Issues in Cost Effectiveness in Health Care

Cost-effectiveness analysis (CEA) is becoming increasingly popular as society moves toward rationalizing health costs. This review describes the applications and limitations of the technique. Conceptually simple though frequently complicated in application, CEA compares the cost of a procedure with its effectiveness, thus helping an administrator to judge whether the procedure is worth its cost. CEA also permits comparison of various interventions that result in a similar health outcome. A major benefit of CEA is that it forces decision makers to confront the tradeoffs implicit in all decisions regarding alternative approaches. Limitations of the CEA philosophy and technique also have to be understood if it is to be employed effectively; it is not an assessment of cost savings, nor is it a decision-making technique because it does not incorporate value judgments. A number of potential applications to dentistry are described.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65700/1/j.1752-7325.1989.tb02085.x.pd

Audit of therapeutic interventions in inpatient children using two scores: are they evidence-based in developing countries?

BACKGROUND: The evidence base of clinical interventions in paediatric hospitals of developing countries has not been formally assessed. We performed this study to determine the proportion of evidence-based therapeutic interventions in a paediatric referral hospital of a developing country METHODS: The medical records of 167 patients admitted in one-month period were revised. Primary diagnosis and primary therapeutic interventions were determined for each patient. A systematic search was performed to assess the level of evidence for each intervention. Therapeutic interventions were classified using the Ellis score and the Oxford Centre for Evidence Based Medicine Levels of Evidence RESULTS: Any dehydration due to diarrhoea (59 cases) and pneumonia (42 cases) were the most frequent diagnoses. Based on Ellis score, level I evidence supported the primary therapeutic intervention in 21%, level II in 73% and level III in 6% cases. Using the Oxford classification 16%, 8%, 1% and 75% therapeutic interventions corresponded to grades A, B, C, and D recommendations, respectively. Overall, according to Ellis score, 94% interventions were evidence based. However, out of the total, 75% interventions were based on expert opinion or basic sciences. Most children with mild to moderate dehydration (52 cases) were inappropriately treated with slow intravenous fluids, and most children with non-complicated community acquired pneumonia (42 cases) received intravenous antibiotics CONCLUSIONS: Most interventions were inappropriate, despite the availability of effective therapy for several of them. Diarrhoeal dehydration and community acquired pneumonia were the most common diagnoses and were inappropriately managed. Existing effective interventions for dehydration and pneumonia need to be put into practice at referral hospitals of developing countries. For the remaining problems, there is the need to conduct appropriate clinical studies. Caution must be taken when assigning the level of evidence supporting therapeutic interventions, as commonly used classifications may be misleadin

Thinking like a fish: a key ingredient for development of effective fish passage facilities at river obstructions

Worldwide, obstructions on watercourses have interfered with migratory pathways of fish species, reducing life‐cycle success and often eliminating diadromous fish species altogether from river basins. Over the last century, efforts to mitigate these effects were initially directed at developing fishways for upstream, high‐value migrant adult salmon. In more recent years, efforts have turned to developing fishways for other species. Results of past research suggest that the development of effective fishways requires biological knowledge of fish behaviour when encountering variable flows, velocity and turbulence, combined with hydraulic and civil engineering knowledge and expertise to develop facilities that provide ppropriate hydraulic conditions that fish will exploit. Further, it often requires substantial financial resources for biological and hydraulic testing as well as engineering design, particularly where prior knowledge of the behaviour of target fish species does not exist. Where biological or engineering knowledge (or both) is absent, development of effective passage facilities must take on a trial and error approach that will almost certainly require years to attain success. Evaluations of existing adult and juvenile fish passage facilities, where they have been carried out, suggest that migrant fish reject areas with hydraulic conditions they determine unsuitable. Even well designed fish ladders or nature‐like bypass channels for upstream migrants, even those with good attraction flows, will fail if incorrectly sited. Although progress has been made, developing successful installations for downstream migrants remains much more difficult, probably because downstream fish move with the flow and have less time to assess cues at entrances to any bypasses that they encounter

Fish Passage Technologies: Protection at Hydropower Facilities

None supplied. From executive summary: The focus of this report is technologies for fish passage around hydropower generation facilities and protection against entrainment and turbine mortality. Emphasis is given to Federal Energy Regulatory Commission (FERC)-licensed hydropower projects where fish protection is a subject of controversy and congressional interest due to the Federal Power Act (FPA) and the Electric Consumers Protection Act (ECPA). Thus insitutional issues related to the FERC-relicensing are also discussed. (Major points of controversy are highlighted in box 1-1.) Federal hydropower projects, especially in the Columbia River Basin, and irrigation water diversions in the Pacific Northwest and California are included to the extent that they provide information on fish passage technologies (see table 1-1). Many of the technologies discussed are applicable to other types of dams and water diversions. In fact, there are many more obstructions to fish passage that are not covered by FERC-licensing requirements, than are (approximately 76,000 dams versus 1,825 FERC-licensed facilities)

Technology Roadmap for Tesla Motors Sedan EV

In order for the United States, as well as other nations, to decrease their dependency and reliance on imported fossil fuel, to control and reduce the largest source of their carbon emission, and to secure their national transportation system, a faster transition from the Internal Combustion Engine to the Electric Vehicle has to be promoted. The public and private sectors will have to work hand in hand to ensure reaching such a national goal. This paper lays out a technology roadmap for a private company ‘Tesla Motors’, proposing a balanced mixed basket of Technology Push and market Pull strategy in order to get closer and closer to the desired goal. Fossil fuel does not have to run out in order for the transition to take place. After all, the reason why humanity came out of the Stone Age was not due to the lack of stones, there still plenty out there