The scope of costs in alcohol studies: Cost-of-illness studies differ from economic evaluations

<p>Abstract</p> <p>Background</p> <p>Alcohol abuse results in problems on various levels in society. In terms of health, alcohol abuse is not only an important risk factor for chronic disease, but it is also related to injuries. Social harms which can be related to drinking include interpersonal problems, work problems, violent and other crimes. The scope of societal costs related to alcohol abuse in principle should be the same for both economic evaluations and cost-of-illness studies. In general, economic evaluations report a small part of all societal costs. To determine the cost- effectiveness of an intervention it is necessary that all costs and benefits are included. The purpose of this study is to describe and quantify the difference in societal costs incorporated in economic evaluations and cost-of-illness studies on alcohol abuse.</p> <p>Method</p> <p>To investigate the economic costs attributable to alcohol in cost-of-illness studies we used the results of a recent systematic review (June 2009). We performed a PubMed search to identify economic evaluations on alcohol interventions. Only economic evaluations in which two or more interventions were compared from a societal perspective were included. The proportion of health care costs and the proportion of societal costs were estimated in both type of studies.</p> <p>Results</p> <p>The proportion of healthcare costs in cost-of-illness studies was 17% and the proportion of societal costs 83%. In economic evaluations, the proportion of healthcare costs was 57%, and the proportion of societal costs was 43%.</p> <p>Conclusions</p> <p>The costs included in economic evaluations performed from a societal perspective do not correspond with those included in cost-of-illness studies. Economic evaluations on alcohol abuse underreport true societal cost of alcohol abuse. When considering implementation of alcohol abuse interventions, policy makers should take into account that economic evaluations from the societal perspective might underestimate the total effects and costs of interventions.</p

Cost-effectiveness of counseling and pedometer use to increase physical activity in the Netherlands: a modeling study

Background: Counseling in combination with pedometer use has proven to be effective in increasing physical activity and improving health outcomes. We investigated the cost-effectiveness of this intervention targeted at one million insufficiently active adults who visit their general practitioner in the Netherlands.Methods: We used the RIVM chronic disease model to estimate the long-term effects of increased physical activity on the future health care costs and quality adjusted life years (QALY) gained, from a health care perspective.Results: The intervention resulted in almost 6000 people shifting to more favorable physical-activity levels, and in 5100 life years and 6100 QALYs gained, at an additional total cost of EUR 67.6 million. The incremental cost-effectiveness ratio (ICER) was EUR 13,200 per life year gained and EUR 11,100 per QALY gained. The intervention has a probability of 0.66 to be cost-effective if a QALY gained is valued at the Dutch informal threshold for cost-effectiveness of preventive intervention of EUR 20,000. A sensitivity analysis showed substantial uncertainty of ICER values.Conclusion: Counseling in combination with pedometer use aiming to increase physical activity may be a cost-effective intervention. However, the intervention only yields relatively small health benefits in the Netherlands

A comprehensive review on Gossypium hirsutum resistance against cotton leaf curl virus

Cotton (Gossypium hirsutum L.) is a significant fiber crop. Being a major contributor to the textile industry requires continuous care and attention. Cotton is subjected to various biotic and abiotic constraints. Among these, biotic factors including cotton leaf curl virus (CLCuV) are dominant. CLCuV is a notorious disease of cotton and is acquired, carried, and transmitted by the whitefly (Bemisia tabaci). A cotton plant affected with CLCuV may show a wide range of symptoms such as yellowing of leaves, thickening of veins, upward or downward curling, formation of enations, and stunted growth. Though there are many efforts to protect the crop from CLCuV, long-term results are not yet obtained as CLCuV strains are capable of mutating and overcoming plant resistance. However, systemic-induced resistance using a gene-based approach remained effective until new virulent strains of CLCuV (like Cotton Leaf Curl Burewala Virus and others) came into existence. Disease control by biological means and the development of CLCuV-resistant cotton varieties are in progress. In this review, we first discussed in detail the evolution of cotton and CLCuV strains, the transmission mechanism of CLCuV, the genetic architecture of CLCuV vectors, and the use of pathogen and nonpathogen-based approaches to control CLCuD. Next, we delineate the uses of cutting-edge technologies like genome editing (with a special focus on CRISPR-Cas), next-generation technologies, and their application in cotton genomics and speed breeding to develop CLCuD resistant cotton germplasm in a short time. Finally, we delve into the current obstacles related to cotton genome editing and explore forthcoming pathways for enhancing precision in genome editing through the utilization of advanced genome editing technologies. These endeavors aim to enhance cotton’s resilience against CLCuD

