Appraisal of health care: from patient value to societal benefit

Aim: This paper summarizes the deficiencies and weaknesses of the most frequently used methods for the allocation of health-care resources. New, more transparent and practical methods for optimizing the allocation of these resources are proposed. Method: The examples of quality-adjusted life years (QALYs) and efficiency frontier (EF) are analyzed to describe weaknesses and problems in decisions regulating health-care provision. After conducting a literature search and discussions with an international group of professionals, three groups of professionals were formed to discuss the assessment and appraisal of health-care services and allocation of available resources. Results: At least seven essential variables were identified that should be heeded when applying the concept of QALYs for decisions concerning health-care provision. The efficiency frontier (EF) concept can be used to set a ceiling price and perform a cost-benefit analysis of provision, but different stakeholders—a biostatistician (efficacy), an economist (costs), a clinician (effectiveness), and the patient (value)—could provide a fairer appraisal of health-care services. Efficacy and costs are often based on falsifiable data. Effectiveness and value depend on the success with which a particular clinical problem has been solved. These data cannot be falsified. The societal perspective is generated by an informal cost-benefit analysis including appraisals by the above-mentioned stakeholders and carried out by an authorized institution. Conclusion: Our analysis suggests that study results expressed in QALYs or as EF cannot be compared unless the variables included in the calculation are specified. It would be far more objective and comprehensive if an authorized institution made an informal decision based on formal assessments of the effectiveness of health-care services evaluated by health-care providers, of the value assessed by consumers, of efficacy described by biostatisticians, and of costs calculated by economists

Appraisal of health care: from patient value to societal benefit

Aim: This paper summarizes the deficiencies and weaknesses of the most frequently used methods for the allocation of health-care resources. New, more transparent and practical methods for optimizing the allocation of these resources are proposed. Method: The examples of quality-adjusted life years (QALYs) and efficiency frontier (EF) are analyzed to describe weaknesses and problems in decisions regulating health-care provision. After conducting a literature search and discussions with an international group of professionals, three groups of professionals were formed to discuss the assessment and appraisal of health-care services and allocation of available resources. Results: At least seven essential variables were identified that should be heeded when applying the concept of QALYs for decisions concerning health-care provision. The efficiency frontier (EF) concept can be used to set a ceiling price and perform a cost-benefit analysis of provision, but different stakeholders—a biostatistician (efficacy), an economist (costs), a clinician (effectiveness), and the patient (value)—could provide a fairer appraisal of health-care services. Efficacy and costs are often based on falsifiable data. Effectiveness and value depend on the success with which a particular clinical problem has been solved. These data cannot be falsified. The societal perspective is generated by an informal cost-benefit analysis including appraisals by the above-mentioned stakeholders and carried out by an authorized institution. Conclusion: Our analysis suggests that study results expressed in QALYs or as EF cannot be compared unless the variables included in the calculation are specified. It would be far more objective and comprehensive if an authorized institution made an informal decision based on formal assessments of the effectiveness of health-care services evaluated by health-care providers, of the value assessed by consumers, of efficacy described by biostatisticians, and of costs calculated by economists

Exchangeable Immobilized Enzyme Reactor (EIMER)

Since Flow-Injection Analysis (FIA) was introduced by Ruzicka and Hansenin 1975, a large numberofapplications using biological active reactors have been discribed. These reactors are often designedas fixed bed reactors with bio-material held between two nets or immobilized in tubes or on membrane surfaces. These designs allow the use of the enzyme’s naturalcatalytic activities. When denaturation, fowling or inhibition occure, however, thereislittle chance of reactivating the enzyme and the entire reactor must be discarded. Ourintent to design a fully automated biosensor for pesticide detection using enzyme inhibition made it necessary to develop methods for exchanging immobilized enzyme between two runs of analysis

Failure of CFRP airframe sandwich panels under crash-relevant loading conditions

New aircraft fuselage concepts have to prove equivalent crashworthiness standards compared to conventional metallic fuselages for certification. Brittle failure mechanisms of CFRP structures make the verification of equivalent crashworthiness for novel CFRP fuselage concepts challenging since conventional metal fuselages absorb a significant part of the kinetic energy by plasticization. In this context, the damage initiation and failure of twin-walled fuselage panels were investigated under crash relevant bending–compression loads. Since the sandwich failure is initiated by core failure, a trigger concept for CFRP composite sandwich panels was developed based on local modifications in the fold pattern of the core for controlled failure initiation. By locally adjusting the collapse strength of the core in normal direction, the failure position and failure load can be adapted according to the defined kinematic hinge requirements. The core trigger concept was validated in experiments with triggered and untriggered sandwich panels under identical loading conditions