Understanding conditions for sustainable supply chain development

As the world enters an era of rapidly growing demand for food, declining resource availability and rising volatility, leaders in global food processing have recognized the need for more sustainable food production and are beginning to implement strategies for improved environmental, social and economic performance in their supply chains. With significant growth occurring in emerging markets like China, multinational food processors must consider the context of the market and the impact this has on the viability of their sustainable supply chain management (SSCM) strategies. Addressing a shortage of related literature, this study aims to understand the conditions for sustainable supply chain development in China’s food processing sector and factors that companies pursuing this strategy must consider. An exploratory case study of two multinational food processors based in China and serving the domestic market, investigates progress made in implementing SSCM strategies, with a focus on the upstream and agricultural producers. Use of Transaction Cost Economics (TCE) and the Sustainable Purchasing Portfolio (SPP) model highlight differences in asset specificity and supply risk that contribute to understanding observed variations, despite the firms having similar stakeholders, common threats to triple bottom line sustainability and proven track records for SSCM in their home countries. Findings suggest that current conditions in China’s food sector may not support widespread adoption of SSCM strategies. While undergoing remarkable change, the industry is still characterized by a high degree of fragmentation and low levels of development. Intense competition, a lack of traceability infrastructure and the need for more reliable enforcement of regulations has spurred opportunistic behaviour that threatens basic food quality and safety. Stakeholders concerned with these issues and the affordability of food for consumers spending more than a third of their income on food, have low expectations for triple bottom line (TBL) sustainability. As such, the high cost of pursuing SSCM represents a significant risk to the economic sustainability of commodity food processors. However in contrast, processors of specialized inputs that require high levels of coordination to achieve quality standards face less risk in pursuing SSCM. Furthermore, the process and the relationships fostered may support reduction of supply risk stemming from market volatility and the short-term investment focus of many agricultural producers. Future study of a wider range of MNC food processors are necessary to test the findings from in this study. Including MNCs processing for export markets or Chinese-owned MNCs may produce new insights into the application of the SPP, and facilitate a more detailed stakeholder analysis that considers differences in expectations of overseas stakeholders or those in different segments of China’s domestic market. Lastly, as findings suggest the importance of supply chain relationships, a closer investigation of the entire chain using Vurro et al.’s (2009) network view of SSCM may also provide understanding of interactions with and the impact of retail and food service sustainability strategies

Economic Evaluation of a Personalized Nutrition Plan Based on Omic Sciences Versus a General Nutrition Plan in Adults with Overweight and Obesity:A Modeling Study Based on Trial Data in Denmark

Background: Since there is no diet that is perfect for everyone, personalized nutrition approaches are gaining popularity to achieve goals such as the prevention of obesity-related diseases. However, appropriate choices about funding and encouraging personalized nutrition approaches should be based on sufficient evidence of their effectiveness and cost-effectiveness. In this study, we assessed whether a newly developed personalized plan (PP) could be cost-effective relative to a non-personalized plan in Denmark. Methods: Results of a 10-week randomized controlled trial were combined with a validated obesity economic model to estimate lifetime cost-effectiveness. In the trial, the intervention group (PP) received personalized home-delivered meals based on metabolic biomarkers and personalized behavioral change messages. In the control group these meals and messages were not personalized. Effects were measured in body mass index (BMI) and quality of life (EQ-5D-5L). Costs [euros (€), 2020] were considered from a societal perspective. Lifetime cost-effectiveness was assessed using a multi-state Markov model. Univariate, probabilistic sensitivity, and scenario analyses were performed. Results: In the trial, no significant differences were found in the effectiveness of PP compared with control, but wide confidence intervals (CIs) were seen [e.g., BMI (−0.07, 95% CI −0.51, 0.38)]. Lifetime estimates showed that PP increased costs (€520,102 versus €518,366, difference: €1736) and quality-adjusted life years (QALYs) (15.117 versus 15.106, difference: 0.011); the incremental cost-utility ratio (ICUR) was therefore high (€158,798 to gain one QALY). However, a 20% decrease in intervention costs would reduce the ICUR (€23,668 per QALY gained) below an unofficial gross domestic product (GDP)-based willingness-to-pay threshold (€47,817 per QALY gained). Conclusion: On the basis of the willingness-to-pay threshold and the non-significant differences in short-term effectiveness, PP may not be cost-effective. However, scaling up the intervention would reduce the intervention costs. Future studies should be larger and/or longer to reduce uncertainty about short-term effectiveness. Trial Registration Number: ClinicalTrials.gov registry (NCT04590989).</p

