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Bharadwaj P, Nicola L, Breau-Brunel M, Sensini F, Tanova-Yotova N, Atanasov P, Lobig F, Blankenburg M. Unlocking the Value: Quantifying the Return on Investment of Hospital Artificial Intelligence. J Am Coll Radiol 2024:S1546-1440(24)00292-8. [PMID: 38499053 DOI: 10.1016/j.jacr.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/23/2024] [Accepted: 02/28/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE A comprehensive return on investment (ROI) calculator was developed to evaluate the monetary and nonmonetary benefits of an artificial intelligence (AI)-powered radiology diagnostic imaging platform to inform decision makers interested in adopting AI. METHODS A calculator was constructed to calculate comparative costs, estimated revenues, and quantify the clinical value of using an AI platform compared with no use of AI in radiology workflows of a US hospital over a 5-year time horizon. Parameters were determined on the basis of expert interviews and a literature review. Scenario and deterministic sensitivity analyses were conducted to evaluate calculator drivers. RESULTS In the calculator, the introduction of an AI platform into the hospital radiology workflow resulted in labor time reductions and delivery of an ROI of 451% over a 5-year period. The ROI was increased to 791% when radiologist time savings were considered. Time savings for radiologists included more than 15 8-hour working days of waiting time, 78 days in triage time, 10 days in reading time, and 41 days in reporting time. Using the platform also provided revenue benefits for the hospital in bringing in patients for clinically beneficial follow-up scans, hospitalizations, and treatment procedures. Results were sensitive to the time horizon, health center setting, and number of scans performed. Among those, the most influential outcome was the number of additional necessary treatments performed because of AI identification of patients. CONCLUSIONS The authors demonstrate a substantial 5-year ROI of implementing an AI platform in a stroke management-accredited hospital. The ROI calculator may be useful for decision makers evaluating AI-powered radiology platforms.
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Affiliation(s)
| | - Lauren Nicola
- CEO/Partner, Triad Radiology Associates; Chair, Ultrasound Commission, ACR; Chair, Reimbursement Committee, ACR
| | | | | | | | - Petar Atanasov
- Principal Consultant, Amaris Consulting, London, United Kingdom
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Zanghelini F, Xydopoulos G, Fordham R, Rodgers G, Khanal S. Early economic evaluation of the digital gait analysis system for fall prevention-Preliminary analysis of the GaitSmart system. Aging Med (Milton) 2024; 7:74-83. [PMID: 38571670 PMCID: PMC10985772 DOI: 10.1002/agm2.12290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 04/05/2024] Open
Abstract
Objective To develop an early economics evaluation (EEE) to assess the cost-effectiveness of the GS in reducing the RoF and FoF. Methods A cost-effectiveness analysis (CEA) with a return on investment (RoI) estimation was performed. CEA used the most relevant parameters, such as increased gait speed and decreased FoF, to estimate the reduction in the RoF, the impact on health care resources used and financial implications for the National Health System in the United Kingdom. Outcomes were measured as incremental cost-effectiveness ratio per quality-adjusted life years (QALYs) gained based on the reduction of the RoF and FoF. Uncertainties around the main parameters used were evaluated by probabilistic sensitivity analysis. Results The CEA results showed that the GS is a dominant strategy over the standard of care to improve the movements of older persons who have suffered a fall or are afraid of falling (incremental QALYs based on FoF = 0.77 and QALYs based on RoF = 1.07, cost of FoF = -£4479.57 and cost of RoF = -£2901.79). By implementing the GS, the ROI results suggest that every pound invested in the GS could result in cost savings of £1.85/patient based on the RoF reduction and £11.16/patient based on the FoF reduction. The probability of being cost saving based on the number of iterations were 79.4 percent (based on FoF) and 100 percent (based on RoF). Conclusion The EEE supports the main hypothesis that the GS is an effective intervention to avoid falls and is potentially cost saving.
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Affiliation(s)
- Fernando Zanghelini
- Health Economics Consulting, Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Georgios Xydopoulos
- Health Economics Consulting, Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Richard Fordham
- Health Economics Consulting, Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | | | - Saval Khanal
- Health Economics Consulting, Norwich Medical SchoolUniversity of East AngliaNorwichUK
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Abstract
INTRODUCTION Powerful medical education (PME) involves the use of new technologies informed by the science of expertise that are embedded in laboratories and organizations that value evidence-based education and support innovation. This contrasts with traditional medical education that relies on a dated apprenticeship model that yields uneven results. PME involves an amalgam of features, conditions and assumptions, and contextual variables that comprise an approach to developing clinical competence grounded in education impact metrics including efficiency and cost-effectiveness. METHODS This article is a narrative review based on SANRA criteria and informed by realist review principles. The review addresses the PME model with an emphasis on mastery learning and deliberate practice principles drawn from the new science of expertise. Pub Med, Scopus, and Web of Science search terms include medical education, the science of expertise, mastery learning, translational outcomes, cost effectiveness, and return on investment. Literature coverage is comprehensive with selective citations. RESULTS PME is described as an integrated set of twelve features embedded in a group of seven conditions and assumptions and four context variables. PME is illustrated via case examples that demonstrate improved ventilator patient management learning outcomes compared to traditional clinical education and mastery learning of breaking bad news communication skills. Evidence also shows that PME of physicians and other health care providers can have translational, downstream effects on patient care practices, patient outcomes, and return on investment. Several translational health care quality improvements that derive from PME include reduced infections; better communication among physicians, patients, and families; exceptional birth outcomes; more effective patient education; and return on investment. CONCLUSIONS The article concludes with challenges to hospitals, health systems, and medical education organizations that are responsible for producing physicians who are expected to deliver safe, effective, and cost-conscious health care.
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Affiliation(s)
- William C McGaghie
- Departments of Medical Education and Preventive Medicine and Northwestern Simulation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey H Barsuk
- Departments of Medicine and Medical Education and Northwestern Simulation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Diane B Wayne
- Departments of Medicine and Medical Education and Northwestern Simulation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - S Barry Issenberg
- Departments of Medicine and Medical Education and the Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
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Kollipara A, Moonasar D, Balawanth R, Silal SP, Yuen A, Fox K, Njau J, Pillay YG, Blecher M. Mobilizing resources with an investment case to mitigate cross-border malaria transmission and achieve malaria elimination in South Africa. Glob Health Action 2023; 16:2205700. [PMID: 37158217 PMCID: PMC10171117 DOI: 10.1080/16549716.2023.2205700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
South Africa's effort to eliminate malaria is significantly challenged by a large number of imported malaria cases, especially from neighbouring Mozambique. The country has a funding gap to achieve its malaria elimination goals (prior to 2019) and is ineligible to receive a national allocation from the Global Fund. The findings of an IC were utilised to successfully mobilise resources for malaria elimination in South Africa in 2018. A five-step resource mobilisation strategy was implemented to highlight financing challenges and leverage the economic evidence from an IC for malaria elimination in South Africa. South Africa's malaria programme implements control and elimination activities in three malaria-endemic provinces (KwaZulu Natal, Limpopo, and Mpumalanga). Driven by the IC findings, the South African government took an unprecedented step and increased total domestic malaria financing by approximately 36%, from the 2018/19 to the 2019/20 financial years through the creation of a new conditional grant for malaria. The IC findings predicted that malaria control in southern Mozambique is a prerequisite to eliminate malaria in South Africa. Based on this, the South African government also allocated funding towards a co-financing mechanism to support malaria control efforts in southern Mozambique. The IC findings assisted the South African National Department of Health to make a convincing case to key government decision-makers to invest in national malaria elimination and maximise economic returns in the long run. The South African government is the first in Southern Africa to mobilise a significant increase in domestic malaria financing to address the financial sustainability of both national and regional malaria elimination efforts. Continued surveillance activities will be required to prevent the re-establishment of malaria transmission even after malaria elimination is achieved in South Africa. Information sharing and close collaboration with provincial and national government officials were key to the successful outcome.
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Affiliation(s)
- Aparna Kollipara
- San Francisco Global Health Group, Malaria Elimination Initiative at the University of California, San Francisco, CA, USA
| | - Devanand Moonasar
- National Department of Health, Malaria Vector and Zoonotic Disease Directorate, Pretoria, South Africa
- School of Public Health and Health Systems, University of Pretoria, Pretoria, South Africa
| | - Ryleen Balawanth
- South Africa Regional Office, Clinton Health Access Initiative, Inc. (CHAI), Pretoria, South Africa
| | - Sheetal P Silal
- Modelling and Simulation Hub, Africa (MASHA), Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Anthony Yuen
- South Africa Regional Office, Clinton Health Access Initiative, Inc. (CHAI), Pretoria, South Africa
| | - Katie Fox
- San Francisco Global Health Group, Malaria Elimination Initiative at the University of California, San Francisco, CA, USA
| | - Joseph Njau
- JoDon Consulting Group, Health Economist, Lilburn, GA, USA
| | - Yogan G Pillay
- National Department of Health, Malaria Vector and Zoonotic Disease Directorate, Pretoria, South Africa
- Affiliate Center for Innovation in Global Health, Georgetown University, Washington, DC, USA
| | - Mark Blecher
- Public Finance Division, National Treasury, Pretoria, South Africa
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Kuo M, Dettweiler U, Faber Taylor A, Jordan C, Wells NM. Editorial: Nature-based learning and development: maximizing the returns on investment, volume II. Front Psychol 2023; 14:1304644. [PMID: 37908821 PMCID: PMC10614632 DOI: 10.3389/fpsyg.2023.1304644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/05/2023] [Indexed: 11/02/2023] Open
Affiliation(s)
- Ming Kuo
- Landscape and Human Health Laboratory, Department of Natural Resources and Environmental Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Ulrich Dettweiler
- Department of Cultural Studies and Languages, Faculty of Arts and Education, University of Stavanger, Stavanger, Norway
| | - Andrea Faber Taylor
- Department of Crop Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Catherine Jordan
- Department of Pediatrics, University of Minnesota, Saint Paul, MN, United States
- Children and Nature Network, University of Minnesota, Minneapolis, MN, United States
| | - Nancy M. Wells
- Department of Design and Environmental Analysis, Cornell University, Ithaca, NY, United States
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Blanch S, Frazer A. Understanding Post-occupancy Evaluation Processes for Public Healthcare Facilities in Australia and Aotearoa New Zealand. HERD 2023; 16:69-81. [PMID: 37170529 DOI: 10.1177/19375867231171706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The following research paper seeks to explore how post-occupancy evaluations (POEs) are undertaken in the nine health jurisdictions across Australia and Aotearoa New Zealand and investigate if the process can be strengthened to better inform healthcare design and investment. BACKGROUND Healthcare expenditure in both nations is increasing, and the rigorous evaluation of healthcare facilities can provide evidence to improve their return on investment. A POE is a research method used to undertake this analysis, usually 12 months after a facility has been occupied. There is limited information available about how POEs are undertaken in each jurisdiction, and there has never been research conducted to understand these processes across the region. METHODS Focus groups were conducted with participants from the government health organization in each jurisdiction to collect qualitative data regarding various aspects of POE processes and barriers to undertaking POEs. RESULTS Only five of the nine jurisdictions undertake POEs on healthcare facilities (with varied frequencies), and there is no standardized framework in use. However, every jurisdiction does undertake a "benefits realization" process. There is limited involvement of external consultants in POEs or benefits realization processes. POE benchmarks should be established at project commencement, and POE results should then inform future projects. Top-down support is required for POEs to occur. CONCLUSIONS The primary conclusion is that strengthening any evaluation process requires a nuanced approach in each jurisdiction to account for their unique context and challenges. Regular rigorous evaluations are required to feed results into the Australasian Health Facility Guidelines and encourage innovative facility design.
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Ohneck MC, Dake JA, Maughan ED, Telljohann SK, Glassman T. A Cost-Benefit Analysis of School Nursing in One Large Urban School District. J Sch Nurs 2023:10598405231197836. [PMID: 37661668 DOI: 10.1177/10598405231197836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
This study is a cost-benefit analysis examining an urban district's partial school nurse coverage conversion to full-time coverage. Through a partnership with a health care system, the district received funding, resulting in the hiring of full-time nurses to cover all K-8 elementary schools. Researchers compared the cost of nursing services to the savings in teacher, secretary, principal, and parent productivity, reduced medical procedure costs, and grants nurses managed. The year before implementing additional nurses, the return on investment (ROI) to the community for nursing services was calculated to be $1.59 for every dollar invested in schools with full-time coverage and $1.29 for schools with partial coverage. After implementing full-time nurses in each school, there was an ROI of $1.50 during the 2015-2016 school year, $1.64 for 2016-2017, and $1.67 for 2017-2018. The analysis provides evidence that full-time coverage could result in a positive ROI for schools and the community.
