Assessing the Economics of Obesity and Obesity Interventions

Examines projections for healthcare costs associated with the obesity epidemic; policy solutions and proven cost-effective interventions for addressing it; and the need to improve the Congressional Budget Office's projections

Economic Model of a Birth Cohort Screening Program for Hepatitis C Virus

Recent research has identified high hepatitis C virus (HCV) prevalence among older U.S. residents who contracted HCV decades ago and may no longer be recognized as high risk. We assessed the cost-effectiveness of screening 100% of U.S. residents born 1946-1970 over 5 years (birth-cohort screening), compared with current risk-based screening, by projecting costs and outcomes of screening over the remaining lifetime of this birth cohort. A Markov model of the natural history of HCV was developed using data synthesized from surveillance data, published literature, expert opinion, and other secondary sources. We assumed eligible patients were treated with pegylated interferon plus ribavirin, with genotype 1 patients receiving a direct-acting antiviral in combination. The target population is U.S. residents born 1946-1970 with no previous HCV diagnosis. Among the estimated 102 million (1.6 million chronically HCV infected) eligible for screening, birth-cohort screening leads to 84,000 fewer cases of decompensated cirrhosis, 46,000 fewer cases of hepatocellular carcinoma, 10,000 fewer liver transplants, and 78,000 fewer HCV-related deaths. Birth-cohort screening leads to higher overall costs than risk-based screening ($80.4 billion versus$53.7 billion), but yields lower costs related to advanced liver disease ($31.2 billion versus$39.8 billion); birth-cohort screening produces an incremental costeffectiveness ratio (ICER) of $37,700 per quality-adjusted life year gained versus riskbased screening. Sensitivity analyses showed that reducing the time horizon during which health and economic consequences are evaluated increases the ICER; similarly, decreasing the treatment rates and efficacy increases the ICER. Model results were relatively insensitive to other inputs. Conclusion: Birth-cohort screening for HCV is likely to provide important health benefits by reducing lifetime cases of advanced liver disease and HCV-related deaths and is cost-effective at conventional willingness-topay thresholds. (HEPATOLOGY 2012;55:1344-1355 H epatitis C virus (HCV) is the most common blood-borne viral infection in the United States, 1 affecting an estimated 3.6 million U.S. residents. 2 The majority of infected individuals develop chronic hepatitis; persistent liver injury leads to cirrhosis in 5$5 billion per year, 4 with projected HCV-related societal costs for the years 2010-2019 estimated to total $54.2 billion. 5 For the last decade, the standard of care for treating HCV has been the combination of pegylated interferon (Peg-IFN) and ribavirin (RBV), 6 which successfully eradicates virus (sustained virologic response; SVR) in 40%-80% of treated patients

Step-Indexed Normalization for a Language with General Recursion

The Trellys project has produced several designs for practical dependently typed languages. These languages are broken into two fragments-a_logical_fragment where every term normalizes and which is consistent when interpreted as a logic, and a_programmatic_fragment with general recursion and other convenient but unsound features. In this paper, we present a small example language in this style. Our design allows the programmer to explicitly mention and pass information between the two fragments. We show that this feature substantially complicates the metatheory and present a new technique, combining the traditional Girard-Tait method with step-indexed logical relations, which we use to show normalization for the logical fragment.Comment: In Proceedings MSFP 2012, arXiv:1202.240