Does responsibility affect the public valuation of health care interventions? A relative valuation approach to health care safety

This article is available open access through the publisher’s website at the link below. Copyright © 2012, International Society for Pharmacoeconomics and Outcomes Research (ISPOR).Objective - Health services often spend more on safety interventions than seems cost-effective. This study investigates whether the public value safety-related health care improvements more highly than the same improvements in contexts where the health care system is not responsible. Method - An online survey was conducted to elicit the relative importance placed on preventing harms caused by 1) health care (hospital-acquired infections, drug administration errors, injuries to health care staff), 2) individuals (personal lifestyle choices, sports-related injuries), and 3) nature (genetic disorders). Direct valuations were obtained from members of the public by using a person trade-off or “matching” method. Participants were asked to choose between two preventative interventions of equal cost and equal health benefit per person for the same number of people, but differing in causation. If participants indicated a preference, their strength of preference was measured by using person trade-off. Results - Responses were obtained from 1030 people, reflecting the sociodemographic mix of the UK population. Participants valued interventions preventing hospital-acquired infections (1.31) more highly than genetic disorders (1.0), although drug errors were valued similarly to genetic disorders (1.07), and interventions to prevent injury to health care staff were given less weight than genetic disorders (0.71). Less weight was also given to interventions related to lifestyle (0.65) and sports injuries (0.41). Conclusion - Our results suggest that people do not attach a simple fixed premium to “safety-related” interventions but that preferences depend more subtly on context. The use of the results of such public preference surveys to directly inform policy would therefore be premature.Brunel University

Bio-activities of Powders four plants against Prostephanus truncatus Horn. (Coleoptera: Bostrichidae) and Tribolium Castaneum Herbst (Coleoptera: Tenebrionidae)

The effect of the dry powders of the roots and leaves of Ocimum canum, Zanthoxylum xanthoxyloides, Moringa oleifera and Securidaca  longipedunculata on the survival of Prostephanus truncatus (Horn)  (Coleoptera: Bostrichidae) and Tribolium castaneum Herbst (Coleoptera:  Tenebrionidae) was determined in the laboratory. Generally, all the plant  materials exhibited various levels of bio efficacies, with Z. xanthoxyloides and S. longipedunculata exhibiting the highest potency. Percentage survivorship of 35% and 40% were recorded for the roots and leaves, respectively, of Z.  xanthoxyloides against T. casteeneum while 20% and 30% were recorded for roots and leaves of S. longipedunculata, respectively, against P.tuncatus

Economic evaluation of ASCOT-BPLA: Antihypertensive treatment with an amlodipine-based regimen is cost-effective compared to an atenolol-based regimen

Copyright © 2010 BMJ Publishing Group Ltd & British Cardiovascular Society. Internal or personal use of this material is permitted. However, permission to reprint/republish this material must be obtained from the Publisher.Objective: To compare the cost effectiveness of an amlodipine-based strategy and an atenolol-based strategy in the treatment of hypertension in the UK and Sweden. Design: A prospective, randomised trial complemented with a Markov model to assess long-term costs and health effects. Setting: Primary care. Patients: Patients with moderate hypertension and three or more additional risk factors. Interventions: Amlodipine 5–10 mg with perindopril 4–8 mg added as needed or atenolol 50–100 mg with bendroflumethiazide 1.25–2.5 mg and potassium added as needed Main outcome measures: Cost per cardiovascular event and procedure avoided, and cost per quality-adjusted life-year gained. Results: In the UK, the cost to avoid one cardiovascular event or procedure would be €18 965, and the cost to gain one quality-adjusted life-year would be €21 875. The corresponding figures for Sweden were €13 210 and €16 856. Conclusions: Compared with the thresholds applied by NICE and in the Swedish National Board of Health and Welfare’s Guidelines for Cardiac Care, an amlodipine-based regimen is cost effective for the treatment of hypertension compared with an atenolol-based regimen in the population studied.The study was supported by the principal funding source, Pfizer, New York, USA

Bill Buxton oral history interview by Andrew Huse, September 16, 2003

Bill Buxton, a former WUSF-TV station manager who came to the university as an administrator and filmmaker in 1969, discusses the development of the TV station and how facilities have changed and improved over time. Buxton worked with many university programs to create films and many of the projects he was involved with have won Emmys. Bill Buxton still works independently with the station program

On the biological and genetic diversity in Neospora caninum

Published: 22 March 2010Neospora caninum is a parasite regarded a major cause of foetal loss in cattle. A key requirement to an understanding of the epidemiology and pathogenicity of N. caninum is knowledge of the biological characteristics of the species and the genetic diversity within it. Due to the broad intermediate host range of the species, worldwide geographical distribution and its capacity for sexual reproduction, significant biological and genetic differences might be expected to exist. N. caninum has now been isolated from a variety of different host species including dogs and cattle. Although isolates of this parasite show only minor differences in ultrastructure, considerable differences have been reported in pathogenicity using mainly mouse models. At the DNA level, marked levels of polymorphism between isolates were detected in mini- and microsatellites found in the genome of N. caninum. Knowledge of what drives the biological differences that have been observed between the various isolates at the molecular level is crucial in aiding our understanding of the epidemiology of this parasite and, in turn, the development of efficacious strategies, such as live vaccines, for controlling its impact. The purpose of this review is to document and discuss for the first time, the nature of the diversity found within the species Neospora caninum.Sarwat E. Al-Qassab, Michael P. Reichel and John T. Elli

