Application of statistical and decision-analytic models for evidence synthesis for decision-making in public health and the healthcare sector

With the awareness that healthcare is a limited resource, decision-makers are challenged to allocate it rationally and efficiently. Health economic methods of evidence synthesis for decision-making are useful to quantify healthcare resource utilisation, critically evaluate different interventions and ensure the implementation of the most effective or cost-effective strategy. The nine studies included in the present cumulative doctoral thesis aim to demonstrate the capability of statistical and decision-analytic modelling techniques to inform and support rational healthcare decision-making in Germany. Five studies apply statistical modelling in analyses of public health and health economic data. They show that the developed models are valuable instruments for examining patterns in the data and generating knowledge from observable data which can further be used in devising disease management and care programs as well as economic evaluations. Further, two health economic evaluations, which adopt the decision-analytic-modelling approach, show that decision-analytic modelling is a powerful tool to represent the epidemiology of infectious and non-infectious diseases on a population level, quantify the burden of the diseases, generalise the outcomes of clinical trials, and predict how the interventions can change the impact of the diseases on the health of the population. Additionally, two literature reviews examine the application of decision-analytic modelling in health economic evaluations. The first study reviews and empirically analyses health technology assessments by the German Institute for Medical Documentation and Information and demonstrates that the application of decision-analytic models improves the evidence produced for policy-making in the healthcare sector in Germany. The second systematic review focuses on methodological choices made in constructing decision-analytic models and explains how critically the structural and parametrical assumptions can influence the final message of the economic evaluations and shows that building a validated, reliable model as well as the transparent reporting is of high priority in facilitating the communication and implementation of the most cost-effective course of action. Overall, the present thesis shows the relevance and advantage of the application of models in synthesising evidence for decision-making. The included studies contribute to the current and future development of the methods used to address the problems of health economic efficiency. Further advances in the computational modelling techniques and data collection, from one side, will ease the decision-making process, but, from another side, will require increasing competence and understanding within the decision-making bodies

Waterproofing of thermally insulating products based on caustic dolomite ПОВЫШЕНИЕ ВОДОСТОЙКОСТИ ТЕПЛОИЗОЛЯЦИОННЫХ ИЗДЕЛИЙ НА ОСНОВЕ КАУСТИЧЕСКОГО ДОЛОМИТА

The Constructional materials production based on magnesia cement, the waterproofing and the cold endurance of these materials is described. The composition and the hardening kinetics of magnesia cement is investigated.<br>Рассмотрены получение строительных материалов на основе магнезиальных вяжущих; повышение водо- и морозостойкости этих материалов. Исследованы состав и кинетика твердения магнезиальных вяжущих

Estimation of Health-State Utility Values and Factors Driving Health-Related Quality of Life in People Living with HIV and AIDS and Receiving cART in Germany: Baseline Analysis of a Cohort Study

HIV has become a chronic disease since widespread of combined antiretroviral therapy (cART). Understanding the influence of therapeutic and preventive interventions on health-related quality of life (HRQoL) of people living with HIV and AIDS (PLWHA) is important. Information about health state utilities and HRQoL in PLWHA after the introduction of cART is limited, especially in Germany. The study aims to estimate and describe health state utilities and HRQoL in PLWHA in Germany and explore the effects of patient characteristics, clinical and treatment factors. Utilities and HRQoL in PLWHA in Germany were measured with the generic EQ-5D-3L questionnaire. Health state utilities were calculated based on the EQ-5D descriptive system using the German EQ-5D-3L time trade-off (TTO) value set. HRQoL was calculated based on the EQ visual analogue scale (EQ-VAS). Extensive descriptive analyses were performed to represent utility values for different groups of the patients. Generalized linear models (GLMs) with beta-inflated distributions were used to determine patient characteristics and clinical factors that influence TTO utilities and VAS scores. 1056 PLWHA completed the EQ-5D-3L questionnaires at the beginning of the study. The mean TTO utility value is 0.912 (SD ± 0.154), and the mean VAS HRQoL is 84.32 (SD ± 18.55). “Anxiety/depression” and “pain/physical discomfort” are the most affected dimensions. A longer period of living with HIV, a lower CD4-cell count, having symptomatic HIV or AIDS and an increased number of changes in therapy are associated with decreased utilities and a lower probability of having HRQoL of perfect health. No significant effect of duration of regimen was found. Depression significantly decreases TTO utility values. Higher education, full-time employment and female gender are associated with higher utilities. The resulted EQ-VAS values for PLWHA in Germany are comparable with EQ-VAS estimates for the general population. The obtained estimates can be used as inputs for health economic evaluations of HIV-interventions. Addressing anxiety and depression may reduce the quality of life impairment in PLWHA. Impact of comorbidities needs further investigation. © 2021, The Author(s)