The Drug Reimbursement Decision-Making System in Iran

Background: &nbsp;Previous studies of health policies in Iran have not focused exclusively on the drug reimbursement process. Objective: The aim of this study was to describe the entire drug reimbursement process and the stakeholders, and discuss issues faced by policymakers. Methods: Review of documents describing the administrative rules and directives of stakeholders, supplemented by published statistics and interviews with experts and policymakers. Results: Iran has a systematic process for the assessment, appraisal, and judgment of drug reimbursements. The two most important organizations in this process are the Food and Drug Organization, which considers clinical effectiveness, safety, and economic issues, and the Supreme Council of Health Insurance, which considers various criteria, including budget impact and cost-effectiveness. Ultimately, the Iranian Cabinet approves a drug and recommends its use to all health insurance organizations. Reimbursed drugs account for about 53.5% of all available drugs and 77.3% of drug expenditures. Despite its strengths, the system faces various issues, including conflicting stakeholder aims, lengthy decision-making duration, limited access to decision-making details, and rigidity in the assessment process. Conclusions: The Iranian drug reimbursement system uses decision-making criteria and a structured approach similar to those in other countries. Important shortcomings in the system include out-of-pocket contributions due to lengthy decision making, lack of transparency, and conflicting interests among stakeholders. Iranian policymakers should consider a number of ways to remedy these problems, such as case studies of individual drugs and closer examination of experiences in other countries

Health related quality of life in patients with type I diabetes mellitus:generic &amp; disease-specific measurement

Background & objectives: An ideal instrument for the assessment of health related quality of life (HRQOL) in patients with diabetes mellitus type I (T1DM) should incorporate the benefits of both generic and disease-specific instruments. The objective of this study was to investigate the responsiveness and the ability to provide information about diabetes-specific associations with HRQOL, of two generic instruments, in comparison with two diabetes-specific instruments, in patients with T1DM. Methods: In a Dutch cohort of 234 patients with T1DM we longitudinally assessed HRQOL using both generic and diabetes-specific instruments. We investigated the responsiveness, the associations with diabetes-specific variables and the Identification of specific patients by the Instruments used. Results: The generic RAND-36 was able to detect statistically significant and clinically relevant changes in HRQOL over time. Moreover, the RAND-36 was associated with (changes In) diabetes. specific variables. The generic and diabetes-specific Instruments partly Identified different patients with lowest HRQOL. Interpretation & conclusion: The RAND-36 was highly responsive to changes in HRQOL in patients with T1DM and revealed diabetes-specific associations with HRQOL. A low correlation between the generic and diabetes-specific instruments and partly different identification of patients with lower HRQOL support the complementary use of these instruments In patients with T1DM

Economic evaluation of a pharmacogenetic dosing algorithm for coumarin anticoagulants in The Netherlands

AIM: To investigate the cost-effectiveness of a pharmacogenetic dosing algorithm versus a clinical dosing algorithm for coumarin anticoagulants in The Netherlands. MATERIALS & METHODS: A decision-analytic Markov model was used to analyze the cost-effectiveness of pharmacogenetic dosing of phenprocoumon and acenocoumarol versus clinical dosing. RESULTS: Pharmacogenetic dosing increased costs by €33 and quality-adjusted life-years (QALYs) by 0.001. The incremental cost-effectiveness ratios were €28,349 and €24,427 per QALY gained for phenprocoumon and acenocoumarol, respectively. At a willingness-to-pay threshold of €20,000 per QALY, the pharmacogenetic dosing algorithm was not likely to be cost effective compared with the clinical dosing algorithm. CONCLUSION: Pharmacogenetic dosing improves health only slightly when compared with clinical dosing. However, availability of low-cost genotyping would make it a cost-effective option

Costs and Cost-Effectiveness of Hypertension Screening and Treatment in Adults with Hypertension in Rural Nigeria in the Context of a Health Insurance Program.

