Clostridium difficile</i> infection

Fidaxomicin was non-inferior to vancomycin with respect to clinical cure rates in the treatment of Clostridium difficile infections (CDIs) in two Phase III trials, but was associated with significantly fewer recurrences than vancomycin. This economic analysis investigated the cost-effectiveness of fidaxomicin compared with vancomycin in patients with severe CDI and in patients with their first CDI recurrence. A 1 year time horizon Markov model with seven health states was developed from the perspective of Scottish public healthcare providers. Model inputs for effectiveness, resource use, direct costs and utilities were obtained from published sources and a Scottish expert panel. The main model outcome was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life year (QALY), for fidaxomicin versus vancomycin; ICERs were interpreted using willingness-to-pay thresholds of A 20aEuroS000 pound/QALY and A 30aEuroS000 pound/QALY. One-way and probabilistic sensitivity analyses were performed. Total costs were similar with fidaxomicin and vancomycin in patients with severe CDI (A 14aEuroS515 pound and A 14aEuroS344 pound, respectively) and in patients with a first recurrence (A 16aEuroS535 pound and A 16aEuroS926 pound, respectively). Improvements in clinical outcomes with fidaxomicin resulted in small QALY gains versus vancomycin (severe CDI, +0.010; patients with first recurrence, +0.019). Fidaxomicin was cost-effective in severe CDI (ICER A 16aEuroS529 pound/QALY) and dominant (i.e. more effective and less costly) in patients with a first recurrence. The probability that fidaxomicin was cost-effective at a willingness-to-pay threshold of A 30aEuroS000 pound/QALY was 60% for severe CDI and 68% in a first recurrence. Fidaxomicin is cost-effective in patients with severe CDI and in patients with a first CDI recurrence versus vancomycin