Специализация и концентрация инвестиций в основной капитал предприятий: информация из России

The purpose of this study was to assess the current levels of sectoral concentration and regional specialization of investments in Russia using Krugman’s Indexes of concentration and specialization. The study used data from the official statistical observation of activities of all Russian enterprises for the year 2014, representing 78 Russian regions and 14 types of economic activity. A calculated indices based sectoral and regional analysis of investments has enabled us to assess the achieved level of investment differentiation, to identify the most significant contributions to the sectoral concentration and regional specialization, as well as to perform a comparative analysis of investment flows. A high level of concentration was observed in hospitality, fishing and aquaculture sectors. The regional specialization is relatively small in Russia. These results could be of interest to entrepreneurs when choosing the type of sectors. The economic models developed in this study can be widely applied to monitor and diagnose the level of investment, as well as to transform the national policy in order to increase the return on fixed capital investment of enterprises. The methodological significance of this work consists in the development of tools describing the investment processes in Russia, as well as in the assessment of the current level of their territorial and sectoral differentiation.El propósito de este estudio fue evaluar los niveles actuales de concentración sectorial y la especialización regional de las inversiones en Rusia utilizando los índices de concentración y especialización de Krugman. El estudio utilizó datos de la observación estadística oficial de las actividades de todas las empresas rusas para el año 2014, que representan 78 regiones rusas y 14 tipos de actividad económica. Un análisis sectorial y regional de inversiones calculado a partir de índices nos ha permitido evaluar el nivel alcanzado de diferenciación de inversiones, identificar las contribuciones más significativas a la concentración sectorial y la especialización regional, así como realizar un análisis comparativo de los flujos de inversión. Se observó un alto nivel de concentración en los sectores de hostelería, pesca y acuicultura. La especialización regional es relativamente pequeña en Rusia. Estos resultados podrían ser de interés para los empresarios a la hora de elegir el tipo de sectores. Los modelos económicos desarrollados en este estudio pueden aplicarse ampliamente para monitorear y diagnosticar el nivel de inversión, así como para transformar la política nacional a fin de aumentar el rendimiento de la inversión de capital fijo de las empresas. La importancia metodológica de este trabajo consiste en el desarrollo de herramientas que describen los procesos de inversión en Rusia, así como en la evaluación del nivel actual de su diferenciación territorial y sectorial.Целью настоящего исследования явилась оценка современных уровней отраслевой концентрации и региональной специализации инвестиций в России с использованием индексов концентрации и специализации Кругмана. В исследовании использованы данные официального статистического наблюдения за деятельностью всех российских предприятий за 2014 год, представляющих 78 регионов России и 14 видов экономической деятельности. Рассчитанные на основе отраслевого и регионального анализа инвестиций показатели позволили оценить сложившийся уровень инвестиционной дифференциации, выявить наиболее значимые вклады в отраслевую концентрацию и региональную специализацию, а также провести сравнительный анализ инвестиционных потоков. Высокий уровень концентрации наблюдался в таких видах деятельности, как гостиницы и рестораны, а также рыболовство. Региональная специализация в России относительно невелика. Эти результаты могут быть интересны предпринимателям при выборе вида экономической деятельности. Разработанные в данном исследовании экономические модели могут найти широкое применение для мониторинга и диагностики уровня инвестиций, а также для трансформации&nbsp;национальной политики с целью повышения отдачи от инвестиций в основной капитал предприятий. Методологическая значимость данной работы заключается в разработке инструментария описания инвестиционных процессов в России, а также в оценке современного уровня их территориальной и отраслевой дифференциации

Population with an increased risk of severe COVID-19 in Germany.

