Overview of parametric survival analysis for health-economic applications.

Health economic models rely on data from trials to project the risk of events (e.g., death) over time beyond the span of the available data. Parametric survival analysis methods can be applied to identify an appropriate statistical model for the observed data, which can then be extrapolated to derive a complete time-to-event curve. This paper describes the properties of the most commonly used statistical distributions as a basis for these models and describes an objective process of identifying the most suitable parametric distribution in a given dataset. The approach can be applied with both individual-patient data as well as with survival probabilities derived from published Kaplan-Meier curves. Both are illustrated with analyses of overall survival from the Sorafenib Hepatocellular Carcinoma Assessment Randomised Protocol trial

Rational choice of cholinesterase inhibitor for the treatment of Alzheimer's disease in Canada: a comparative economic analysis

BACKGROUND: Cholinesterase inhibitors, such as galantamine, donepezil and rivastigmine are approved for symptomatic treatment of Alzheimer's Disease (AD) in Canada. In making choices amongst these drugs, one should consider their clinical merits and their economic implications. METHODS: Each drug's short-term efficacy was estimated based on independent Cochrane reviews of the clinical trials. Long-term clinical and economic outcomes were estimated using the Assessment of Health Economics in Alzheimer's Disease (AHEAD) model. RESULTS: While all treatments reduced the need for full-time care, only galantamine and donepezil 10 mg reduced the overall management costs of AD patients. The somewhat greater cognitive effect provided over six months by galantamine leads to the longest estimated delay before full-time care is required and, consequently to lower overall costs, with savings estimated at between $323 and$4,246. CONCLUSION: Although there is uncertainty in estimated results, the best information currently available suggests that the first choice for treatment of AD should be galantamine. These results should be interpreted with caution, however, as results are not based on direct comparisons among the drugs and the differences emerging from meta-analyses of the trials are relatively small

Lifetime economic burden of prostate cancer

<p>Abstract</p> <p>Background</p> <p>Prostate cancer (PCa) is the most common cancer affecting men in the United States. The initial treatment and subsequent monitoring of PCa patients places a large burden on U.S. health care systems. The objectives of this study were to estimate the total and disease-related per-patient lifetime costs using a phase-based model of cancer care for PCa patients enrolled in Medicare.</p> <p>Methods</p> <p>A model was developed to estimate life-time costs for patients diagnosed with PCa. Patients ≥ 65 years old and diagnosed with PCa between calendar years 1991-2002 were selected from the SEER database. Using SEER, we estimated survival times for PCa patients from diagnosis until death. The period of time patients contributed to treatment phases was determined using an algorithm designed to model the natural history of PCa. Costs were obtained from the US SEER-Medicare database and estimated during specific phases of care. Cost estimates were then combined with survival data to yield total and PCa-related life-time costs.</p> <p>Results</p> <p>Overall, the model estimated life-time costs of $110,520 (95$34,432).</p> <p>Conclusions</p> <p>Prostate cancer places a significant burden on U.S. health-care systems with average life-time PCa-related costs in excess of $30,000.</p

Penerapan Solar Home System Bagi Keluarga Petani di Dusun Niskolen

Abstract - This activity tries to reveal the impact of installing a solar home system with energy-saving lamps on the social and economic benefits for farming families in Niskolen hamlet. The social and economic benefits are intended for continuity in efforts to expand access to electricity services in areas not yet covered by electricity, and to encourage economic development and growth as well as improve the welfare of farmers. These social and economic benefits have long-term effects, such as increasing reading and learning opportunities, improving people's health standards, and with electricity at night farmers can carry out social and economic activities, as well as facilitate and speed up information from electronic media. The existence of electric lighting will pave the way for the development of the various talents that exist for innovation and entrepreneurship. Abstrak – Kegiatan ini mencoba untuk mengungkapkan dampak pemasangan solar home system dengan lampu hemat energi terhadap manfaat social dan ekonomi bagi keluarga petani di dusun Niskolen. Manfaat sosial dan ekonomi dimaksudkan untuk kelangsungan dalam upaya perluasan akses pelayanan listrik pada wilayah yang belum terjangkau listrik, dan mendorong pembangunan dan pertumbuhan ekonomi serta meningkatkan kesejateraan petani. Manfaat sosial dan ekonomi ini berpengaruh secara jangka panjang, antara lain seperti, peningkatan kesempatan membaca dan belajar, peningkatan taraf kesehatan rakyat, dan dengan adanya listrik pada waktu malam hari petani dapat melakukan kegiatan sosial dan ekonomi, serta memudahkan dan mempercepat informasi dari media elektronik. Dengan adanya penerangan listrik akan membuka jalan kepada pengembangan berbagai bakat yang ada untuk inovasi dan kewirausahaan

Applying the win ratio method in clinical trials of orphan drugs: an analysis of data from the COMET trial of avalglucosidase alfa in patients with late-onset Pompe disease