A review of health utilities using the EQ-5D in studies of cardiovascular disease

RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are.Abstract Background The EQ-5D has been extensively used to assess patient utility in trials of new treatments within the cardiovascular field. The aims of this study were to review evidence of the validity and reliability of the EQ-5D, and to summarise utility scores based on the use of the EQ-5D in clinical trials and in studies of patients with cardiovascular disease. Methods A structured literature search was conducted using keywords related to cardiovascular disease and EQ-5D. Original research studies of patients with cardiovascular disease that reported EQ-5D results and its measurement properties were included. Results Of 147 identified papers, 66 met the selection criteria, with 10 studies reporting evidence on validity or reliability and 60 reporting EQ-5D responses (VAS or self-classification). Mean EQ-5D index-based scores ranged from 0.24 (SD 0.39) to 0.90 (SD 0.16), while VAS scores ranged from 37 (SD 21) to 89 (no SD reported). Stratification of EQ-5D index scores by disease severity revealed that scores decreased from a mean of 0.78 (SD 0.18) to 0.51 (SD 0.21) for mild to severe disease in heart failure patients and from 0.80 (SD 0.05) to 0.45 (SD 0.22) for mild to severe disease in angina patients. Conclusions The published evidence generally supports the validity and reliability of the EQ-5D as an outcome measure within the cardiovascular area. This review provides utility estimates across a range of cardiovascular subgroups and treatments that may be useful for future modelling of utilities and QALYs in economic evaluations within the cardiovascular area.Published versio

Mapping of the EQ-5D index from clinical outcome measures and demographic variables in patients with coronary heart disease.

RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are.BACKGROUND: The EuroQoL 5D (EQ-5D) is a questionnaire that provides a measure of utility for cost-effectiveness analysis. The EQ-5D has been widely used in many patient groups, including those with coronary heart disease. Studies often require patients to complete many questionnaires and the EQ-5D may not be gathered. This study aimed to assess whether demographic and clinical outcome variables, including scores from a disease specific measure, the Seattle Angina Questionnaire (SAQ), could be used to predict, or map, the EQ-5D index value where it is not available. METHODS: Patient-level data from 5 studies of cardiac interventions were used. The data were split into two groups - approximately 60% of the data were used as an estimation dataset for building models, and 40% were used as a validation dataset. Forward ordinary least squares linear regression methods and measures of prediction error were used to build a model to map to the EQ-5D index. Age, sex, a proxy measure of disease stage, Canadian Cardiovascular Society (CCS) angina severity class, treadmill exercise time (ETT) and scales of the SAQ were examined. RESULTS: The exertional capacity (ECS), disease perception (DPS) and anginal frequency scales (AFS) of the SAQ were the strongest predictors of the EQ-5D index and gave the smallest root mean square errors. A final model was chosen with age, gender, disease stage and the ECS, DPS and AFS scales of the SAQ. ETT and CCS did not improve prediction in the presence of the SAQ scales. Bland-Altman agreement between predicted and observed EQ-5D index values was reasonable for values greater than 0.4, but below this level predicted values were higher than observed. The 95% limits of agreement were wide (-0.34, 0.33). CONCLUSIONS: Mapping of the EQ-5D index in cardiac patients from demographics and commonly measured cardiac outcome variables is possible; however, prediction for values of the EQ-5D index below 0.4 was not accurate. The newly designed 5-level version of the EQ-5D with its increased ability to discriminate health states may improve prediction of EQ-5D index values

Switchgrass Biomass Production in the Midwest USA: Harvest and Nitrogen Management

Information on optimal harvest periods and N fertilization rates for switchgrass (Panicum virgatum L.) grown as a biomass or bioenergy crop in the Midwest USA is limited. Our objectives were to determine optimum harvest periods and N rates for biomass production in the region. Established stands of \u27Cave-in-Rock\u27 switchgrass at Ames, IA, and Mead, NE, were fertilized 0, 60, 120, 180, 240, or 300 kg N ha-1. Harvest treatments were two- or one-cut treatments per year, with initial harvest starting in late June or early July (Harvest 1) and continuing at approximately 7-d intervals until the latter part of August (Harvest 7). A final eighth harvest was completed after a killing frost. Regrowth was harvested on previously harvested plots at that time. Soil samples were taken before fertilizer was applied in the spring of 1994 and again in the spring of 1996. Averaged over years, optimum biomass yields were obtained when switchgrass was harvested at the maturity stages R3 to R5 (panicle fully emerged from boot to postanthesis) and fertilized with 120 kg N ha-1. Biomass yields with these treatments averaged 10.5 to 11.2 Mg ha-1 at Mead and 11.6 to 12.6 Mg ha-1 at Ames. At this fertility level, the amount of N removed was approximately the same as the amount applied. At rates above this level, soil NO3-N concentrations increased

Anderson impurity in pseudo-gap Fermi systems

We use the numerical renormalization group method to study an Anderson impurity in a conduction band with the density of states varying as rho(omega) \propto |omega|^r with r>0. We find two different fixed points: a local-moment fixed point with the impurity effectively decoupled from the band and a strong-coupling fixed point with a partially screened impurity spin. The specific heat and the spin-susceptibility show powerlaw behaviour with different exponents in strong-coupling and local-moment regime. We also calculate the impurity spectral function which diverges (vanishes) with |omega|^{-r} (|\omega|^r) in the strong-coupling (local moment) regime.Comment: 8 pages, LaTeX, 4 figures includes as eps-file