Personal and Societal Health Quality Lost to Tuberculosis

BACKGROUND: In developed countries, tuberculosis is considered a disease with little loss of Quality-Adjusted Life Years (QALYs). Tuberculosis treatment is predominantly ambulatory and death from tuberculosis is rare. Research has shown that there are chronic pulmonary sequelae in a majority of patients who have completed treatment for pulmonary tuberculosis (PTB). This and other health effects of tuberculosis have not been considered in QALY calculations. Consequently both the burden of tuberculosis on the individual and the value of tuberculosis prevention to society are underestimated. We estimated QALYs lost to pulmonary TB patients from all known sources, and estimated health loss to prevalent TB disease. METHODOLOGY/PRINCIPAL FINDINGS: We calculated values for health during illness and treatment, pulmonary impairment after tuberculosis (PIAT), death rates, years-of-life-lost to death, and normal population health. We then compared the lifetime expected QALYs for a cohort of tuberculosis patients with that expected for comparison populations with latent tuberculosis infection and without tuberculosis infection. Persons with culture-confirmed tuberculosis accrued fewer lifetime QALYs than those without tuberculosis. Acute tuberculosis morbidity cost 0.046 QALYs (4% of total) per individual. Chronic morbidity accounted for an average of 0.96 QALYs (78% of total). Mortality accounted for 0.22 QALYs lost (18% of total). The net benefit to society of averting one case of PTB was about 1.4 QALYs. CONCLUSIONS/SIGNIFICANCE: Tuberculosis, a preventable disease, results in QALYs lost owing to illness, impairment, and death. The majority of QALYs lost from tuberculosis resulted from impairment after microbiologic cure. Successful TB prevention efforts yield more health quality than previously thought and should be given high priority by health policy makers. (Refer to Abstracto S1 for Spanish language abstract)

An innovative cost modelling system to support lean product and process development

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Proposal for an Architectural Solution for Economic and Environmental Global Eco-Cost Assessment: Model Combination Analysis

This chapter highlights the complementarities of cost and environmental evaluation in a sustainable approach. Starting with the needs and limits for whole product lifecycle evaluation, this chapter begins with the modeling, data capture and performance indicator aspects. Next, the information issue, regarding the whole lifecycle of the product, is addressed. In order to go further than economical evaluation/assessment, the value concept (for a product or a service) is discussed. Value can combine functional requirements, cost objectives and environmental impact. Finally, knowledge issues are discussed, addressing the complexity of integrating multi-disciplinary expertise into the whole lifecycle of a product

Geometric inspection planning as a key element in industry 4.0

In the context of Industry 4.0, inspection is fundamental: if manufacturing opens the loop by converting digital parts into physical parts, inspection closes the loop by turning physical parts into information. The difference between an effective and a useless inspection is its planning. A well-planned inspection will provide the required data and information without wasting time and money. In this work, we discuss the current role of geometric inspection planning, showing that not only it is a must for Industry 4.0, in order to guarantee a good link between the physical and digital world, but it can take advantage of this framework to improve itself. Methodologies for optimal inspection planning have been already conceptually proved and are just waiting for the required amount of data and information to be available, and Industry 4.0 will be the enabler to fill this gap