Background: Clinical trials for rare diseases often include multiple endpoints that capture the effects of treatment on different disease domains. In many rare diseases, the primary endpoint is not standardized across trials. The win ratio approach was designed to analyze multiple endpoints of interest in clinical trials and has mostly been applied in cardiovascular trials. Here, we applied the win ratio approach to data from COMET, a phase 3 trial in late-onset Pompe disease, to illustrate how this approach can be used to analyze multiple endpoints in the orphan drug context. Methods: All possible participant pairings from both arms of COMET were compared sequentially on changes at week 49 in upright forced vital capacity (FVC) % predicted and six-minute walk test (6MWT). Each participant’s response for the two endpoints was first classified as a meaningful improvement, no meaningful change, or a meaningful decline using thresholds based on published minimal clinically important differences (FVC ± 4% predicted, 6MWT ± 39 m). Each comparison assessed whether the outcome with avalglucosidase alfa (AVA) was better than (win), worse than (loss), or equivalent to (tie) the outcome with alglucosidase alfa (ALG). If tied on FVC, 6MWT was compared. In this approach, the treatment effect is the ratio of wins to losses (“win ratio”), with ties excluded. Results: In the 2499 possible pairings (51 receiving AVA × 49 receiving ALG), the win ratio was 2.37 (95% confidence interval [CI], 1.30–4.29, p = 0.005) when FVC was compared before 6MWT. When the order was reversed, the win ratio was 2.02 (95% CI, 1.13–3.62, p = 0.018). Conclusion: The win ratio approach can be used in clinical trials of rare diseases to provide meaningful insight on treatment benefits from multiple endpoints and across disease domains

Can restaurant revenue management work with menu analysis?

Menu analysis and revenue management approaches contribute to improving a restaurant’s profitability. Yet, both approaches are often implemented independently with constraints. This paper explores the potential of integrating both approaches to improve strategy formulation. Hence, this paper identified the extent of applicability and synergies among both approaches. Findings highlighted that as both approaches become more sophisticated, the practicality of implementation will deprive. The synergies identified the potential to integrate both approaches’ performance indicators, cost efficiency data and strategies. Understanding the applicability and synergies of both approaches will lay the foundation for an effective integrated menu analysis and revenue management framework

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Logistics-related knowledge process capabilities in Malaysian courier service industries

The rapid penetration of the Internet and smart-phones are accelerating the development of Malaysia’s courier and e-business industries. The year 2011 witnessed a creative climax of both industries, where courier services offered consumers the option of paying cash on delivery (COD) for the first time in e-commerce transactions in Malaysia. Nevertheless, to create services, the courier companies need to have efficient knowledge management processes in addition to managing logistics. It has been found that there was lacking of sufficient guidance on bridging the gaps between logistics management, knowledge management and creativity, especially for both courier services and e-business companies. Hence, the study mainly aimed to develop a novel logistics-related knowledge management framework towards e-business performance considering the mediating role of creativity as well as the moderating role of inter-firm dependence. A cross-sectional survey from courier companies was undertaken, which had creativity in Courier Services (C) and four determinants of logistics-related knowledge management (LRKM), namely: logistics-related knowledge generation (LRKG), logistics-related knowledge dissemination (LRKD), logistics-related knowledge shared interpretation (LRKS) and logistics-related knowledge responsiveness (LRKR). E-business companies were surveyed on their financial performance (FP), e-business system adoption levels (EBL) and inter-firm dependence (IFD) on logistic partners. The partial least square structural equation modeling (PLS SEM) was applied for data analysis using SmartPLS 3.0. The results demonstrated that among the factors of LRKM in courier companies, the LRKD was the most contributing factor that drove their e-business partner’s performance, followed by LRKR. Meanwhile, LRKG and LRKS are less contributing factors and were not significant. It was proved that creativity played a mediating role between the LRKM and E-Business Performance relationship. It was also found that IFD played the role of moderator which strengthened the Creativity and E-Business Performance relationship. However, IFD did not mediate the relationship between LRKM and E-Business Performance. Additionally, the results of the effect size demonstrated that Creativity in courier services was better than LRKM towards enhancing e-business performance. Hence, it implies: i) to enhance and help their partners’ e-business performances, the courier companies should continue focusing their efforts on both LRKD and LRKR, but also invest more efforts on the least contributing factors of LRKG and LRKS, as which are part of the LRKM process and also contributing to e-business performance; ii) to further enhance e-business performance, courier companies should also invest in its creativity, which is a latent driver that facilitates E-business performance; and iii) to further assist the contribution of creativity of courier services onto e-business performance, more attention could be paid to IFD, in order to utilize its positive moderating effects. This research presents several theoretical contributions by providing further insights on determinants and outcomes of LRKM towards e-business performance, the importance of creativity of courier companies; and the inter-dependence between courier companies and their e-business partners, especially in Malaysia

No Head-to-Head Trial? Simulate the Missing Arms

Establishing efficacy relative to placebo is no longer sufficient for payers to agree to cover new interventions. Evidence from comparisons of competing interventions is increasingly important, although head-to-head studies are seldom available to inform decisions. In this article, we describe the simulated treatment comparison (STC) approach to incorporating 'missing arms' into an existing trial. This approach yields a simulated head-to-head trial and can address many of the differences among source trials. It provides inputs for economic models and can inform decision makers until actual trial data are available. A simulation is constructed to replicate an index trial, including enrolment, randomization and follow-up of patients. The simulation is driven by predictive equations derived from the index trial. Separate data for the comparators are used to calibrate the index equations to reflect the alternative interventions. The simulation is used to add the missing arms to the index trial and estimate the results that would have been obtained in a head-to-head trial. The STC can also be used to estimate results in various settings and populations and to explore variations in the trial design. An STC offers a way to derive comparative effectiveness in the absence of direct trial evidence and a platform to test design features that may help in planning future head-to-head studies.Clinical-trial-design, Meta-analysis, Treatment-outcome