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Affiliation(s)
- Mallory C Ohneck
- School of Population Health, College of Health and Human Services, University of Toledo, Toledo, OH, USA
| | - Joseph A Dake
- School of Population Health, College of Health and Human Services, University of Toledo, Toledo, OH, USA
| | - Erin D Maughan
- School of Nursing, College of Public Health, George Mason University, Fairfax, VA, USA
| | - Susan K Telljohann
- School of Population Health, College of Health and Human Services, University of Toledo, Toledo, OH, USA
| | - Tavis Glassman
- School of Population Health, College of Health and Human Services, University of Toledo, Toledo, OH, USA
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Yoo BK, Iwamoto R, Chung U, Sasaki T, Kitajima M. Economic Evaluation of Wastewater Surveillance Combined with Clinical COVID-19 Screening Tests, Japan. Emerg Infect Dis 2023; 29:1608-1617. [PMID: 37486197 PMCID: PMC10370838 DOI: 10.3201/eid2908.221775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
The COVID-19 pandemic has imposed substantial burdens on the global society. To find an optimal combination of wastewater surveillance and clinical testing for tracking COVID-19, we evaluated the economic efficiency of hypothetical screening options at a single facility in Japan. To conduct cost-benefit analyses, we developed standard decision models in which we assumed model parameters from literature and primary data, such as screening policies used at the Tokyo Olympic and Paralympic Village in 2021. We compared hypothetical 2-step screening options that used clinical PCR to diagnose COVID-19 after a positive result from primary screening using antigen tests (option 1) or wastewater surveillance (option 2). Our simulation results indicated that option 2 likely would be economically more justifiable than option 1, particularly at lower incidence levels. Our findings could help justify and promote the use of wastewater surveillance as a primary screening at a facility level for COVID-19 and other infectious diseases.
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Chisholm D, Lee YY, Baral PP, Bhagwat S, Dombrovskiy V, Grafton D, Kontsevaya A, Huque R, Kalani Okware K, Kulikov A, Marahatta K, Mavunganidze P, Omar N, Prasai D, Putoud N, Tsoyi E, Vergara J. Cross-country analysis of national mental health investment case studies in sub-Saharan Africa and Central, South and South-East Asia. Front Health Serv 2023; 3:1214885. [PMID: 37533704 PMCID: PMC10392930 DOI: 10.3389/frhs.2023.1214885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/04/2023] [Indexed: 08/04/2023]
Abstract
Introduction Despite the increasing interest in and political commitment to mental health service development in many regions of the world, there remains a very low level of financial commitment and corresponding investment. Assessment of the projected costs and benefits of scaling up the delivery of effective mental health interventions can help to promote, inform and guide greater investment in public mental health. Methods A series of national mental health investment case studies were carried out (in Bangladesh, Kenya, Nepal, Philippines, Uganda, Uzbekistan and Zimbabwe), using standardized guidance developed by WHO and UNDP and implemented by a multi-disciplinary team. Intervention costs and the monetized value of improved health and production were computed in national currency units and, for comparison, US dollars. Benefit-cost ratios were derived. Findings Across seven countries, the economic burden of mental health conditions was estimated at between 0.5%-1.0% of Gross Domestic Product. Delivery of an evidence-based package of mental health interventions was estimated to cost US$ 0.40-2.40 per capita per year, depending on the country and its scale-up period. For most conditions and country contexts there was a return of >1 for each dollar or unit of local currency invested (range: 0.0-10.6 to 1) when productivity gains alone are included, and >2 (range: 0.4-30.3 to 1) when the intrinsic economic value of health is also considered. There was considerable variation in benefit-cost ratios between intervention areas, with population-based preventive measures and treatment of common mental, neurological and conditions showing the most attractive returns when all assessed benefits are taken into account. Discussion and Conclusion Performing a mental health investment case can provide national-level decision makers with new and contextualized information on the outlays and returns that can be expected from renewed local efforts to enhance access to quality mental health services. Economic evidence from seven low- and middle-income countries indicates that the economic burden of mental health conditions is high, the investment costs are low and the potential returns are substantial.
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Affiliation(s)
- Dan Chisholm
- Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva, Switzerland
| | - Yong Yi Lee
- Health Economics Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
- Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - Phanindra Prasad Baral
- Epidemiology and Disease Control Division, Ministry of Health and Population, Kathmandu, Nepal
| | | | | | | | - Anna Kontsevaya
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia
| | - Rumana Huque
- Department of Economics, University of Dhaka, Dhaka, Bangladesh
| | | | - Alexey Kulikov
- United Nations Inter-Agency Task Force on the Prevention and Control of NCDs, Geneva, Switzerland
| | | | | | - Nasri Omar
- Division of Mental Health, Ministry of Health, Nairobi, Kenya
| | - Devi Prasai
- Nepal Development Research Institute, Kathmandu, Nepal
| | - Nadia Putoud
- United Nations Inter-Agency Task Force on the Prevention and Control of NCDs, Geneva, Switzerland
| | - Elena Tsoyi
- Division of Country Health Programmes, WHO Regional Office for Europe, Copenhagen, Denmark
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Waye A, Thanh NX, Buckland T, Scott AN, Owen C, Stewart DA. Return on investment of the lymphoma diagnostic pathway implementation in Alberta, Canada. Leuk Lymphoma 2023; 64:1253-1261. [PMID: 37173288 DOI: 10.1080/10428194.2023.2209232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023]
Abstract
The Lymphoma Diagnostic Pathway (LDP) was developed based upon clinical best practice guidelines and implemented in large urban centers where lymphoma treatment is provided in Alberta, Canada. A return-on-investment analysis of the implementation of this care pathway was conducted to inform future sustainability and expansion. A cohort design with propensity score matching and difference-in-difference estimation methods were used comparing both cost and return (reduced health service utilization) between patients who were diagnosed within the LDP and those who were diagnosed outside the LDP. LDP resulted in $1800 avoided HSU costs per patient. The LDP has been found to be cost-saving with an ROI of 5.3 (ranging from 3.95-8.97) - for every $1 invested, LDP resulted in a $5.30 return for the health system due to capacity improvements in ED, inpatient, outpatient, and a reduction in GP service utilization. Further study of implementation including patient/provider satisfaction and uptake is recommended.
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Affiliation(s)
- Arianna Waye
- Innovation Evidence, and Impact, Alberta Health Services, Calgary, Alberta, Canada
| | - Nguyen X Thanh
- Strategic Clinical Networks, Alberta Health Services, Edmonton, Alberta, Canada
| | - Tim Buckland
- Cancer Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Allison N Scott
- Cancer Care Alberta, Alberta Health Services, Edmonton, Alberta, Canada
| | - Carolyn Owen
- Departments of Medicine and Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Douglas A Stewart
- Cancer Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Departments of Medicine and Oncology, University of Calgary, Calgary, Alberta, Canada
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Le LKD, Faller J, Chatterton ML, Perez JK, Chiotelis O, Tran HNQ, Sultana M, Hall N, Lee YY, Chapman C, Newton N, Slade T, Sunderland M, Teesson M, Mihalopoulos C. Interventions to prevent alcohol use: systematic review of economic evaluations. BJPsych Open 2023; 9:e117. [PMID: 37365798 DOI: 10.1192/bjo.2023.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Alcohol use is a leading risk factor for death and disability worldwide. AIMS We conducted a systematic review on the cost-effectiveness evidence for interventions to prevent alcohol use across the lifespan. METHOD Electronic databases (EMBASE, Medline, PsycINFO, CINAHL and EconLit) were searched for full economic evaluations and return-on-investment studies of alcohol prevention interventions published up to May 2021. The methods and results of included studies were evaluated with narrative synthesis, and study quality was assessed by the Drummond ten-point checklist. RESULTS A total of 69 studies met the inclusion criteria for a full economic evaluation or return-on-investment study. Most studies targeted adults or a combination of age groups, seven studies comprised children/adolescents and one involved older adults. Half of the studies found that alcohol prevention interventions are cost-saving (i.e. more effective and less costly than the comparator). This was especially true for universal prevention interventions designed to restrict exposure to alcohol through taxation or advertising bans; and selective/indicated prevention interventions, which involve screening with or without brief intervention for at-risk adults. School-based interventions combined with parent/carer interventions were cost-effective in preventing alcohol use among those aged under 18 years. No interventions were cost-effective for preventing alcohol use in older adults. CONCLUSIONS Alcohol prevention interventions show promising evidence of cost-effectiveness. Further economic analyses are needed to facilitate policy-making in low- and middle-income countries, and among child, adolescent and older adult populations.
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Affiliation(s)
- Long Khanh-Dao Le
- PhD, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Jan Faller
- MHE, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Mary Lou Chatterton
- PharmD, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Joahna Kevin Perez
- MHE, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Oxana Chiotelis
- MHE, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Australia
| | - Huong Ngoc Quynh Tran
- MHE, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Australia
| | - Marufa Sultana
- PhD, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Australia
| | - Natasha Hall
- MHE, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Australia
| | - Yong Yi Lee
- PhD, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia; School of Public Health, The University of Queensland, Australia; and Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Australia
| | - Cath Chapman
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Nicola Newton
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Tim Slade
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Matt Sunderland
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Maree Teesson
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Cathrine Mihalopoulos
- PhD, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
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Silas U, Blüher M, Bosworth Smith A, Saunders R. Fast In-House Next-Generation Sequencing in the Diagnosis of Metastatic Non-small Cell Lung Cancer: A Hospital Budget Impact Analysis. J Health Econ Outcomes Res 2023; 10:111-118. [PMID: 37389301 PMCID: PMC10306161 DOI: 10.36469/001c.77686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/01/2023] [Indexed: 07/01/2023]
Abstract
Background: Targeted therapy for cancer is becoming more frequent as the understanding of the molecular pathogenesis increases. Molecular testing must be done to use targeted therapy. Unfortunately, the testing turnaround time can delay the initiation of targeted therapy. Objective: To investigate the impact of a next-generation sequencing (NGS) machine in the hospital that would allow for in-house NGS testing of metastatic non-small cell lung cancer (mNSCLC) in a US setting. Methods: The differences between 2 hospital pathways were established with a cohort-level decision tree that feeds into a Markov model. A pathway that used in-house NGS (75%) and the use of external laboratories (so-called send-out NGS) (25%), was compared with the standard of exclusively send-out NGS. The model was from the perspective of a US hospital over a 5-year time horizon. All cost input data were in or inflated to 2021 USD. Scenario analysis was done on key variables. Results: In a hospital with 500 mNSCLC patients, the implementation of in-house NGS was estimated to increase the testing costs and the revenue of the hospital. The model predicted a $710 060 increase in testing costs, a $1 732 506 increase in revenue, and a $1 022 446 return on investment over 5 years. The payback period was 15 months with in-house NGS. The number of patients on targeted therapy increased by 3.38%, and the average turnaround time decreased by 10 days when in-house NGS was used. Discussion: Reducing testing turnaround time is a benefit of in-house NGS. It could contribute to fewer mNSCLC patients lost to second opinion and an increased number of patients on targeted therapy. The model outcomes predicted that, over a 5-year period, there would be a positive return on investment for a US hospital. The model reflects a proposed scenario. The heterogeneity of hospital inputs and the cost of send-out NGS means context-specific inputs are needed. Conclusion: Using in-house NGS testing could reduce the testing turnaround time and increase the number of patients on targeted therapy. Additional benefits for the hospital are that fewer patients will be lost to second opinion and that in-house NGS could generate additional revenue.
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Affiliation(s)
- Ubong Silas
- Coreva Scientific GmbH & Co. KG, Königswinter, Germany
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Lloyd NA, Keating LM, Friesen AJ, Cole DM, McPherson JM, Akçakaya HR, Moehrenschlager A. Prioritizing species conservation programs based on IUCN Green Status and estimates of cost-sharing potential. Conserv Biol 2023; 37:e14051. [PMID: 36661059 DOI: 10.1111/cobi.14051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 11/07/2022] [Accepted: 12/16/2022] [Indexed: 05/30/2023]
Abstract
Over 1 million species around the world are at risk of extinction, and conservation organizations have to decide where to invest their limited resources. Cost-effectiveness can be increased by leveraging funding opportunities and increasing collaborative partnerships to achieve shared conservation goals. We devised a structured decision-making framework to prioritize species' conservation programs based on a cost-benefit analysis that takes collaborative opportunities into account in an examination of national and global conservation return on investment. Conservation benefit is determined by modifying the novel International Union for the Conservation of Nature Green Status for Species to provide an efficient, high-level measure that is comparable among species, even with limited information and time constraints. We applied this prioritization approach to the Wilder Institute/Calgary Zoo, Canada, a nonprofit organization seeking to increase the number of species it assists with conservation translocations. We sought to identify and prioritize additional species' programs for which conservation translocation expertise and actions could make the most impact. Estimating the likelihood of cost-sharing potential enabled total program cost to be distinguished from costs specific to the organization. Comparing a benefit-to-cost ratio on different geographic scales allowed decision makers to weigh alternative options for investing in new species' programs in a transparent and effective manner. Our innovative analysis aligns with general conservation planning frameworks and can be adapted for any organization.
