Institutions under stress and people in distress: Institution-building and drought in a new settlement scheme in Sri Lanka

Institutional constraintsInstitution buildingDroughtSettlement patternsFarmers' associationsResearchWater management

The political dimension of seasonal allocations: Developing a seasonal allocation strategy in a water-short system in Sri Lanka

Water allocation, Irrigation programs, Reservoirs, Participatory management, Farmer participation, Water rights, Irrigated farming, Rice, Water shortage, Farmers' attitudes, Farmer-agency interactions, Sri Lanka

Managing irrigation jointly with farmers: history, present status and future: review of participatory irrigation management in Sri Lanka

Agriculture development has been the main strategy for the socioeconomic development in the country since time immemorial, even though its contribution to GDP has been declining recently. Successive governments of Sri Lanka since independence have invested heavily in the irrigated agriculture sector to address the food security concerns of the country. The continuous investment in irrigation was required to address problems such as spatial and temporal variations in monsoonal rainfall in the country, which has a serious negative impact on food production and livelihoods of people. The need for pursuing irrigation development and management has become more important in the country in the face of rapid population growth and increasing food prices in the world market. In this context, managing irrigation schemes for productivity increase is becoming increasingly important and different irrigation management models have also emerged through attempts made in this direction by countries including Sri Lanka, where irrigation plays a leading role in food production and nation development. Farmers’ active involvement in irrigation management, especially operation and maintenance (O&M) and decision-making as well, has been identified as a key requirement to attain productivity goals and the sustainability of irrigation systems. This paper aims at reviewing participatory irrigation management approaches adopted in medium and major irrigation systems in Sri Lanka with a view to identifying their past and present trends and future directions. The review will contribute to an improved understanding by policymakers, managers of irrigation schemes and farmers of the role of participatory irrigation management, its past and present including institutional structures, responsibilities and performance and the directions it should take to meet future challenges as a dynamic institutional mechanism. As all the medium and major irrigation schemes in the country are jointly managed by farmers and government agencies, the inferences drawn from the review would be important for the agencies and farmers alike to introduce necessary changes in their programs to address future needs and requirements.Length: pp.35-63Participatory managementIrrigation managementFarmers organizationsIndicatorsHistoryIrrigation schemes

Developing effective institutions for water resources management: A case study in the Deduru Oya Basin, Sri Lanka

River basins / Water resource management / Water lifting / Wells / Domestic water / Population / Economic aspects / Income / Irrigation programs / Institutions / Policy / Groundwater / Agricultural development / Fish farming / Pumps / Ecology / Water supply / Drought / Poverty / Land use / Water scarcity / Natural resources / Agricultural production / Cropping systems

Cost-Effectiveness of LDL-C Lowering With Evolocumab in Patients With High Cardiovascular Risk in the United States

Randomized trials have shown marked reductions in low-density lipoprotein cholesterol (LDL-C), a risk factor for cardiovascular disease (CVD), when evolocumab is administered. We hypothesized that evolocumab added to standard of care (SOC) vs SOC alone is cost-effective in the treatment of patients with heterozygous familial hypercholesterolemia (HeFH) or atherosclerotic CVD (ASCVD) with or without statin intolerance and LDL-C >100 mg/dL. Using a Markov cohort state transition model, primary and recurrent CVD event rates were predicted considering population-specific trial-based mean risk factors and calibrated against observed rates in the real world. The LDL-C–lowering effect from population-specific phase 3 randomized studies for evolocumab was used together with estimated LDL-C–lowering effect on CVD event rates per 38.67-mg/dL LDL-C lowering from a statin-trial meta-analysis. Costs and utilities were included from published sources. Evolocumab treatment was associated with both increased cost and improved quality-adjusted life-years (QALY): HeFH (incremental cost: US$153 289, incremental QALY: 2.02, incremental cost-effectiveness ratio: US$75 863/QALY); ASCVD (US$158 307, 1.12, US$141 699/QALY); and ASCVD with statin intolerance (US$136 903, 1.36, US$100 309/QALY). Evolocumab met both the American College of Cardiology/American Heart Association (ACC/AHA) and World Health Organization (WHO) thresholds in each population evaluated. Sensitivity and scenario analyses confirmed that model results were robust to changes in model parameters. Among patients with HeFH and ASCVD with or without statin intolerance, evolocumab added to SOC may provide a cost-effective treatment option for lowering LDL-C using ACC/AHA intermediate/high value and WHO cost-effectiveness thresholds. More definitive information on the clinical and economic value of evolocumab will be available from the forthcoming CVD outcomes study

Cost-effectiveness of Evolocumab therapy for reducing cardiovascular events in patients with atherosclerotic cardiovascular disease