Only a minority of people who test positive for COVID-19 develop a severe or critical form of the disease. Many of these have risk factors such as old age or pre-existing conditions and, therefore, are at the focus of protective measures. This article determines the number of people at risk in Germany and differentiates them according to age, sex, education, household type and federal state. The analyses presented here are based on data from the German Health Update (GEDA) 2019/2020-EHIS, which was carried out as a nationwide cross-sectional telephone-based survey between April 2019 and October 2020. The definition of being at increased risk of severe COVID-19 is primarily based on a respondent’s age and the presence of pre-existing conditions. Around 36.5 million people in Germany are at an increased risk of developing severe COVID-19. Of these, 21.6 million belong to the high-risk group. An above-average number of people at risk live alone. The prevalence of an increased risk is higher among middle-aged men than among women of the same age, and significantly higher among people with a low level of education than among people with a high level of education. The highest proportion of people with an increased risk live in Saarland and in the eastern German federal states. When fighting the pandemic, it is important to account for the fact that more than half of the population aged 15 or over is at increased risk of severe illness. Moreover, the regional differences in risk burden should be taken into account when planning interventions

The Role of decision-analytic modelling in German health technology assessments

BACKGROUND: Decision-analytic modelling (DAM) has become a widespread method in health technology assessments (HTA), but the extent to which modelling is used differs among international HTA institutions. In Germany, the use of DAM is optional within HTAs of the German Institute of Medical Documentation and Information (DIMDI). Our study examines the use of DAM in DIMDI HTA reports and its effect on the quality of information provided for health policies. METHODS: A review of all DIMDI HTA reports (from 1998 to September 2012) incorporating an economic assessment was performed. All included reports were divided into two groups: HTAs with DAM and HTAs without DAM. In both groups, reports were categorized according to the quality of information provided for healthcare decision making. RESULTS: Of the sample of 107 DIMDI HTA reports, 17 (15.9%) used DAM for economic assessment. In the group without DAM, conclusions were limited by the quality of economic information in 51.1% of the reports, whereas we did not find limited conclusions in the group with DAM. Furthermore, 24 reports without DAM (26.7%) stated that using DAM would likely improve the quality of information of the economic assessment. CONCLUSION: The use of DAM techniques can improve the quality of HTAs in Germany. When, after a systematic review of existing literature within a HTA, it is clear that DAM is likely to positively affect the quality of the economic assessment DAM should be used

Оценка инвестиций в основной капитал российских малых предприятий и микропредприятий в 2018 году