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Affiliation(s)
- Natasha A Lloyd
- Wilder Institute/Calgary Zoo, Calgary, Alberta, Canada
- IUCN Species Survival Commission Conservation Translocation Specialist Group, Calgary, Alberta, Canada
| | | | | | - Dylan M Cole
- Wilder Institute/Calgary Zoo, Calgary, Alberta, Canada
| | | | - H Resit Akçakaya
- Department of Ecology and Evolution, Stony Brook University, Stony Brook, New York, USA
- IUCN Species Survival Commission, Caracas, Venezuela
| | - Axel Moehrenschlager
- Wilder Institute/Calgary Zoo, Calgary, Alberta, Canada
- IUCN Species Survival Commission Conservation Translocation Specialist Group, Calgary, Alberta, Canada
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14
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Clifton DR, Nelson DA, Sammy Choi Y, Edgeworth D, Shell D, Deuster PA. Financial Impact of Embedded Injury-Prevention Experts in US Army Initial Entry Training. J Athl Train 2023; 58:511-518. [PMID: 36583956 PMCID: PMC10496456 DOI: 10.4085/1062-6050-0353.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CONTEXT The US Army embedded injury-prevention experts (IPEs), specifically athletic trainers and strength and conditioning coaches, into initial entry training (IET) to limit musculoskeletal (MSK) conditions and their negative consequences. However, little is known about the financial impact of IPEs. OBJECTIVE To assess whether IPEs were associated with fewer sunk training costs due to MSK-related early discharges from service. DESIGN Retrospective cohort study. SETTING Database of US Army soldiers' administrative, medical, and readiness records. PATIENTS OR OTHER PARTICIPANTS A total of 198 166 soldiers (age = 20.7 ± 3.2 years, body mass index = 24.4 ± 3.5 kg/m2) who began IET during 2014 to 2017. MAIN OUTCOME MEASURE(S) Early discharge from service was defined as occurring within 6 months of beginning IET. All IET sites employed IPEs from 2011 to 2017, except for 2 sites during April to November 2015. Soldiers who began IET at these 2 sites during these times were categorized as not having IPE exposure. All others were categorized as having IPE exposure. The unadjusted association between IPE access and MSK-related early discharge from service was assessed using logistic regression. Financial impact was assessed by quantifying differences in yearly sunk costs between groups with and those without IPE exposure and subtracting IPE hiring costs. RESULTS Among 14 094 soldiers without IPE exposure, 2.77% were discharged early for MSK-related reasons. Among 184 072 soldiers with IPE exposure, 1.01% were discharged. Exposure to IPEs was associated with reduced odds of MSK-related early discharge (odds ratio = 0.36, 95% CI = 0.32, 0.40, P < .001) and a decrease in yearly sunk training costs of $11.19 to $20.00 million. CONCLUSIONS Employing IPEs was associated with reduced sunk costs because of fewer soldiers being discharged from service early for MSK-related reasons. Evidence-based recommendations should be developed for guiding policy on the roles and responsibilities of IPEs in the military to reduce negative outcomes from MSK conditions and generate a positive return on investment.
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Affiliation(s)
- Daniel R. Clifton
- Consortium for Health and Military Performance, Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD
- Womack Army Medical Center, Fort Bragg, NC
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD
| | - D. Alan Nelson
- Consortium for Health and Military Performance, Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD
- Womack Army Medical Center, Fort Bragg, NC
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD
| | | | - Daniel Edgeworth
- Consortium for Health and Military Performance, Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD
- Womack Army Medical Center, Fort Bragg, NC
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD
| | - Donald Shell
- Health Services Policy and Oversight, Office of the Assistant Secretary of Defense for Health Affairs, Defense Health Headquarters, Falls Church, VA
| | - Patricia A. Deuster
- Consortium for Health and Military Performance, Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD
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15
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Bowen JM, Ouimet M, Lawarée J, Bielecki J, Rhéaume A, Greenberg C, Rac VE. Describing the state of a research network: A mixed methods approach to network evaluation. Res Eval 2023; 32:188-199. [PMID: 37799115 PMCID: PMC10550251 DOI: 10.1093/reseval/rvac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 08/03/2021] [Accepted: 09/05/2021] [Indexed: 10/07/2023]
Abstract
Diabetes Action Canada Strategy for Patient-Oriented Research (SPOR) Network in Chronic Disease was formed in 2016 and is funded primarily through the Canadian Institutes of Health Research (CIHR). We propose a novel mixed-methods approach to a network evaluation integrating the State of Network Evaluation framework and the Canadian Academy of Health Sciences (CAHS) preferred framework and indicators. We measure key network themes of connectivity, health and results, and impact and return on investment associated with health research networks. Our methods consist of a longitudinal cross-sectional network survey of members and social network analysis to examine Network Connectivity and assess the frequency of interactions, the topics discussed during them, and how networking effectively facilitates interactions and collaboration among members. Network Health will be evaluated through semistructured interviews, a membership survey inquiring about satisfaction and experience with the Network, and a review of documentary sources related to funding and infrastructure to evaluate Network Sustainability. Finally, we will examine Network Results and Impact using the CAHS preferred framework and indicators to measure returns on investment in health research across the five domains of the CAHS framework, which include: advancing knowledge, capacity building, informing decision making, health impact, and economic and social impact. Indicators will be assessed with various methods, including bibliometric analyses, review of relevant documentary sources (annual reports), member activities informing health and research policy, and Patient Partner involvement. The Network Evaluation will provide members and stakeholders with information for planning, improvements, and funding future Network endeavors.
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Affiliation(s)
- James M Bowen
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute (TGHRI), Toronto, ON M5G 2C4, Canada
- THETA Collaborative, University Health Network, 10th Floor Eaton North, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
- Health Technology Assessment and Network Analytics, Diabetes Action Canada, Toronto, ON M5G 2C4,Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M6,Canada
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Mathieu Ouimet
- Health Technology Assessment and Network Analytics, Diabetes Action Canada, Toronto, ON M5G 2C4,Canada
- Département de Science Politique, Faculté des Science Social, Université Laval, Québec, QC G1V 0A6, Canada
| | - Justin Lawarée
- Département de Science Politique, Faculté des Science Social, Université Laval, Québec, QC G1V 0A6, Canada
| | - Joanna Bielecki
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute (TGHRI), Toronto, ON M5G 2C4, Canada
- THETA Collaborative, University Health Network, 10th Floor Eaton North, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
| | - Ashley Rhéaume
- Département de Science Politique, Faculté des Science Social, Université Laval, Québec, QC G1V 0A6, Canada
| | - Caylee Greenberg
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute (TGHRI), Toronto, ON M5G 2C4, Canada
- THETA Collaborative, University Health Network, 10th Floor Eaton North, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
| | - Valeria E Rac
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute (TGHRI), Toronto, ON M5G 2C4, Canada
- THETA Collaborative, University Health Network, 10th Floor Eaton North, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
- Health Technology Assessment and Network Analytics, Diabetes Action Canada, Toronto, ON M5G 2C4,Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M6,Canada
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16
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Hagiwara S, Paoli GM, Price PS, Gwinn MR, Guiseppi-Elie A, Farrell PJ, Hubbell BJ, Krewski D, Thomas RS. A value of information framework for assessing the trade-offs associated with uncertainty, duration, and cost of chemical toxicity testing. Risk Anal 2023; 43:498-515. [PMID: 35460101 PMCID: PMC10515440 DOI: 10.1111/risa.13931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A number of investigators have explored the use of value of information (VOI) analysis to evaluate alternative information collection procedures in diverse decision-making contexts. This paper presents an analytic framework for determining the value of toxicity information used in risk-based decision making. The framework is specifically designed to explore the trade-offs between cost, timeliness, and uncertainty reduction associated with different toxicity-testing methodologies. The use of the proposed framework is demonstrated by two illustrative applications which, although based on simplified assumptions, show the insights that can be obtained through the use of VOI analysis. Specifically, these results suggest that timeliness of information collection has a significant impact on estimates of the VOI of chemical toxicity tests, even in the presence of smaller reductions in uncertainty. The framework introduces the concept of the expected value of delayed sample information, as an extension to the usual expected value of sample information, to accommodate the reductions in value resulting from delayed decision making. Our analysis also suggests that lower cost and higher throughput testing also may be beneficial in terms of public health benefits by increasing the number of substances that can be evaluated within a given budget. When the relative value is expressed in terms of return-on-investment per testing strategy, the differences can be substantial.
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Affiliation(s)
- Shintaro Hagiwara
- Risk Sciences International, Ottawa, Canada
- School of Mathematics and Statistics, Carleton University, Ottawa, Canada
| | | | - Paul S. Price
- Center for Compuational Toxicology and Exposure, Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, North Carolina, USA
| | - Maureen R. Gwinn
- Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, North Carolina, USA
| | - Annette Guiseppi-Elie
- Center for Compuational Toxicology and Exposure, Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, North Carolina, USA
| | - Patrick J. Farrell
- School of Mathematics and Statistics, Carleton University, Ottawa, Canada
| | - Bryan J. Hubbell
- Air, Climate, and Energy Research Program, Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, North Carolina, USA
| | - Daniel Krewski
- Risk Sciences International, Ottawa, Canada
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Canada
| | - Russell S. Thomas
- Center for Compuational Toxicology and Exposure, Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, North Carolina, USA
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17
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Connor L, Dean J, McNett M, Tydings DM, Shrout A, Gorsuch PF, Hole A, Moore L, Brown R, Melnyk BM, Gallagher-Ford L. Evidence-based practice improves patient outcomes and healthcare system return on investment: Findings from a scoping review. Worldviews Evid Based Nurs 2023; 20:6-15. [PMID: 36751881 DOI: 10.1111/wvn.12621] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/14/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Evidence-based practice and decision-making have been consistently linked to improved quality of care, patient safety, and many positive clinical outcomes in isolated reports throughout the literature. However, a comprehensive summary and review of the extent and type of evidence-based practices (EBPs) and their associated outcomes across clinical settings are lacking. AIMS The purpose of this scoping review was to provide a thorough summary of published literature on the implementation of EBPs on patient outcomes in healthcare settings. METHODS A comprehensive librarian-assisted search was done with three databases, and two reviewers independently performed title/abstract and full-text reviews within a systematic review software system. Extraction was performed by the eight review team members. RESULTS Of 8537 articles included in the review, 636 (7.5%) met the inclusion criteria. Most articles (63.3%) were published in the United States, and 90% took place in the acute care setting. There was substantial heterogeneity in project definitions, designs, and outcomes. Various EBPs were implemented, with just over a third including some aspect of infection prevention, and most (91.2%) linked to reimbursement. Only 19% measured return on investment (ROI); 94% showed a positive ROI, and none showed a negative ROI. The two most reported outcomes were length of stay (15%), followed by mortality (12%). LINKING EVIDENCE TO ACTION Findings indicate that EBPs improve patient outcomes and ROI for healthcare systems. Coordinated and consistent use of established nomenclature and methods to evaluate EBP and patient outcomes are needed to effectively increase the growth and impact of EBP across care settings. Leaders, clinicians, publishers, and educators all have a professional responsibility related to improving the current state of EBP. Several key actions are needed to mitigate confusion around EBP and to help clinicians understand the differences between quality improvement, implementation science, EBP, and research.
