A preliminary cost-effectiveness analysis of denitrifying bioreactors in the Lower Burdekin

A cost-effectiveness (CE) analysis was undertaken to assess the cost per kilogram of nitrate-nitrogen ($/kg N) removed by denitrifying bioreactor beds in a sugarcane production system in Queensland. The preliminary analysis evaluates the CE of a 34m3 bioreactor bed trialled on a sugarcane farm in the lower Burdekin delta district, conducted as part of the Bioreactors for GBR Project, funded through the Queensland Reef Water Quality Program. The aim of the project was to investigate the nitrate removal performance of bioreactor beds receiving run-off from sugarcane farms in the lower Burdekin. In addition, the CE of a hypothetical 100m3 bioreactor scenario is also explored. The project trialled and monitored three bioreactor beds in the lower Burdekin. Of the three trials, one produced a more comprehensive dataset compared to the others that had experienced significant blockages during the trial period. Data from this trial was therefore utilised in the CE analysis. High-frequency water quality monitoring was undertaken over 12 months (May 2019 - April 2020) with nitrate concentration, woodchip saturation and water flow analysed to enable calculation of the nitrogen removal rate (NRR)

Cost-Effectiveness Analysis Terapi Antibiotik Seftriakson Dan Sefotaksim Pada Pasien Tifoid Di RSUD Dr. M.M Dunda Limboto

Tifoid merupakan penyakit infeksi yang disebabkan oleh bakteri Salmonella typhi dan telah banyak menginfeksi masyarakat baik di perkotaan maupun pedesaan. Dengan adanya fenomena multidrug resistance Salmonella typhi maka pemilihan terapi antibiotik yang efektif pada tifoid menjadi faktor yang harus diperhatikan selain kendala biaya. Penelitian ini bertujuan untuk mengetahui efektivitas biaya pada terapi dua antibiotik yaitu seftriakson dan sefotaksim yang digunakan dalam pengobatan demam tifoid di RSUD DR. M.M Dunda Limboto. Penelitian ini dilakukan dengan menggunakan metode survei analitik dengan desain cross sectional. Penelitian ini menggunakan data sekunder pasien demam tifoid periode Januari-Desember 2014. Data yang diambil meliputi, data demografi, lama rawat inap, dan data keuangan pasien. Hasil penelitian menunjukkan bahwa kelompok terapi antibiotik seftriakson lebih cost effective yaitu dengan biaya Rp 3.650.091 dengan lama rawat inap 2,8 hari dibandingkan dengan kelompok terapi antibiotik sefotaksim dengan biaya lebih besar yaitu Rp 4.036.015 dengan lama rawat inap 3,7 hari

Using cost effectiveness analysis; a beginners guide

Objective ‐ This report seeks to describe the key elements of cost effectiveness analysis (CEA) and to demonstrate how such analysis may be used in the library environment. Methods ‐ The paper uses a step‐by‐step approach to walk the non‐economist reader through the basics of conducting a cost effectiveness study. It provides an outline of the key elements of CEA using examples from the library sector, and it presents a case study of a CEA in a hospital library. The case study compares two library services, mediated searching and information skills training, to illustrate the application of CEA and to highlight some of its limitations. Results ‐ CEA is a comparative analysis tool. Its key elements include a study question regarding a particular process or procedure that identifies both costs and effectiveness; a justification of the study’s perspective; evidence of effectiveness; comprehensive identification of all relevant costs, and appropriate measurement of costs and effectiveness. Conclusions ‐ CEA enables comparison of services or interventions regarding particular processes or procedures in terms of their costs, and it measures their effectiveness. The results can be used to aid decision‐making about service provision

Cost‐effectiveness analysis of computer‐based assessment

The need for more cost‐effective and pedagogically acceptable combinations of teaching and learning methods to sustain increasing student numbers means that the use of innovative methods, using technology, is accelerating. There is an expectation that economies of scale might provide greater cost‐effectiveness whilst also enhancing student learning. The difficulties and complexities of these expectations are considered in this paper, which explores the challenges faced by those wishing to evaluate the cost‐effectiveness of computer‐based assessment (CBA). The paper outlines the outcomes of a survey which attempted to gather information about the costs and benefits of CBA

A Bayesian approach to stochastic cost-effectiveness analysis

The aim of this paper is to discuss the use of Bayesian methods in cost-effectiveness analysis (CEA) and the common ground between Bayesian and traditional frequentist approaches. A further aim is to explore the use of the net benefit statistic and its advantages over the incremental cost-effectiveness ratio (ICER) statistic. In particular, the use of cost-effectiveness acceptability curves is examined as a device for presenting the implications of uncertainty in a CEA to decision makers. Although it is argued that the interpretation of such curves as the probability that an intervention is cost-effective given the data requires a Bayesian approach, this should generate no misgivings for the frequentist. Furthermore, cost-effectiveness acceptability curves estimated using the net benefit statistic are exactly equivalent to those estimated from an appropriate analysis of ICERs on the cost-effectiveness plane. The principles examined in this paper are illustrated by application to the cost-effectiveness of blood pressure control in the U.K. Prospective Diabetes Study (UKPDS 40). Due to a lack of good-quality prior information on the cost and effectiveness of blood pressure control in diabetes, a Bayesian analysis assuming an uninformative prior is argued to be most appropriate. This generates exactly the same cost-effectiveness results as a standard frequentist analysis