Importance: The proprotein convertase subtilisin/kexin type 9 inhibitor evolocumab has been demonstrated to reduce the composite of myocardial infarction, stroke, or cardiovascular death in patients with established atherosclerotic cardiovascular disease. To our knowledge, long-term cost-effectiveness of this therapy has not been evaluated using clinical trial efficacy data. Objective: To evaluate the cost-effectiveness of evolocumab in patients with atherosclerotic cardiovascular disease when added to standard background therapy. Design, Setting, and Participants: A Markov cohort state-transition model was used, integrating US population-specific demographics, risk factors, background therapy, and event rates along with trial-based event risk reduction. Costs, including price of drug, utilities, and transitional probabilities, were included from published sources. Exposures: Addition of evolocumab to standard background therapy including statins. Main Outcomes and Measures: Cardiovascular events including myocardial infarction, ischemic stroke and cardiovascular death, quality-adjusted life-year (QALY), incremental cost-effectiveness ratio (ICER), and net value-based price. Results: In the base case, using US clinical practice patients with atherosclerotic cardiovascular disease with low-density lipoprotein cholesterol levels of at least 70 mg/dL (to convert to millimoles per liter, multiply by 0.0259) and an annual events rate of 6.4 per 100 patient-years, evolocumab was associated with increased cost and improved QALY: incremental cost, $105 398; incremental QALY, 0.39, with an ICER of$268 637 per QALY gained ($165 689 with discounted price of$10 311 based on mean rebate of 29% for branded pharmaceuticals). Sensitivity and scenario analyses demonstrated ICERs ranging from $100 193 to$488 642 per QALY, with ICER of $413 579 per QALY for trial patient characteristics and event rate of 4.2 per 100 patient-years ($270 192 with discounted price of $10 311) and$483 800 if no cardiovascular mortality reduction emerges. Evolocumab treatment exceeded $150 000 per QALY in most scenarios but would meet this threshold at an annual net price of$9669 ($6780 for the trial participants) or with the discounted net price of$10 311 in patients with low-density lipoprotein cholesterol levels of at least 80 mg/dL. Conclusions and Relevance: At its current list price of $14 523, the addition of evolocumab to standard background therapy in patients with atherosclerotic cardiovascular disease exceeds generally accepted cost-effectiveness thresholds. To achieve an ICER of$150 000 per QALY, the annual net price would need to be substantially lower ($9669 for US clinical practice and$6780 for trial participants), or a higher-risk population would need to be treated

Climate change and agricultural adaptation in Sri Lanka: a review

Climate change is inevitable and will continue into the next century. Since the agricultural sector in Sri Lanka is one of the most vulnerable to climate change, a thorough understanding of climate transition is critical for formulating effective adaptation strategies. This paper provides an overview of the status of climate change and adaptation in the agricultural sector in Sri Lanka. The review clearly indicates that climate change is taking place in Sri Lanka in terms of rainfall variability and an increase in climate extremes and warming. A number of planned and reactive adaptation responses stemming from policy and farm-level decisions are reported. These adaptation efforts were fragmented and lacked a coherent connection to the national development policies and strategies. Research efforts are needed to develop and identify adaptation approaches and practices that are feasible for smallholder farmers, particularly in the dry zone where paddy and other food crops are predominately cultivated. To achieve the envisaged growth in the agricultural sector, rigorous efforts are necessary to mainstream climate change adaptation into national development policies and ensure that they are implemented at national, regional and local levels

Water resources management in a river basin: Institutional gaps and implications - Case study of Deduru Oya River Basin, Sri Lanka

River basins, Water management, Irrigated farming, Institutions, Organizational change, Legislation, Case studies, Sri Lanka

Managing irrigation jointly with farmers: history, present status and future: review of participatory irrigation management in Sri Lanka

Agriculture development has been the main strategy for the socioeconomic development in the country since time immemorial, even though its contribution to GDP has been declining recently. Successive governments of Sri Lanka since independence have invested heavily in the irrigated agriculture sector to address the food security concerns of the country. The continuous investment in irrigation was required to address problems such as spatial and temporal variations in monsoonal rainfall in the country, which has a serious negative impact on food production and livelihoods of people. The need for pursuing irrigation development and management has become more important in the country in the face of rapid population growth and increasing food prices in the world market. In this context, managing irrigation schemes for productivity increase is becoming increasingly important and different irrigation management models have also emerged through attempts made in this direction by countries including Sri Lanka, where irrigation plays a leading role in food production and nation development. Farmers’ active involvement in irrigation management, especially operation and maintenance (O&M) and decision-making as well, has been identified as a key requirement to attain productivity goals and the sustainability of irrigation systems. This paper aims at reviewing participatory irrigation management approaches adopted in medium and major irrigation systems in Sri Lanka with a view to identifying their past and present trends and future directions. The review will contribute to an improved understanding by policymakers, managers of irrigation schemes and farmers of the role of participatory irrigation management, its past and present including institutional structures, responsibilities and performance and the directions it should take to meet future challenges as a dynamic institutional mechanism. As all the medium and major irrigation schemes in the country are jointly managed by farmers and government agencies, the inferences drawn from the review would be important for the agencies and farmers alike to introduce necessary changes in their programs to address future needs and requirements