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Affiliation(s)
- Linda Connor
- Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing & Healthcare, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Jennifer Dean
- Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing & Healthcare, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Molly McNett
- Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing & Healthcare, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Donna M Tydings
- St. John Fisher University, Wegmans School of Nursing, Rochester, New York, USA
| | | | - Penelope F Gorsuch
- Summa Health System, Akron, Ohio, USA.,The Ohio State University, College of Nursing, Columbus, Ohio, USA
| | - Ashley Hole
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | | | - Roy Brown
- Affiliate Faculty, VCU Libraries, Health Sciences Library, Virginia Commonwealth University School of Nursing, Richmond, Virginia, USA
| | - Bernadette Mazurek Melnyk
- Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing & Healthcare, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Lynn Gallagher-Ford
- Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing & Healthcare, College of Nursing, The Ohio State University, Columbus, Ohio, USA
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18
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Shah JL, Moinfar Z, Anderson KK, Gould H, Hutt-Macleod D, Jacobs P, Mitchell S, Nguyen T, Rodrigues R, Reaume-Zimmer P, Rudderham H, Rudderham S, Smyth R, Surood S, Urichuk L, Malla AK, Iyer SN, Latimer E. Return on investment from service transformation for young people experiencing mental health problems: Approach to economic evaluations in ACCESS Open Minds (Esprits ouverts), a multi-site pan-Canadian youth mental health project. Front Psychiatry 2023; 14:1030407. [PMID: 36896344 PMCID: PMC9988897 DOI: 10.3389/fpsyt.2023.1030407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 01/03/2023] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION Mental health problems are common globally, and typically have their onset in adolescence and early adulthood-making youth (aged 11-25) an optimal target for prevention and early intervention efforts. While increasing numbers of youth mental health (YMH) initiatives are now underway, thus far few have been subject to economic evaluations. Here we describe an approach to determining the return on investment of YMH service transformation via the pan-Canadian ACCESS Open Minds (AOM) project, for which a key focus is on improving access to mental health care and reducing unmet need in community settings. APPROACH As a complex intervention package, it is hoped that the AOM transformation will: (i) enable early intervention through accessible, community-based services; (ii) shift care away toward these primary/community settings and away from acute hospital and emergency services; and (iii) offset at least some of the increased costs of primary care/community-based mental health services with reductions in the volume of more resource-intensive acute, emergency, hospital or specialist services utilized. Co-designed with three diverse sites that represent different Canadian contexts, a return on investment analysis will (separately at each site) compare the costs generated by the intervention, including volumes and expenditures associated with the AOM service transformation and any contemporaneous changes in acute, emergency, hospital or service utilization (vs. historical or parallel comparators). Available data from health system partners are being mobilized to assess these hypotheses. ANTICIPATED RESULTS Across urban, semi-urban and Indigenous sites, the additional costs of the AOM transformation and its implementation in community settings are expected to be at least partially offset by a reduction in the need for acute, emergency, hospital or specialist care. DISCUSSION Complex interventions such as AOM aim to shift care "upstream": away from acute, emergency, hospital and specialist services and toward community-based programming which is more easily accessible, often more appropriate for early-stage presentations, and more resource-efficient. Carrying out economic evaluations of such interventions is challenging given the constraints of available data and health system organization. Nonetheless, such analyses can advance knowledge, strengthen stakeholder engagement, and further implementation of this public health priority.
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Affiliation(s)
- Jai L Shah
- ACCESS Open Minds, Douglas Research Centre, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Zeinab Moinfar
- ACCESS Open Minds, Douglas Research Centre, Montreal, QC, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Institute of Clinical and Evaluative Sciences, Toronto, ON, Canada
| | | | | | - Philip Jacobs
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Stephen Mitchell
- Canadian Mental Health Association Lambton Kent, Chatham-Kent, ON, Canada
| | - Thanh Nguyen
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Rebecca Rodrigues
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Paula Reaume-Zimmer
- Canadian Mental Health Association Lambton Kent, Chatham-Kent, ON, Canada.,Bluewater Health, Chatham-Kent, ON, Canada
| | | | | | - Rebecca Smyth
- Canadian Mental Health Association Lambton Kent, Chatham-Kent, ON, Canada
| | | | | | - Ashok K Malla
- ACCESS Open Minds, Douglas Research Centre, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Srividya N Iyer
- ACCESS Open Minds, Douglas Research Centre, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Eric Latimer
- ACCESS Open Minds, Douglas Research Centre, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
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19
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Mellott CE, Jaworski R, Carrico J, Talbird SE, Dobrowolska I, Golicki D, Bencina G, Clinkscales M, Karamousouli E, Eiden AL, Sabale U. Public health impact and return on investment of the pediatric immunization program in Poland. Expert Rev Vaccines 2023; 22:1114-1125. [PMID: 37909887 DOI: 10.1080/14760584.2023.2275712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND This study aims to evaluate the epidemiological impact and return on investment of the pediatric immunization program (PIP) in Poland from the healthcare-sector and societal perspectives. RESEARCH DESIGN AND METHODS A health-economic model was developed focusing on the nine vaccines, targeting 11 pathogens, recommended by the public health authorities for children aged 0-6 years in Poland. The 2019 birth cohort (388,178) was followed over their lifetime, with the model estimating discounted health outcomes, life-years gained, quality-adjusted life-years, and direct and indirect costs with and without the PIP based on current and pre-vaccine - era disease incidence estimates, respectively. RESULTS Across 11 targeted pathogens, the Polish PIP prevented more than 452,300 cases of disease, 1,600 deaths, 37,900 life-years lost, and 38,800 quality-adjusted life-years lost. The PIP was associated with vaccination costs of €54 million. Pediatric immunization averted €65 million from a healthcare-sector perspective (benefit-cost ratio [BCR], 2.2) and averted €358 million from a societal perspective (BCR, 7.6). The BCRs from both perspectives remained >1.0 in scenario analyses. CONCLUSIONS The Polish PIP, which has not previously been systematically assessed, brings large-scale prevention of disease-related morbidity, premature mortality, and associated costs. This analysis highlights the value of continued investment in pediatric immunization in Poland.
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Affiliation(s)
| | | | | | | | | | - Dominik Golicki
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Goran Bencina
- Center for Observational and Real-World Evidence, (CORE), MSD, Madrid, Spain
| | | | | | - Amanda L Eiden
- Center for Observational and Real-World Evidence (CORE), Merck & Co, Rahway, NJ, USA
| | - Ugne Sabale
- Center for Observational and Real-World Evidence (CORE), MSD, Vilnius, Lithuania
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20
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Boccalini S, Bonito B, Zanella B, Liedl D, Bonanni P, Bechini A. The First 30 Years of the Universal Hepatitis-B Vaccination-Program in Italy: A Health Strategy with a Relevant and Favorable Economic-Profile. Int J Environ Res Public Health 2022; 19:16365. [PMID: 36498435 PMCID: PMC9736534 DOI: 10.3390/ijerph192316365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/24/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
In 1991, Italy was one of the first countries worldwide to introduce a universal hepatitis-B vaccination for children. Since then, epidemiological data have clearly demonstrated the huge clinical benefits of the vaccination. The aim of this study was to update the favorable economic impact of the hepatitis B virus (HBV) vaccination, 30 years after its implementation. A mathematical model was developed to simulate the clinical/economic impact of the universal HBV-vaccination program versus a hypothetical no-vaccination scenario as a posteriori analysis. We assessed the vaccination benefits over a 30-year-immunization-period (1991−2020), and the following period, 2021−2070. Our data showed a big drop in HBV-related diseases (−82% in infections, chronic disease, and hepatocellular-carcinoma cases), and related costs (−67% in the immunization period and −85% in 2021−2070), attributable to vaccination. The return on investment (ROI) and the benefit-to-cost (BCR) ratios are >1 for the first thirty-year-immunization-period, and are predicted to almost triplicate the economic savings in the period 2021−2070, both for the National Health Service (NHS) and from societal perspectives. Our model confirmed that the implementation of universal HBV-vaccination in Italy during the first 30 years continues to be a cost-saving strategy, and more advantageous effects will be further achieved in the future. The HBV-vaccination strategy greatly expresses a huge impact in both the short- and long-term, and from the clinical and economic point-of-views.
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Affiliation(s)
- Sara Boccalini
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | - Benedetta Bonito
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | - Beatrice Zanella
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | - Davide Liedl
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | - Angela Bechini
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
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21
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Uyeh DD, Mallipeddi R, Park T, Woo S, Ha Y. Technological Advancements and Economics in Plant Production Systems: How to Retrofit? Front Plant Sci 2022; 13:929672. [PMID: 35860536 PMCID: PMC9289745 DOI: 10.3389/fpls.2022.929672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
Plant production systems such as plant factories and greenhouses can help promote resilience in food production. These systems could be used for plant protection and aid in controlling the micro- and macro- environments needed for optimal plant growth irrespective of natural disasters and changing climate conditions. However, to ensure optimal environmental controls and efficient production, several technologies such as sensors and robots have been developed and are at different stages of implementation. New and improved systems are continuously being investigated and developed with technological advances such as robotics, sensing, and artificial intelligence to mitigate hazards to humans working in these systems from poor ventilation and harsh weather while improving productivity. These technological advances necessitate frequent retrofits considering local contexts such as present and projected labor costs. The type of agricultural products also affects measures to be implemented to maximize returns on investment. Consequently, we formulated the retrofitting problem for plant production systems considering two objectives; minimizing the total cost for retrofitting and maximizing the yearly net profit. Additionally, we considered the following: (a) cost of new technologies; (b) present and projected cost for human labor and robotics; (c) size and service life of the plant production system; (d) productivity before and after retrofit, (e) interest on loans for retrofitting, (f) energy consumption before and after retrofit and, (g) replacement and maintenance cost of systems. We solved this problem using a multi-objective evolutionary algorithm that results in a set of compromised solutions and performed several simulations to demonstrate the applicability and robustness of the method. Results showed up to a 250% increase in annual net profits in an investigated case, indicating that the availability of all the possible retrofitting combinations would improve decision making. A user-friendly system was developed to provide all the feasible retrofitting combinations and total costs with the yearly return on investment in agricultural production systems in a single run.
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Affiliation(s)
- Daniel Dooyum Uyeh
- Department of Bio-Industrial Machinery Engineering, Kyungpook National University, Daegu, South Korea
- Upland-Field Machinery Research Centre, Kyungpook National University, Daegu, South Korea
- Smart Agriculture Innovation Center, Kyungpook National University, Daegu, South Korea
| | - Rammohan Mallipeddi
- Department of Artificial Intelligence, School of Electronics Engineering, Kyungpook National University, Daegu, South Korea
| | - Tusan Park
- Department of Bio-Industrial Machinery Engineering, Kyungpook National University, Daegu, South Korea
- Smart Agriculture Innovation Center, Kyungpook National University, Daegu, South Korea
| | - Seungmin Woo
- Department of Bio-Industrial Machinery Engineering, Kyungpook National University, Daegu, South Korea
- Upland-Field Machinery Research Centre, Kyungpook National University, Daegu, South Korea
- Smart Agriculture Innovation Center, Kyungpook National University, Daegu, South Korea
| | - Yushin Ha
- Department of Bio-Industrial Machinery Engineering, Kyungpook National University, Daegu, South Korea
- Upland-Field Machinery Research Centre, Kyungpook National University, Daegu, South Korea
- Smart Agriculture Innovation Center, Kyungpook National University, Daegu, South Korea
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Nearing KA, Adams HM, Alsphaugh J, Douglas SE, Feller TR, Fleak R, Moore V, Martin-Sanders S, Schultz TM, Stratton K, Sullivan JP, Van Sickle L, Yates JD, Yates TA, Matlock DD. Engaging the Wisdom of Older Veterans to Enhance VA Healthcare, Research, and Services. J Gen Intern Med 2022; 37:22-32. [PMID: 35349016 DOI: 10.1007/s11606-021-07076-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Stakeholder engagement helps ensure that research is relevant, clinical innovations are responsive, and healthcare services are patient-centered. OBJECTIVE Establish and sustain a Veteran engagement board involving older Veterans and caregivers to provide input on aging-related research and clinical demonstration projects. DESIGN AND PARTICIPANTS The Older Veteran Engagement Team (OVET)-a group of eight Veterans and one caregiver who range in age from 62 to 92-was formed in November 2017 and has met monthly since January 2018. The OVET provides feedback on topics that reflect the foci of the VA Eastern Colorado Geriatric Research Education and Clinical Center (GRECC) (e.g., physical functioning, hearing health, and emotional wellness/mental health). Ongoing evaluation documents the return on investment of Veteran engagement. MAIN MEASURES The OVET member and provider/investigator meeting evaluations with longitudinal follow-up at 6 and 12 months. RESULTS Return on investment of Veteran engagement is multi-faceted. For OVET, ROI ranges from grant support to improved healthcare quality/efficiency to social-emotional benefits. To date, funding awards total over $2.3 M for NIH and VA-funded projects to which OVET provided substantive feedback. Documented impacts on healthcare services include reductions in patient wait times, more appropriate utilization of services and increased patient satisfaction. Social-emotional benefits include generativity, as OVET members contribute to improving clinical and community-based supports for other Veterans. The OVET provides an opportunity for older Veterans to share their lived experience with trainees and early career investigators who are preparing for careers serving Veterans. CONCLUSION The OVET is similar to other established stakeholder engagement groups; team members offer their individual viewpoints at any stage of research, clinical demonstration, or quality improvement projects. The OVET provides a mechanism for the voice of older Veterans and caregivers to shape aspects of individual projects. Importantly, these projects support patient-centered care and promote the characteristics of an age-friendly healthcare system.