(Correcting) misdiagnoses of asthma: A cost effectiveness analysis

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: The prevalence of physician-diagnosed-asthma has risen over the past three decades and misdiagnosis of asthma is potentially common. Objective: to determine whether a secondary-screening-program to establish a correct diagnosis of asthma in those who report a physician diagnosis of asthma is cost effective.Method: Randomly selected physician-diagnosed-asthmatic subjects from 8 Canadian cities were studied with an extensive diagnostic algorithm to rule-in, or rule-out, a correct diagnosis of asthma. Subjects in whom the diagnosis of asthma was excluded were followed up for 6-months and data on asthma medications and heath care utilization was obtained. Economic analysis was performed to estimate the incremental lifetime costs associated with secondary screening of previously diagnosed asthmatic subjects. Analysis was from the perspective of the Canadian healthcare system and is reported in Canadian dollars.Results: Of 540 randomly selected patients with physician diagnosed asthma 150 (28%; 95%CI 19-37%) did not have asthma when objectively studied. 71% of these misdiagnosed patients were on some asthma medications. Incorporating the incremental cost of secondary-screening for the diagnosis of asthma, we found that the average cost savings per 100 individuals screened was $35,141 (95$4,588-$69,278).Conclusion: Cost savings primarily resulted from lifetime costs of medication use averted in those who had been misdiagnosed.This work was funded by the Canadian Institute of Health Research, Canada and the University Of Ottawa Division Of Respiratory Medicine

Delivering diabetes education through nurseled telecoaching : cost-effectiveness analysis

Background : People with diabetes have a high risk of developing micro-and macrovascular complications associated with diminished life expectancy and elevated treatment costs. Patient education programs can improve diabetes control in the short term, but their cost-effectiveness is uncertain. Our study aimed to analyze the lifelong cost-effectiveness of a nurse-led tele-coaching program compared to usual care in people with type 2 diabetes from the perspective of the Belgian healthcare system. Methods : The UKPDS Outcomes Model was populated with patient-level data from an 18-month randomized clinical trial in the Belgian primary care sector involving 574 participants; trial data were extrapolated to 40 years; Quality Adjusted Life Years (QALYs), treatment costs and Incremental Cost-Effectiveness Ratio (ICER) were calculated for the entire cohort and the subgroup with poor glycemic control at baseline ("elevated HbA1c subgroup") and the associated uncertainty was explored. Results : The cumulative mean QALY (95% CI) gain was 0.21 (0.13; 0.28) overall and 0.56 (0.43; 0.68) in elevated HbA1c subgroup; the respective incremental costs were (sic)1,147 (188; 2,107) and (sic)2,565 (654; 4,474) and the respective ICERs (sic)5,569 ((sic)677; (sic)15,679) and (sic)4,615 (1,207; 9,969) per QALY. In the scenario analysis, repeating the intervention for lifetime had the greatest impact on the cost-effectiveness and resulted in the mean ICERs of (sic) 13,034 in the entire cohort and (sic)7,858 in the elevated HbA1c subgroup. Conclusion : Taking into account reimbursement thresholds applied in West-European countries, nurseled telecoaching of people with type 2 diabetes may be considered highly cost-effective within the Belgian healthcare system

Pressure relieving support surfaces (PRESSURE) trial : cost effectiveness analysis

Objective To assess tire cost effectiveness of alternating pressure mattresses compared with alternating pressure overlays for the prevention of pressure ulcers in patients admitted to hospital. Design Cost effectiveness analysis carried out alongside the pressure relieving support surfaces (PRESSURE) trial; a multicentre UK based pragmatic randomised controlled trial. Setting 11 hospitals in six UK NHS trusts. Participants Intention to treat population comprising 1971 participants. Main outcome measures Kaplan Meier estimates of restricted mean time to development of pressure ulcers and total costs for treatment in hospital. Results Alternating pressure mattresses were associated with lower overall costs (283.6 pound per patient on average, 95% confidence interval -377.59 pound to. 976.79) pound mainly due to reduced length of stay in hospital, and greater benefits (a delay in time to ulceration of 10.64 days on average, - 24.40 to 3.09). The differences in health benefits and total costs for hospital stay between alternating pressure mattresses and alternating pressure overlays were not statistically significant; however, a cost effectiveness acceptability curve indicated that on average alternating pressure mattresses compared with alternating pressure overlays were associated with air 80% probability of being cost saving. Conclusion Alternating pressure mattresses for the prevention of pressure ulcers are more likely to be cost effective and are more acceptable to patients than alternating pressure overlays