The cost-effectiveness of increasing alcohol taxes: a modelling study

<p>Abstract</p> <p>Background</p> <p>Excessive alcohol use increases risks of chronic diseases such as coronary heart disease and several types of cancer, with associated losses of quality of life and life-years. Alcohol taxes can be considered as a public health instrument as they are known to be able to decrease alcohol consumption. In this paper, we estimate the cost-effectiveness of an alcohol tax increase for the entire Dutch population from a health-care perspective focusing on health benefits and health-care costs in alcohol users.</p> <p>Methods</p> <p>The chronic disease model of the National Institute for Public Health and the Environment was used to extrapolate from decreased alcohol consumption due to tax increases to effects on health-care costs, life-years gained and quality-adjusted life-years gained, A Dutch scenario in which tax increases for beer are planned, and a Swedish scenario representing one of the highest alcohol taxes in Europe, were compared with current practice in the Netherlands. To estimate cost-effectiveness ratios, yearly differences in model outcomes between intervention and current practice scenarios were discounted and added over the time horizon of 100 years to find net present values for incremental life-years gained, quality-adjusted life-years gained, and health-care costs.</p> <p>Results</p> <p>In the Swedish scenario, many more quality-adjusted life-years were gained than in the Dutch scenario, but both scenarios had almost equal incremental cost-effectiveness ratios: €5100 per quality-adjusted life-year and €5300 per quality-adjusted life-year, respectively.</p> <p>Conclusion</p> <p>Focusing on health-care costs and health consequences for drinkers, an alcohol tax increase is a cost-effective policy instrument.</p

Cost-Effectiveness of an Opportunistic Screening Programme and Brief Intervention for Excessive Alcohol Use in Primary Care

Effective prevention of excessive alcohol use has the potential to reduce the public burden of disease considerably. We investigated the cost-effectiveness of Screening and Brief Intervention (SBI) for excessive alcohol use in primary care in the Netherlands, which is targeted at early detection and treatment of ‘at-risk’ drinkers.We compared a SBI scenario (opportunistic screening and brief intervention for ‘at-risk’ drinkers) in general practices with the current practice scenario (no SBI) in the Netherlands. We used the RIVM Chronic Disease Model (CDM) to extrapolate from decreased alcohol consumption to effects on health care costs and Quality Adjusted Life Years (QALYs) gained. Probabilistic sensitivity analysis was employed to study the effect of uncertainty in the model parameters. In total, 56,000 QALYs were gained at an additional cost of €298,000,000 due to providing alcohol SBI in the target population, resulting in a cost-effectiveness ratio of €5,400 per QALY gained.Prevention of excessive alcohol use by implementing SBI for excessive alcohol use in primary care settings appears to be cost-effective

Dynamic Modeling of an Optimal Hybrid Power System for a Captive Power Plant in Pakistan

This paper presents the optimized design, economic feasibility and dynamic modeling of a grid-tied captive hybrid renewable energy power plant for a Pakistani industrial area. Since the proposed plant, encompasses a photovoltaic (PV) array - as its main component - and for an efficient and reliable operation many issues - including industrial load variations and expected dynamics - should be investigated before its implementation. In this context, Homer Pro software is utilized in the design and economic optimized sizing of the PV array, and the PVWatts is used in land requirement analysis. The designed grid-tied plant is modeled in the MATLAB/Simulink using Simscape blocksets to investigate the plant’s dynamic behavior due to typical practical disturbances. The obtained results reveal that the plant has a low per-unit energy cost and provides significant savings. Results of dynamic simulation show that the plant can respond to the ramp-up and ramp-down load variations in industrial settings. Moreover, the plant has a fast response to step changes in irradiance; proving that the proposed plant is reliable and suitable candidate for fulfilling the designated load

Design of Hybrid Electrical Power System for an Industrial Unit in Pakistan

This paper is about the design of a solar power system for an industrial unit in Lahore Punjab, Pakistan. A hybrid power system is designed in HOMER after collecting the site data and load profile The land requisition analysis has been done using the PVWatt software. The average load of consume is found to be 2485.6 kW and the peak load is 3257.7 kW. After the simulation, the system architecture is such that 8382 kW, ENN Solar Energy 480EST solar module-based array is required in a grid tied operation. For converting the DC to AC, 3119 kW Eaton Power Xpert inverter is needed. Overall, the initial cost of designed system is found to be $3080100.00. The proposed system reduces the cost of energy to$ 0.1020 per kWh, which provides good savings along with a renewable energy system. Design details and system simulation results are included in the paper

Role of Rivaroxaban in Patients with Cerebral Venous Thrombosis

Objective:&nbsp;&nbsp;Cerebral venous thrombosis is a common neurological disease. It has been treated so far with Warfarin that needs continuous monitoring of PT (prothrombin time) and INR (International Normalization Ratio) with potential complications due to this problem. Newer oral anticoagulants have been recommended for other thromboembolic events like pulmonary embolism and can be a good alternative treatment of CVT. We determined the effectiveness of new oral anticoagulant Rivaroxaban in patients with cerebral venous thrombosis. Material and Methods:&nbsp;&nbsp;The study was conducted in the indoor department of Neurology, Punjab Institute of neurosciences for 1year. Magnetic cerebral venography (MRV) Brain was done at the start of Rivaroxaban, at 3 months and at 6 months where needed. The bias effect was removed by getting MRV done and reported from the same department. Results:&nbsp;&nbsp;A total of 18 patients were enrolled in the study. One patient was lost to followup. Mean age of our patient data was 28.66 ± 6.66. 16 (88%) patients were females and 2 (11%) were males. 9 patients (50%) had clinical and radiological recovery based on MRV brain at 3 months.7 patients (38%) had recovery based on clinical and radiological parameters at 6 months. Only 1 patient had partial recanalization but that also improved clinically. Conclusion:&nbsp;&nbsp;Rivaroxabancan is a very effective alternative for warfarin in cerebral venous sinus thrombosis which will avoid concerns commonly encountered with warfarin