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Katz DL, Govani R, Anderson K, Rhee LQ, Aronson DL. The Financial Case for Food as Medicine: Introduction of a ROI Calculator. Am J Health Promot 2022; 36:768-771. [PMID: 35038266 DOI: 10.1177/08901171211070751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Diet quality is now established as the single leading predictor of perennial premature death in modern countries. However, practice at scale in modern medicine is driven as much by financial as clinical imperatives and yet, the ability to quantify the potential ROI of Food as medicine (FaM) interventions is limited by a lack of data. Utilizing a novel advance in dietary assessment and data from the peer-reviewed literature, we constructed and tested a web-based calculator simulating the return-on-investment associated with FaM interventions.
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Rambo-Hernandez KE, Makel MC, Peters SJ, Worley C. Differential return on investment: Academic growth in mathematics and reading based on initial performance. Br J Educ Psychol 2021; 92:817-842. [PMID: 34913476 DOI: 10.1111/bjep.12479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Students vary in their initial achievement when they enter school and their rate of academic growth as they move through school. These differences have implications for classroom instruction and educational policy. Although previous research has examined initial achievement and growth differences, a gap remains in understanding how initial level of achievement interacts with subsequent growth as children move through school. AIM Using Vygotsky's zone of proximal development (ZPD) and return on investment as theoretical grounding, this registered report examined how students' initial academic performance relative to their school predicts their subsequent academic achievement. The stage 1 accepted registered report is available at https://osf.io/9zmak/. Specifically, we tracked the achievement of a cohort of students who started at or above their school's mean at the beginning of third grade and tested a range of hypotheses regarding their achievement and growth as well as which students showed the greatest gains from their time in school. SAMPLE Using a large database of student academic achievement in the United States, this registered report included de-identified data from all students from fall 2014 to spring 2017 in grades three through five from the ten US states with the highest participation for the Northwest Evaluation Association's Measures of Academic Progress (MAP®) - a computer adaptive test of academic achievement in mathematics and reading. Because the MAP is taken at least twice per school year, up to six scores were included on mathematics and reading achievement for effective samples of approximately 220,000 students. METHOD We built separate reading and mathematics three-level piecewise longitudinal hierarchical linear models (student repeated measures, nested within students, nested within schools) to model student growth from the beginning of third grade to the end of fifth grade (i.e., three academic years and two summers). RESULTS For both mathematics and reading, average student achievement growth slowed as they progressed from third through fifth grade. From there, the findings diverged. In mathematics, student growth was mostly similar across achievement levels and grades from third through fifth. However, in reading, above-average students demonstrated slower growth than average students during the school year but faster growth during the summer. Also of note, at the beginning of third grade, the highest achieving students outscored average students in their school by more than 2 years in mathematics and 3 years in reading. CONCLUSIONS Our results may be able to be explained via a ZPD model, which posits development only occurs when students are placed in appropriately challenging environments. In mathematics, the observed pattern of relatively consistent growth across achievement levels suggests average students were just as likely to be in their ZPD as higher achieving students. In reading, as initial achievement increased, student reading growth slowed, which suggests the higher the initial achievement, the less likely students were to be in their ZPD. If a goal of education is for students to learn new things, our results suggest existing school offerings in reading are not meeting that goal equitably for students across the performance spectrum. Differential growth patterns should be considered when designing learning experiences for students who enter with a wide range of prior mastery.
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Gurnani V, Dhalaria P, Chatterjee S, Singh P, Agrahari K, Kashyap S, Bhargava R, Nandi P, Dhawan V, Aggarwal MK, Haldar P. Return on investment of the electronic vaccine intelligence network in India. Hum Vaccin Immunother 2021; 18:2009289. [PMID: 34905441 PMCID: PMC8928793 DOI: 10.1080/21645515.2021.2009289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The electronic vaccine intelligence network (eVIN) was introduced by India's Ministry of Health and Family Welfare in 12 states and was implemented by the United Nations Development Programme through the Gavi health system strengthening support during 2014-17 to replace the traditional paper-based cold-chain management system with an electronic vaccine logistics management system. An economic assessment was conducted as part of the overall assessment of eVIN. The objective of the economic assessment was to conduct a return on investment analysis of eVIN implementation. Return on investment was defined as the ratio of total benefits (savings) from eVIN to total investment in eVIN. All costs were calculated in 2020 prices and reported in Indian rupees (1 US dollar = INR 74.132). A one-rupee investment in eVIN led to a return of INR 0.52 for traditional vaccines. The highest cost savings from eVIN was from better vaccine stock management. When same percentage of savings from the new vaccines were incorporated into the analysis, one-rupee investment in eVIN led to a return of INR 1.41. In the future, when only recurrent costs will exist, the return from eVIN will be even higher: a one-rupee investment in eVIN will yield a return of INR 2.93. The assessment of eVIN showed promising results in streamlining the vaccine flow network and ensuring equity in vaccine stock management along with good return on investment; hence, there was a rapid expansion of eVIN in all 731 districts across 36 states and union territories in the country.
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Affiliation(s)
- Vandana Gurnani
- Immunization Division, Ministry of Health & Family Welfare, Government of India, New Delhi, India
| | - Pritu Dhalaria
- John Snow India, Immunization Technical Support Unit (ITSU), New Delhi, India
| | - Susmita Chatterjee
- Research Department, George Institute for Global Health, New Delhi, India.,Department of Medicine, University of New South Wales, Sydney, Australia.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Prem Singh
- John Snow India, Immunization Technical Support Unit (ITSU), New Delhi, India
| | - Kiran Agrahari
- John Snow India, Immunization Technical Support Unit (ITSU), New Delhi, India
| | - Satabdi Kashyap
- John Snow India, Immunization Technical Support Unit (ITSU), New Delhi, India
| | - Ruma Bhargava
- John Snow India, Immunization Technical Support Unit (ITSU), New Delhi, India
| | - Partha Nandi
- College of Medicine, Ministry of Higher Education, University of Bisha, Bisha, Saudi Arabia
| | - Veena Dhawan
- Immunization Division, Ministry of Health & Family Welfare, Government of India, New Delhi, India
| | - Mahesh Kumar Aggarwal
- Immunization Division, Ministry of Health & Family Welfare, Government of India, New Delhi, India
| | - Pradeep Haldar
- Immunization Division, Ministry of Health & Family Welfare, Government of India, New Delhi, India
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Woods ER, Sommer SJ, Bryson EA, Shreeve KM, Graham D, Nethersole S, Bhaumik U. Improved 10-year cost savings for patients served by the Boston Children's Hospital Community Asthma Initiative. J Asthma 2021; 59:2258-2266. [PMID: 34904928 DOI: 10.1080/02770903.2021.2010746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To provide a 10-year follow-up of asthma cost-savings for patients served by the Community Asthma Initiative (CAI) group compared to a coarsely cost-matched comparison group from similar neighborhoods (comparison group). METHODS CAI provided home visits and case management services for patients identified through emergency department (ED) visits and hospitalizations. Asthma costs for the two groups were extracted from the hospital administrative database for ED visits and hospitalizations for one year before and 10 years of follow-up. To eliminate cost differences at intake, a coarse cost-matching was implemented by randomly selecting comparison patients with similar costs to CAI patients (N = 208 pairs). The difference in cost-reduction between CAI and comparison patients was used to compute the adjusted Return on Investment (aROI). RESULTS There were no significant differences between CAI and comparison groups, including baseline age (5.9 years [SD 2.9] v. 4.4 [SD 3.1]); Hispanic (46.2% v. 35.1%) and Black (43.9% v. 53.0%) race/ethnicity; and public insurance (71.2% v. 68.8%). The cost reduction difference for CAI was significant at one year (P = 0.0001) and two years (P = 0.03), but did not reach the level of significance for years 3-10. The CAI group had a greater cumulative cost reduction of $5,321 (P = 0.08, not significant). Average program cost per patient was $2,636. CAI broke-even after 3 years (aROI = 1.04) and yielded an adjusted ROI of 1.99 at 10 years. CONCLUSIONS The greater reduction in cumulative cost for CAI patients suggested a shift in trajectory at 10 years of follow-up, resulting in a positive aROI after three years.
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Affiliation(s)
- Elizabeth R Woods
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Susan J Sommer
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Emily A Bryson
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Kyra M Shreeve
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Dionne Graham
- Harvard Medical School, Boston, MA, USA.,Program for Patient Quality and Safety, Boston Children's Hospital, Boston, MA, USA
| | - Shari Nethersole
- Harvard Medical School, Boston, MA, USA.,Office of Community Health, Boston Children's Hospital, Boston, MA, USA
| | - Urmi Bhaumik
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.,Office of Community Health, Boston Children's Hospital, Boston, MA, USA
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Doran CM, Wadds P, Shakeshaft A, Tran DA. Impact and Return on Investment of the Take Kare Safe Space Program-A Harm Reduction Strategy Implemented in Sydney, Australia. Int J Environ Res Public Health 2021; 18:12111. [PMID: 34831867 DOI: 10.3390/ijerph182212111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022]
Abstract
Safe spaces are increasingly utilized to reduce alcohol-related harm, violence, crime and improve public safety in nightlife settings. This study aimed to determine the impact and return on investment of the Take Kare Safe Space (TKSS) program-a harm reduction program implemented to address alcohol-related violence and disorder in three locations in Sydney's night-time economy between 2014 and 2019. TKSS ambassadors provided support at static safe spaces and patrolled designated nightlife precincts to provide practical assistance to vulnerable and intoxicated people. Ambassadors recorded information relating to these interactions including 'client' age, gender, perceived level of intoxication, time and length of engagement with the program. Costs of program implementation and benefits of major incidents averted were obtained to allow calculation of return on investment. From December 2014 to April 2019, 66,455 people were supported by TKSS ambassadors. Most users were male (62%) and aged 18-25 years (66%). Of 3633 interventions by ambassadors, serious risk of harm was averted in 735 cases (20%). The program's return on investment is estimated at 2.67, suggesting that a $1 investment results in $2.67 in benefits. Safe Spaces are extensively utilized, particularly by young males with high levels of intoxication, and represent a positive return on investment. Despite the growth of such services, there remains a notable absence of rigorous, independent evaluation regarding the outcomes and/or social benefit of safe space programs. From a policy perspective, there is a need for more high-quality economic evaluations to better inform decisions about competing uses of limited resources.
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Wiklund SJ. Do strict decision criteria hamper productivity in the pharmaceutical industry? J Biopharm Stat 2021; 31:788-808. [PMID: 34709137 DOI: 10.1080/10543406.2021.1975129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The discouragingly high rates of attrition in drug development, and in particular in Phase 2, warrant a closer look at the decision criteria applied for investment in the next phase (Phase 3). We have in this article evaluated Stop/Go criteria after Phase 2, based on a model encompassing both Phase 2 and 3, as well as the eventual outcome on the market. The results indicate that the value of a drug project is often maximized if rather liberal decision criteria are applied. The routine adherence to standard criteria, e.g. requiring significance at 5% level, may lead to an unduly high rate of false negative decisions. This might ultimately hamper the productivity of drug development and leading to potentially useful drugs not being taken forward to benefit the intended patients.
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Abstract
Academic researchers concentrate on the scientific and technological feasibility of novel treatments. Investors and commercial partners, however, understand that success depends even more on strategies for regulatory approval, reimbursement, marketing, intellectual property protection and risk management. These considerations are critical for technologically complex and highly invasive treatments that entail substantial costs and risks in small and heterogeneous patient populations. Most implanted neural prosthetic devices for novel applications will be in FDA Device Class III, for which guidance documents have been issued recently. Less invasive devices may be eligible for the recently simplified “de novo” submission routes. We discuss typical timelines and strategies for integrating the regulatory path with approval for reimbursement, securing intellectual property and funding the enterprise, particularly as they might apply to implantable brain-computer interfaces for sensorimotor disabilities that do not yet have a track record of approved products.