BACKGROUND: High blood pressure is a leading risk factor for death and disability in sub-Saharan Africa (SSA). We evaluated the costs and cost-effectiveness of hypertension care provided within the Kwara State Health Insurance (KSHI) program in rural Nigeria. METHODS: A Markov model was developed to assess the costs and cost-effectiveness of population-level hypertension screening and subsequent antihypertensive treatment for the population at-risk of cardiovascular disease (CVD) within the KSHI program. The primary outcome was the incremental cost per disability-adjusted life year (DALY) averted in the KSHI scenario compared to no access to hypertension care. We used setting-specific and empirically-collected data to inform the model. We defined two strategies to assess eligibility for antihypertensive treatment based on 1) presence of hypertension grade 1 and 10-year CVD risk of >20%, or grade 2 hypertension irrespective of 10-year CVD risk (hypertension and risk based strategy) and 2) presence of hypertension in combination with a CVD risk of >20% (risk based strategy). We generated 95% confidence intervals around the primary outcome through probabilistic sensitivity analysis. We conducted one-way sensitivity analyses across key model parameters and assessed the sensitivity of our results to the performance of the reference scenario. RESULTS: Screening and treatment for hypertension was potentially cost-effective but the results were sensitive to changes in underlying assumptions with a wide range of uncertainty. The incremental cost-effectiveness ratio for the first and second strategy respectively ranged from US$1,406 to US$ 7,815 and US$732 to US$ 2,959 per DALY averted, depending on the assumptions on risk reduction after treatment and compared to no access to antihypertensive treatment. CONCLUSIONS: Hypertension care within a subsidized private health insurance program may be cost-effective in rural Nigeria and public-private partnerships such as the KSHI program may provide opportunities to finance CVD prevention care in SSA

Blood pressure patterns in rural, semi-urban and urban children in the Ashanti region of Ghana, West Africa

BACKGROUND: High blood pressure, once rare, is rapidly becoming a major public health burden in sub-Saharan/Africa. It is unclear whether this is reflected in children. The main purpose of this study was to assess blood pressure patterns among rural, semi-urban, and urban children and to determine the association of blood pressure with locality and body mass index (BMI) in this sub-Saharan Africa setting. METHODS: We conducted a cross-sectional survey among school children aged 8–16 years in the Ashanti region of Ghana (West-Africa). There were 1277 children in the study (616 boys and 661 females). Of these 214 were from rural, 296 from semi-urban and 767 from urban settings. RESULTS: Blood pressure increased with increasing age in rural, semi-urban and urban areas, and in both boys and girls. The rural boys had a lower systolic and diastolic blood pressure than semi-urban boys (104.7/62.3 vs. 109.2/66.5; p < 0.001) and lower systolic blood pressure than urban boys (104.7 vs. 107.6; p < 0.01). Girls had a higher blood pressure than boys (109.1/66.7 vs. 107.5/63.8; p < 0.01). With the exception of a lower diastolic blood pressure amongst rural girls, no differences were found between rural girls (107.4/64.4) and semi-urban girls (108.0/66.1) and urban girls (109.8/67.5). In multiple linear regression analysis, locality and BMI were independently associated with blood pressure in both boys and girls. CONCLUSION: These findings underscore the urgent need for public health measures to prevent increasing blood pressure and its sequelae from becoming another public health burden. More work on blood pressure in children in sub-Saharan African and other developing countries is needed to prevent high blood pressure from becoming a major burden in many of these countries