The purpose of this work is the assessment of the investments into fixed capital of small enterprises and microenterprises and influence on investment such factors as size categories, types of economic activity and territorial placement. The comparative analysis of small enterprises and microenterprises investments is based on relative indicators, which are calculated per enterprise and per worker. The research was conducted with the usage of the official statistical information obtained in the course of observation activity of the enterprises in 2018. Modeling of empirical data was based on functions of normal distribution. We defined the values investments in small enterprises and microenterprises which are located in 82 regions and related to two categories and sixteen types of activity. We revealed regularities of distribution of investments calculated per enterprise and per worker, and identified the regions with the lowest investments in small enterprises and microenterprises. New knowledge of the investment in the fixed capital in the Russian small enterprises and microenterprises was achieved. Proposed information and tools are applicable for justification of the investments can be used for the small enterprises and microenterprises development.El propósito de este trabajo es evaluar las inversiones en capital fijo de pequeñas empresas y microempresas e influir en la inversión, tales como categorías de tamaño, tipos de actividad económica y colocación territorial. El análisis comparativo de las inversiones de pequeñas empresas y microempresas se basa en indicadores relativos, que se calculan por empresa y por trabajador. La investigación se realizó con el uso de la información estadística oficial obtenida en el curso de la actividad de observación de las empresas en 2018. El modelado de datos empíricos se basó en funciones de distribución normal. Definimos las inversiones en valores en pequeñas empresas y microempresas que se ubican en 82 regiones y están relacionadas con dos categorías y dieciséis tipos de actividad. Revelamos las regularidades de la distribución de las inversiones calculadas por empresa y por trabajador, e identificamos las regiones con las inversiones más bajas en pequeñas empresas y microempresas. Se logró un nuevo conocimiento de la inversión en capital fijo en las pequeñas empresas y microempresas rusas. La información y las herramientas propuestas son aplicables para la justificación de las inversiones que se pueden utilizar para el desarrollo de pequeñas empresas y microempresas.Целью данной работы является оценка инвестиций в основной капитал малых предприятий и микропредприятий, а также влияния на инвестиции таких факторов, как размерные категории, виды экономической деятельности и территориальное размещение. Сравнительный анализ инвестиций малых предприятий и микропредприятий основан на относительных показателях, которые рассчитываются на одно предприятие и на одного работника. Исследование проводилось с использованием официальной статистической информации, полученной в ходе наблюдения за деятельностью предприятий в 2018 году. Моделирование эмпирических данных проводилось с использованием функций нормального распределения. Определены величины инвестиций в малые предприятия и микропредприятия, расположенные в 82 регионах и относящиеся к двум категориям и шестнадцати видам деятельности. Выявлены закономерности распределения инвестиций в расчете на предприятие и на одного работника, выявлены регионы с наименьшими инвестициями в малые предприятия и микропредприятия. Получены новые знания об инвестициях в основной&nbsp;капитал российских малых предприятий и микропредприятий. Предлагаемая информация и инструментарий применимы для обоснования инвестиций, могут быть использованы для развития малых предприятий и микропредприятий

Assessment of the Effects of Active Immunisation against Respiratory Syncytial Virus (RSV) using Decision-Analytic Models: A Systematic Review with a Focus on Vaccination Strategies, Modelling Methods and Input Data

Background: Several vaccine and antibody candidates are currently in development for the prevention of lower respiratory tract infections caused by the respiratory syncytial virus (RSV). Methods: We searched MEDLINE, Embase, and SCOPUS and included model-based evaluations of RSV vaccinations. Two reviewers performed the selection, data extraction, and quality evaluation with EVIDEM. Cost-effectiveness (CE) estimates were converted to $US purchasing power parity (PPP), year 2018 values. Potential economic and epidemiological outcomes were summarised for maternal, infant, children, and elderly vaccinations. The PROSPERO identifier is CRD42019122570. Results: In total, 22 model-based studies were reviewed. On average, a potential 27$US1766–5857 PPP 2018/disability-adjusted life-years (DALYs) for Global Alliance for Vaccines and Immunisation (Gavi)-eligible countries. For England, the maximum cost-effective price of maternal vaccination was estimated at $US81.5 PPP 2018. Infant vaccination was associated with higher CE ratios in low- and high-income settings. Vaccination of neonates born before the RSV season was the most cost effective in high-income settings. Higher values for vaccine effectiveness, duration of protection, and vaccine uptake increased the benefits. Due to indirect effects, the vaccination of school-age children and a cocooning strategy were effective alternatives to protect infants, and the vaccination of children aged < 5 years had a beneficial impact on the elderly. Conclusion: RSV vaccines with anticipated characteristics may reduce a sizeable proportion of the RSV burden. The results are subject to uncertainty because of the limited epidemiological and clinical data. Data on RSV incidence and hospitalisation risk for granular age strata should be prioritised to facilitate the evaluation of RSV interventions and decision making.Peer Reviewe

The Development of Musical Abilities of Senior Preschool Children in the Process of Musical and Theatrical Activity

The article defines the methods and techniques for the development of musical abilities of children of senior preschool age, recommended exercises, games, musical tales, song repertoire.В статье определены методы и приемы развития музыкальных способностей детей старшего дошкольного возраста, рекомендованы упражнения, игры, музыкальные сказки, песенный репертуар