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Affiliation(s)
- Gerald E Loeb
- Medical Device Development Facility, Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Frances J Richmond
- DK Kim International Center for Regulatory Science, Department of Regulatory and Quality Sciences, University of Southern California, Los Angeles, CA, United States
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Abstract
Worksite health and well-being initiatives will ideally be integrated with employers' efforts to address diversity, equity and inclusion issues. Social Determinants of Health (SDOH) include race, class, community health, income and other variables that companies can play a role in ameliorating. As much as spirituality is commonly espoused as a component of a holistic approach to health promotion, making space to discuss faith and health remains an uncommon strategy in the workplace wellness movement. Recognizing the value on investment (VOI) in wellness has eclipsed a return on investment as a driver of an employer's well-being strategy. This editorial argues that making space for learning about faith and health will intersect in vital ways with anti-racism work, diversity programs and similar efforts to eliminate health inequities, address SDOH and bolster the VOI of worksite well-being initiatives. A fictional dialogue between executives is used to review these issues and related literature.
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Affiliation(s)
- Paul E Terry
- Editor in Chief, American Journal of Health Promotion, Senior Fellow, HERO (The Health Enhancement Research Organization)
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Chu LC, Rowe SP, Fishman EK. Clinician-Scientists: Can They Survive in the Modern Era? J Am Coll Radiol 2021; 18:192-7. [PMID: 33413899 DOI: 10.1016/j.jacr.2020.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/25/2020] [Accepted: 09/02/2020] [Indexed: 11/22/2022]
Abstract
Clinician-scientists are commonly characterized as health care professionals who are proficient in both research and clinical practice. Their dual expertise positions them to play a vital role in translating research outcomes to clinical practice. However, economic changes in the past few decades are threatening their very survival. The purposes of this article are to review some of the economic forces that pose the greatest risks to clinician-scientists in the modern era and to glean lessons from the business world in overcoming these challenges. Health care consolidation and decreasing reimbursements are putting increasing financial pressure on academic institutions, leaving them more inclined to cut back on departmental research support. Innovative companies commit a certain percentage of their revenue to research and discovery. Academic institutions should similarly view their research budget as research and discovery that will sustain the future growth of radiology. They should quantify and define expectations for academic productivity, focus on return on investment, and bolster the infrastructure to foster commercial partnerships that can provide additional revenue to support the research mission. Success in academics does not occur by accident. It requires more than individual talent and hard work. It also requires institutional leaders who are committed to developing future academic leaders and supporting innovation.
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Dalmasso G, Di Prinzio RR, Gilardi F, De Falco F, Vinci MR, Camisa V, Santoro A, Casasanta D, Raponi M, Giorgi G, Magnavita N, Zaffina S. Effectiveness of Psychological Support to Healthcare Workers by the Occupational Health Service: A Pilot Experience. Healthcare (Basel) 2021; 9:732. [PMID: 34198556 DOI: 10.3390/healthcare9060732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/06/2021] [Accepted: 06/10/2021] [Indexed: 12/03/2022] Open
Abstract
Work-related stress is a significant risk for healthcare workers (HCWs). This study aims at evaluating the effectiveness of an individual psychological support programme for hospital workers. In all, 35 workers participated (n). A control group of 245 workers (7n) was set. Occupational distress was measured by the General Health Questionnaire, (GHQ-12), the quality of life by the Short Form-36 health survey, (SF-36), and sickness absence was recorded. Costs and benefits of the service were evaluated and the return on investment (ROI) was calculated. The level of distress was significantly reduced in the treated group at the end of the follow-up (p < 0.001). Quality of life had significantly improved (p < 0.003). A 60% reduction of sickness absence days (SADs) following the intervention was recorded. After the treatment, absenteeism in cases was significantly lower than in controls (p < 0.02). The individual improvement of mental health and quality of life was significantly correlated with the number of meetings with the psychologist (p < 0.01 and p < 0.03, respectively). The recovery of direct costs due to reduced sick leave absence was significantly higher than the costs of the programme; ROI was 2.73. The results must be examined with caution, given the very limited number of workers treated; this first study, however, encouraged us to continue the experience.
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Wu CH, Dodd AJ, Hauser CE, McCarthy MA. Reallocating budgets among ongoing and emerging conservation projects. Conserv Biol 2021; 35:955-966. [PMID: 32648317 DOI: 10.1111/cobi.13585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 06/11/2023]
Abstract
Conserving biodiversity and combating ecological hazards require cost-effective allocation of limited resources among potential management projects. Project priorities, however, can change over time as underlying social-ecological systems progress, novel priorities emerge, and management capabilities evolve. Thus, reallocation of ongoing investments in response to shifting priorities could improve management outcomes and address urgent demands, especially when additional funding is not available immediately. Resource reallocation, however, could incur transaction costs, require additional monitoring and reassessment, and be constrained by ongoing project commitments. Such complexities may prevent managers from considering potentially beneficial reallocation strategies, reducing long-term effectiveness. We propose an iterative project prioritization approach, based on marginal return-on-investment estimation and portfolio optimization, that guides resource reallocation among ongoing and new projects. Using simulation experiments in 2 case studies, we explored how this approach can improve efficacy under varying reallocation constraints, frequencies, costs, and rates of project portfolio change. Periodic budget reallocation could enhance the management of stochastically emerging invasive weeds in Australia and thus reduce the overall risk by up to 50% compared with a static budget. Reallocation frequency and the rate of new weed incursion synergistically increased the conservation gains achieved by allowing unconstrained reallocation. Conversely, budget reallocation would not improve the International Union for Conservation of Nature conservation status of threatened Australian birds due to slow rates of transition among conservation states; extinction risk could increase if portfolio reassessment is costly. Although other project prioritization studies may recommend periodic reassessment and reallocation, our findings revealed conditions when reallocation is valuable and demonstrated a structured approach that can help conservation agencies schedule and implement iterative budget-allocation decisions cost-effectively.
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Affiliation(s)
- Chung-Huey Wu
- School of Biosciences, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Aaron J Dodd
- School of Biosciences, The University of Melbourne, Parkville, VIC, 3010, Australia
- Centre of Excellence for Biosecurity Risk Analysis, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Cindy E Hauser
- School of Biosciences, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Michael A McCarthy
- School of Biosciences, The University of Melbourne, Parkville, VIC, 3010, Australia
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Baus A, Shawley-Brzoska S, Wright J, Carey S, Berry ED, Burrell S, Ross M, Pollard C, Semel A, Calkins A, Gadde D, Jarrett T. Informatics-Supported Diabetes Prevention Programming in West Virginia. Perspect Health Inf Manag 2021; 18:1l. [PMID: 34035793 PMCID: PMC8120671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Addressing diabetes, prediabetes, and related health conditions such as high blood pressure, high cholesterol, obesity, and physical inactivity are critical public health priorities for the United States, particularly West Virginia. Preventing chronic conditions through early identification of risk and intervention to reduce risk is essential. Primary care and community-based programs need a more connected informatics system by which they work in tandem to identify, refer, treat, and track target populations. This case study in quality improvement examines the effectiveness of national diabetes prevention programming in West Virginia via the West Virginia Health Connection initiative, which was designed to provide such an informatics structure. Cohort analysis reveals an average weight loss of 13.6 pounds-or 6.3 percent total body weight loss-per person. These changes represent decreased risk of diabetes incidence and increased healthcare savings. Lessons learned are applicable to other areas aiming to build and sustain a data-informed health analytics network.
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Rusatira JC, Silberg C, Mickler A, Salmeron C, Twahirwa Rwema JO, Johnstone M, Martinez M, Rimon JG, Zimmerman L. Family planning science and practice lessons from the 2018 International Conference on Family Planning. Gates Open Res 2021; 4:43. [PMID: 32760880 PMCID: PMC7374012 DOI: 10.12688/gatesopenres.13130.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2020] [Indexed: 11/20/2022] Open
Abstract
Background Since 2009, the International Conference on Family Planning (ICFP) has served as an opportunity for the global reproductive health community to share FP advances and practice lessons in the areas of research, programming, and advocacy. The purpose of this paper was to synthesize the key results and findings presented by members of the FP community at the 2018 ICFP Conference. Methods More than 700 abstracts from all 15 conference tracks were reviewed and 64 abstracts total were selected for this paper based on the novelty and urgency of the findings. The content analysis of conference abstracts were grouped into six final thematic areas. Results 1 ) Investing in family planning for a lifetime of returns. FP continues to face a shortage of funding. Domestically based and locally owned funding models provide alternative financing solutions. 2) Addressing inequities in family planning for key populations. Various populations still face challenges in accessing FP. Youth-inclusive and user-centered programming show promise in addressing such challenges. 3) Reproductive justice, Unsafe abortions tend to be more common among younger, poor, uneducated and rural women. Legislation is still needed to facilitate a culture of safe abortions. 4) Couple dynamics and decision-making. Couples who share equitable responsibility in decision-making processes are more likely to use contraceptives; couple disagreement influences women's decisions to covertly use FP. 5) Male involvement in programming. Male champions can successfully promote uptake of FP. Gender-transformative programming promotes gender equity and impacts behavior change. 6) Breakthroughs in novel contraceptives and systems improvement in family planning. Recent advances include user-centered contraceptive technologies that allow for self-administration and information systems which optimize supply chain management. Conclusion The research, advocacy, and programmatic abstracts at ICFP 2018 highlighted research advances, showcased implementation science wins, and provided evidence of critical knowledge gaps in global FP access and use.
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Affiliation(s)
- Jean Christophe Rusatira
- Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Claire Silberg
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Alexandria Mickler
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Carolina Salmeron
- Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | | | - Maia Johnstone
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Michelle Martinez
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Jose G Rimon
- Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Linnea Zimmerman
- Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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Chen HH, Higgins C, Laing SK, Bliese SL, Lieberman M, Ozawa S. Cost savings of paper analytical devices (PADs) to detect substandard and falsified antibiotics: Kenya case study. Med Access Point Care 2021; 5. [PMID: 33834120 PMCID: PMC8026160 DOI: 10.1177/2399202620980303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Over 10% of antibiotics in low- and middle-income countries (LMICs) are
substandard or falsified. Detection of poor-quality antibiotics via the gold
standard method, high-performance liquid chromatography (HPLC), is slow and
costly. Paper analytical devices (PADs) and antibiotic paper analytical
devices (aPADs) have been developed as an inexpensive way to estimate
antibiotic quality in LMICs. Aim: To model the impact of using a rapid screening tools, PADs/aPADs, to improve
the quality of amoxicillin used for treatment of childhood pneumonia in
Kenya. Methods: We developed an agent-based model, ESTEEM (Examining Screening Technologies
with Economic Evaluations for Medicines), to estimate the effectiveness and
cost savings of incorporating PADs and aPADs in amoxicillin quality
surveillance in Kenya. We compared the current testing scenario (batches of
entire samples tested by HPLC) with an expedited HPLC scenario (testing
smaller batches at a time), as well as a screening scenario using PADs/aPADs
to identify poor-quality amoxicillin followed by confirmatory analysis with
HPLC. Results: Scenarios using PADs/aPADs or expedited HPLC yielded greater incremental
benefits than the current testing scenario by annually averting 586 (90%
uncertainty range (UR) 364–874) and 221 (90% UR 126–332) child pneumonia
deaths, respectively. The PADs/aPADs screening scenario identified and
removed poor-quality antibiotics faster than the expedited or regular HPLC
scenarios, and reduced costs significantly. The PADs/aPADs scenario resulted
in an incremental return of $14.9 million annually compared with the
reference scenario of only using HPLC. Conclusion: This analysis shows the significant value of PADs/aPADs as a medicine quality
screening and testing tool in LMICs with limited resources.
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Affiliation(s)
- Hui-Han Chen
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Colleen Higgins
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Sarah K Laing
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Sarah L Bliese
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA
| | - Marya Lieberman
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA
| | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA.,Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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George DS, Ainslie-Garcia MH, Ferko NC, Cheng H. Successful Implementation of Femtosecond Laser-Assisted Cataract Surgery: A Real-World Economic Analysis. Clin Ophthalmol 2021; 15:923-929. [PMID: 33688160 PMCID: PMC7936671 DOI: 10.2147/opth.s293111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/08/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose To calculate the minimum number of Femtosecond laser-assisted cataract surgery (FLACS) procedures required per month to pay off the fixed investment cost over 5 years to achieve break-even. Setting A rural ophthalmology practice located in the mid-West United States. Design An economic analysis, based on real-world, retrospectively collected data over 12 months, from an ambulatory surgical care perspective. Methods FLACS was initiated in 2017 with the LenSx® laser (Alcon Vision LLC., Fort Worth, TX). The incremental cost of FLACS, cases needed to break-even, return on investment (ROI), patient education, and marketing efforts were assessed. The financial analysis considered cataract volume, conversion rates, fixed (eg, principal) and variable (eg, supplies) costs, and revenue in the first 12 months. Results The clinic performed 2717 cataract surgeries in the 12-month period, with 1304 (48%) of patients converting to FLACS. Of FLACS procedures, 613 (47%) selected an advanced-technology intraocular lens (AT-IOL; eg, toric or lifestyle IOL), and the remaining patients selected a monofocal IOL with laser astigmatism correction. FLACS increased AT-IOL use by 113 procedures (23%) compared to volumes in the year prior to FLACS. Overall, FLACS was predicted to be profitable, with only 13 cases required per month to break even in 5 years. If both facility and physician fees are considered revenue, only eight cases per month are required to break-even in 5 years. Conclusion The practice experienced a greater-than-anticipated conversion to FLACS and increased selection of AT-IOLs, well above the break-even volume required, contributing to a rapid return on their investment.
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Affiliation(s)
- David S George
- The Eye MDs, Parkersburg, WV, USA.,Physicians Outpatient Surgery Center, Belpre, OH, USA
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Obšteter J, Jenko J, Gorjanc G. Genomic Selection for Any Dairy Breeding Program via Optimized Investment in Phenotyping and Genotyping. Front Genet 2021; 12:637017. [PMID: 33679899 PMCID: PMC7928407 DOI: 10.3389/fgene.2021.637017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/14/2021] [Indexed: 12/02/2022] Open
Abstract
This paper evaluates the potential of maximizing genetic gain in dairy cattle breeding by optimizing investment into phenotyping and genotyping. Conventional breeding focuses on phenotyping selection candidates or their close relatives to maximize selection accuracy for breeders and quality assurance for producers. Genomic selection decoupled phenotyping and selection and through this increased genetic gain per year compared to the conventional selection. Although genomic selection is established in well-resourced breeding programs, small populations and developing countries still struggle with the implementation. The main issues include the lack of training animals and lack of financial resources. To address this, we simulated a case-study of a small dairy population with a number of scenarios with equal available resources yet varied use of resources for phenotyping and genotyping. The conventional progeny testing scenario collected 11 phenotypic records per lactation. In genomic selection scenarios, we reduced phenotyping to between 10 and 1 phenotypic records per lactation and invested the saved resources into genotyping. We tested these scenarios at different relative prices of phenotyping to genotyping and with or without an initial training population for genomic selection. Reallocating a part of phenotyping resources for repeated milk records to genotyping increased genetic gain compared to the conventional selection scenario regardless of the amount and relative cost of phenotyping, and the availability of an initial training population. Genetic gain increased by increasing genotyping, despite reduced phenotyping. High-genotyping scenarios even saved resources. Genomic selection scenarios expectedly increased accuracy for young non-phenotyped candidate males and females, but also proven females. This study shows that breeding programs should optimize investment into phenotyping and genotyping to maximize return on investment. Our results suggest that any dairy breeding program using conventional progeny testing with repeated milk records can implement genomic selection without increasing the level of investment.
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Affiliation(s)
- Jana Obšteter
- Department of Animal Science, Agricultural Institute of Slovenia, Ljubljana, Slovenia
| | - Janez Jenko
- Geno Breeding and A. I. Association, Hamar, Norway
| | - Gregor Gorjanc
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, United Kingdom
- Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia
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Abstract
OBJECTIVE Debates about the effectiveness of workplace wellness programs (WWPs) call for a review of the evidence for return on investment (ROI) of WWPs. We examined literature on the heterogeneity in methods used in the ROI of WWPs to show how this heterogeneity may affect conclusions and inferences about ROI. METHODS We conducted a scoping review using systematic review methods and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We reviewed PubMed, EconLit, Proquest Central, and Scopus databases for published articles. We included articles that (1) were published before December 20, 2019, when our last search was conducted, and (2) met our inclusion criteria that were based on target population, target intervention, evaluation method, and ROI as the main outcome. RESULTS We identified 47 peer-reviewed articles from the selected databases that met our inclusion criteria. We explored the effect of study characteristics on ROI estimates. Thirty-one articles had ROI measures. Studies with costs of presenteeism had the lowest ROI estimates compared with other cost combinations associated with health care and absenteeism. Studies with components of disease management produced higher ROI than programs with components of wellness. We found a positive relationship between ROI and program length and a negative relationship between ROI and conflict of interest. Evaluations in small companies (≤500 employees) were associated with lower ROI estimates than evaluations in large companies (>500 employees). Studies with lower reporting quality scores, including studies that were missing information on statistical inference, had lower ROI estimates. Higher methodologic quality was associated with lower ROI estimates. CONCLUSION This review provides recommendations that can improve the methodologic quality of studies to validate the ROI and public health effects of WWPs.
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Affiliation(s)
- Nilay Unsal
- 37504 Department of Economics, Ankara University, Ankara, Turkey
| | - GracieLee Weaver
- 14616 Office of Research & Engagement, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Jeremy Bray
- Department of Economics, Bryan School of Business and Economics, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Daniel Bibeau
- Department of Public Health Education, School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, NC, USA
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Laillou A, Baye K, Meseret Z, Darsene H, Rashid A, Chitekwe S. Wasted Children and Wasted Time: A Challenge to Meeting the Nutrition Sustainable Development Goals with a High Economic Impact to Ethiopia. Nutrients 2020; 12:E3698. [PMID: 33266008 PMCID: PMC7760409 DOI: 10.3390/nu12123698] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 11/08/2022] Open
Abstract
Despite some progress in the reduction of the prevalence of child wasting in Ethiopia, the pace of progress has been slow. Despite millions of dollars being spent on the treatment of wasting every year, the increased frequency and magnitude of environmental and anthropogenic shocks has halted progress. This study aimed to present the trends of child wasting in Ethiopia and estimate the economic losses related to the slow progress towards meeting the sustainable development goal (SDG) targets. Weather shocks and civil unrest between 2015 and 2018 have halted progress. We used a "consequence model" to apply the coefficient risk-deficit on economic losses established in the global scientific literature to the Ethiopian health, demographic, and economic data to estimate economic losses related to child wasting. The impact of wasting on the national economy of Ethiopia is estimated to be 157.8-230.2 million United States dollars (USD), annually. The greatest contributor to the economic burden (43.5-63.5% of the burden depending on the discount rate) is the cost of supplies and human resources to treat wasting. To reach the 2030 SDGs, Ethiopia should increase its annual average reduction rate (AARR) in the numbers of child (<59 months) wasting from 0.1% to 5.4%. This will avert the wasting in 7.9 million cases and prevent additional economic costs of up to 803.7 million USD over the next decade. Increasing the reach of therapeutic interventions, but also identifying and implementing wasting prevention interventions, will be critical if the SDG targets are to be met and the opportunity of the children to thrive is not to be wasted.
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Affiliation(s)
- Arnaud Laillou
- United Nations Children’s Fund (UNICEF), Addis Ababa 12000, Ethiopia; (A.R.); (S.C.)
| | - Kaleab Baye
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa 12000, Ethiopia;
| | - Zelalem Meseret
- Department for Maternal, Child Health and Nutrition, Federal Ministry of Health, Addis Ababa 12000, Ethiopia; (Z.M.); (H.D.)
| | - Hiwot Darsene
- Department for Maternal, Child Health and Nutrition, Federal Ministry of Health, Addis Ababa 12000, Ethiopia; (Z.M.); (H.D.)
| | - Abdulai Rashid
- United Nations Children’s Fund (UNICEF), Addis Ababa 12000, Ethiopia; (A.R.); (S.C.)
| | - Stanley Chitekwe
- United Nations Children’s Fund (UNICEF), Addis Ababa 12000, Ethiopia; (A.R.); (S.C.)
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Camisa V, Gilardi F, Di Brino E, Santoro A, Vinci MR, Sannino S, Bianchi N, Mesolella V, Macina N, Focarelli M, Brugaletta R, Raponi M, Ferri L, Cicchetti A, Magnavita N, Zaffina S. Return on Investment (ROI) and Development of a Workplace Disability Management Program in a Hospital-A Pilot Evaluation Study. Int J Environ Res Public Health 2020; 17:ijerph17218084. [PMID: 33147861 PMCID: PMC7662934 DOI: 10.3390/ijerph17218084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 12/14/2022]
Abstract
The progressive ageing of the working population and the increase in related chronic diseases tend to affect working capacity. The aim of this study was to evaluate a Workplace Disability Management Program (WDMP) within a pediatric hospital. Absenteeism due to healthcare workers’ (HCWs) pre- and post- WDMP and the related costs were used for the program evaluation. The Return on Investment (ROI), the Break-Even Analysis (BEA) and the value of the average annual productivity of HCWs who took advantage of the Disability Management (DM) interventions to assess the economic impact of the program, were also used. The HCWs enrolled in the program were 131 (approximately 4% of hospital staff), of which 89.7% females and with an average age of 50.4 years (SD ± 8.99). Sick leave days of the HCWs involved decreased by 66.6% in the year following the end of WDMP compared to the previous one (p < 0.001). The total estimated cost reduction of absenteeism is 427,896€ over a year. ROI was equal to 27.66€. BEA indicated that the break-even point was reached by implementing the program on 3.27 HCWs. The program evaluation demonstrated the particular effectiveness of the implemented WDMP model, acting positively on the variables that affect productivity and the limitation to work.
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Affiliation(s)
- Vincenzo Camisa
- Health Directorate, Occupational Medicine Service, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (V.C.); (F.G.); (A.S.); (M.R.V.); (R.B.)
- Post-Graduate School of Occupational Health, Catholic University of Sacred Heart, 00168 Rome, Italy; (L.F.); (N.M.)
| | - Francesco Gilardi
- Health Directorate, Occupational Medicine Service, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (V.C.); (F.G.); (A.S.); (M.R.V.); (R.B.)
| | - Eugenio Di Brino
- Graduate School of Health Economics and Management, Catholic University of Sacred Heart (ALTEMS), 00168 Rome, Italy; (E.D.B.); (A.C.)
| | - Annapaola Santoro
- Health Directorate, Occupational Medicine Service, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (V.C.); (F.G.); (A.S.); (M.R.V.); (R.B.)
| | - Maria Rosaria Vinci
- Health Directorate, Occupational Medicine Service, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (V.C.); (F.G.); (A.S.); (M.R.V.); (R.B.)
- Post-Graduate School of Occupational Health, Catholic University of Sacred Heart, 00168 Rome, Italy; (L.F.); (N.M.)
| | - Serena Sannino
- Health Directorate, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (S.S.); (M.R.)
| | - Natalia Bianchi
- Nursing and Health Allied Professionals Service, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy;
| | - Valentina Mesolella
- Human Resources Directorate, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (V.M.); (N.M.); (M.F.)
| | - Nadia Macina
- Human Resources Directorate, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (V.M.); (N.M.); (M.F.)
| | - Michela Focarelli
- Human Resources Directorate, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (V.M.); (N.M.); (M.F.)
| | - Rita Brugaletta
- Health Directorate, Occupational Medicine Service, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (V.C.); (F.G.); (A.S.); (M.R.V.); (R.B.)
| | - Massimiliano Raponi
- Health Directorate, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (S.S.); (M.R.)
| | - Livia Ferri
- Post-Graduate School of Occupational Health, Catholic University of Sacred Heart, 00168 Rome, Italy; (L.F.); (N.M.)
| | - Americo Cicchetti
- Graduate School of Health Economics and Management, Catholic University of Sacred Heart (ALTEMS), 00168 Rome, Italy; (E.D.B.); (A.C.)
| | - Nicola Magnavita
- Post-Graduate School of Occupational Health, Catholic University of Sacred Heart, 00168 Rome, Italy; (L.F.); (N.M.)
- Department of Woman, Child & Public Health, Gemelli Policlinic Foundation IRCCS, 00168 Rome, Italy
| | - Salvatore Zaffina
- Health Directorate, Occupational Medicine Service, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (V.C.); (F.G.); (A.S.); (M.R.V.); (R.B.)
- Human Resources Directorate, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (V.M.); (N.M.); (M.F.)
- Correspondence: ; Tel.: +39-06-6859-3150; Fax: +39-06-6859-3852
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Schaetz L, Rimner T, Pathak P, Fang J, Chandrasekhar D, Mueller J, Sandor PS, Gantenbein AR. Employee and Employer Benefits From a Migraine Management Program: Disease Outcomes and Cost Analysis. Headache 2020; 60:1947-1960. [PMID: 32799346 PMCID: PMC7589238 DOI: 10.1111/head.13933] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/15/2020] [Accepted: 07/06/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the impact of a migraine management program offered as a complimentary service by a company within its corporate well-being program. BACKGROUND Migraine imposes a substantial burden on patients, families, employers, and societies. As migraine primarily affects working-age adults, this has important implications for both employees and employers. Workplace educational and well-being programs positively contribute to employees' productivity, reduce costs related to absenteeism, and improve the quality of life of the employees living with migraine. METHODS This was a non-interventional cohort study, which followed employees and their family members over time. Participants received 1 telemedicine consultation to determine migraine diagnosis or a high probability of having migraine and 6 sessions of individualized telecoaching from a specialized nurse via a specially developed smartphone application to optimize their migraine management leveraging all appropriate medical and lifestyle options. Participants were evaluated during the program and at 3 months after completion through a series of validated questionnaires including Migraine Disability Assessment (MIDAS), Patient Activation Measure (PAM), and satisfaction with the services offered. A cost analysis was also performed to determine the economic benefit of the program considering the number of completers, dropouts, their associated program costs, MIDAS data, average salary of a Swiss employee in the pharma sector, and working days per year. RESULTS Of the 141 participants enrolled in the program, 79 completed 6-month and 42 completed 9-month assessments. The total MIDAS scores (mean, standard deviation [SD]) significantly improved from baseline by 54% at Month 6 (15.0 [13.6] vs 6.9 [8.2]; mean [SD] reduction: 8.1 [12.9], 95% confidence interval [CI]: 5.6-10.6; P < .0001) and by 64% at Month 9 (15.4 [14.7] vs 5.6 [6.0]; mean [SD] reduction: 9.8 [14.0], 95% CI: 6.6-13.0; P < .0001). The PAM scores also significantly improved from baseline by 8% at Month 6 (63.8 [10.9] vs 69.6 [12.8]; mean [SD] increase: 5.8 [12.8], 95% CI: 3.2-8.4; P = .003) and 11% at Month 9 (63.5 [10.7] vs 71.3 [12.2]; mean [SD] increase: 7.8 [11.0], 95% CI: 4.3-11.2; P = .003). At Month 6, common coaching lessons and respective action plans focused on progressive muscle relaxation, sleep, hydration, nutrition, general disease education, and stress management. The exit survey showed that the majority of the participants who completed the program had a meaningful and sustained improvement in their overall health and reported a high level of satisfaction with the program. The cost analysis revealed that on average participants gained 10.8 (95% CI: 9.3-12.3) working days/year that were previously lost due to migraine, resulting in a positive return on investment (ROI) of 490% (95% CI: 410%-570%), indicating a higher magnitude of savings that could be achieved by the implementation of such program. In addition to ROI and work productivity gained, participants also gained on average 13.6 (95% CI: 9.9-17.3) migraine-free days/year for their private and social life. CONCLUSION The employer-sponsored disease management program provided a better understanding of migraine, promoted methods and approaches to improve management by combining medical and lifestyle options leading to significant improvements in migraine symptoms that sustained beyond the intervention, supporting prolonged effectiveness of such programs. The program also provided a high ROI to the employer, supporting that the systematic inclusion of such programs into corporate well-being initiatives can be of significant benefit not only to the impacted individuals but to the employers as well.
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Affiliation(s)
| | | | | | - Juanzhi Fang
- Novartis Pharmaceuticals CorporationEast HanoverNJUSA
| | | | | | - Peter S. Sandor
- Neurology & NeurorehabilitationRehaClinicBad ZurzachSwitzerland
- Department of NeurologyUniversity Hospital ZurichZürichSwitzerland
| | - Andreas R. Gantenbein
- Neurology & NeurorehabilitationRehaClinicBad ZurzachSwitzerland
- Department of NeurologyUniversity Hospital ZurichZürichSwitzerland
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McGowan J, Weary R, Carriere L, Game ET, Smith JL, Garvey M, Possingham HP. Prioritizing debt conversion opportunities for marine conservation. Conserv Biol 2020; 34:1065-1075. [PMID: 32424907 PMCID: PMC8129986 DOI: 10.1111/cobi.13540] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 01/30/2020] [Accepted: 03/04/2020] [Indexed: 05/28/2023]
Abstract
Incentivized debt conversion is a financing mechanism that can assist countries with a heavy debt burden to bolster their long-term domestic investment in nature conservation. The Nature Conservancy, an international conservation-based nongovernmental organization, is adapting debt conversions to support marine conservation efforts by small island developing states and coastal countries. Prioritizing debt conversion opportunities according to their potential return on investment can increase the impact and effectiveness of this finance mechanism. We developed guidance on how to do so with a decision-support approach that relies on a novel threat-based adaptation of cost-effectiveness analysis. We constructed scenarios by varying parameters of the approach, including enabling conditions, expected benefits, and threat classifications. Incorporating both abatable and unabatable threats affected priorities across planning scenarios. Similarly, differences in scenario construction resulted in unique solution sets for top priorities. We show how environmental organizations, private entities, and investment banks can adopt structured prioritization frameworks for making decisions about conservation finance investments, such as debt conversions. Our guidance can accommodate a suite of social, ecological, and economic considerations, making the approach broadly applicable to other conservation finance mechanisms or investment strategies that seek to establish a transparent process for return-on-investment decision-making.
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Affiliation(s)
- Jennifer McGowan
- The Nature Conservancy4245 Fairfax Dr #100ArlingtonVA22203U.S.A.
| | - Rob Weary
- NatureVestThe Nature Conservancy4245 Fairfax Dr #100ArlingtonVA22203U.S.A.
| | - Leah Carriere
- NatureVestThe Nature Conservancy4245 Fairfax Dr #100ArlingtonVA22203U.S.A.
| | - Edward T. Game
- The Nature Conservancy48 Montague RoadSouth BrisbaneQld4101Australia
| | - Joanna L. Smith
- Nature UnitedThe Nature Conservancy366 Adelaide Street East, Suite 331TorontoONM5A 3X9Canada
| | - Melissa Garvey
- The Nature Conservancy4245 Fairfax Dr #100ArlingtonVA22203U.S.A.
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Abstract
BACKGROUND Workplace wellness programs (WWPs) are increasingly promoted by businesses and governments as an important strategy to improve workers' overall health and well-being and to reduce health care and other organizational costs. Few studies have evaluated WWPs in small businesses to provide evidence on the potential return-on-investment (ROI) that WWPs might yield. This study aimed to fill this gap by presenting a quasi-experimental, ROI analysis of a WWP in a small company. METHODS This observational quasi-experimental study evaluated economic outcomes of a multicomponent WWP implemented by a small long-term care company. The company provided approximately 2 years of de-identified, individualized data on its employees for 2013-2015. There were 116 WWP participants and 323 nonparticipants. Difference-in-differences models were used to evaluate the program using organizational costs and ROI estimates. FINDINGS The estimated program cost was $132.692 (95% confidence interval [CI]: [$112.957, $156.101]) per participant and the estimated organizational costs savings were $210.342 (95% CI: [-4354.095, 2002.890]). The WWP achieved an ROI of $0.585 (95% CI: [-$35.095, $14.103]) per participant. Although not statistically significant, the results suggest that the WWP saved $1.585 for every $1 invested. CONCLUSIONS/APPLICATION TO PRACTICE These results suggest that the evaluated WWP yielded a positive, although nonsignificant, ROI estimate. While ROI is still one of the most common evaluation metrics used in workplace wellness, few studies present ROI estimates of WWPs in small companies. Given policy efforts to promote WWPs in small businesses, there is a need to conduct high-quality ROI analyses for WWPs in smaller companies.
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Armsworth PR, Benefield AE, Dilkina B, Fovargue R, Jackson HB, Le Bouille D, Nolte C. Allocating resources for land protection using continuous optimization: biodiversity conservation in the United States. Ecol Appl 2020; 30:e02118. [PMID: 32173929 DOI: 10.1002/eap.2118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/15/2019] [Accepted: 01/07/2020] [Indexed: 06/10/2023]
Abstract
Spatial optimization approaches that were originally developed to help conservation organizations determine protection decisions over small spatial scales are now used to inform global or continental scale priority setting. However, the different decision contexts involved in large-scale resource allocation need to be considered. We present a continuous optimization approach in which a decision-maker allocates funding to regional offices. Local decision-makers then use these funds to implement habitat protection efforts with varying effectiveness when evaluated in terms of the funder's goals. We illustrate this continuous formulation by examining the relative priority that should be given to different counties in the coterminous United States when acquiring land to establish new protected areas. If weighting all species equally, counties in the southwest United States, where large areas can be bought cheaply, are priorities for protection. If focusing only on species of conservation concern, priorities shift to locations rich in such species, particularly near expanding exurban areas facing high rates of future habitat conversion (e.g., south-central Texas). Priorities for protection are sensitive to what is assumed about local ecological and decision-making processes. For example, decision-makers who doubt the efficacy of local land protection efforts should focus on a few key areas, while optimistic decision-makers should disperse funding more widely. Efforts to inform large-scale conservation priorities should reflect better the types of choice that decision-makers actually face when working over these scales. They also need to report the sensitivity of recommended priorities to what are often unstated assumptions about local processes affecting conservation outcomes.
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Affiliation(s)
- Paul R Armsworth
- Department of Ecology and Evolutionary Biology and National Institute for Mathematical and Biological Synthesis, University of Tennessee, 569 Dabney Hall, 1416 Circle Dr, Knoxville, Tennessee, 37996, USA
| | - Amy E Benefield
- Department of Ecology and Evolutionary Biology, University of Tennessee, 569 Dabney Hall, 1416 Circle Dr, Knoxville, Tennessee, 37996, USA
| | - Bistra Dilkina
- Department of Computer Science, University of Southern California, 941 Bloom Walk, Los Angeles, California, 90089, USA
| | - Rachel Fovargue
- Department of Ecology and Evolutionary Biology, University of Tennessee, 569 Dabney Hall, 1416 Circle Dr, Knoxville, Tennessee, 37996, USA
| | - Heather B Jackson
- Department of Ecology and Evolutionary Biology, University of Tennessee, 569 Dabney Hall, 1416 Circle Dr, Knoxville, Tennessee, 37996, USA
| | - Diane Le Bouille
- Department of Ecology and Evolutionary Biology, University of Tennessee, 569 Dabney Hall, 1416 Circle Dr, Knoxville, Tennessee, 37996, USA
| | - Christoph Nolte
- Department of Earth and Environment, Boston University, 685 Commonwealth Avenue, Boston, Massachusetts, 02215, USA
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Nash DB, Dobbins J, Cockerell T, Woodard L. Multi-Sector Partnerships and Networks to Support Social Health, Medical Education, and Return on Investment. Popul Health Manag 2020; 24:161-163. [PMID: 32639191 DOI: 10.1089/pop.2020.0110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- David B Nash
- Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
| | | | | | - LeChauncy Woodard
- College of Medicine, University of Houston, Houston, Texas, USA.,Houston Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
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Ekwaru JP, Ohinmaa A, Veugelers PJ. An Enhanced Approach for Economic Evaluation of Long-Term Benefits of School-Based Health Promotion Programs. Nutrients 2020; 12:nu12041101. [PMID: 32316099 PMCID: PMC7230436 DOI: 10.3390/nu12041101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/10/2020] [Accepted: 04/12/2020] [Indexed: 12/22/2022] Open
Abstract
Chronic diseases constitute a tremendous public health burden globally. Poor nutrition, inactive lifestyles, and obesity are established independent risk factors for chronic diseases. Public health decision-makers are in desperate need of effective and cost-effective programs that prevent chronic diseases. To date, most economic evaluations consider the effect of these programs on body weight, without considering their effects on other risk factors (nutrition and physical activity). We propose an economic evaluation approach that considers program effects on multiple risk factors rather than on a single risk factor. For demonstration, we developed an enhanced model that incorporates health promotion program effects on four risk factors (weight status, physical activity, and fruit and vegetable consumption). Relative to this enhanced model, a model that considered only the effect on weight status produced incremental cost-effectiveness ratio (ICER) estimates for quality-adjusted life years that were 1% to 43% higher, and ICER estimates for years with chronic disease prevented that were 1% to 26% higher. The corresponding estimates for return on investment were 1% to 20% lower. To avoid an underestimation of the economic benefits of chronic disease prevention programs, we recommend economic evaluations consider program effects on multiple risk factors.
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Abstract
Economics and mental health are intertwined. Apart from the accumulating evidence of the huge economic impacts of mental ill-health, and the growing recognition of the effects that economic circumstances can exert on mental health, governments and other budget-holders are putting increasing emphasis on economic data to support their decisions. Here we consider how economic evaluation (including cost-effectiveness analysis, cost-utility analysis and related techniques) can contribute evidence to inform the development of mental health policy strategies, and to identify some consequences at the treatment or care level that are of relevance to service providers and funding bodies. We provide an update and reflection on economic evidence relating to mental health using a lifespan perspective, analyzing costs and outcomes to shed light on a range of pressing issues. The past 30 years have witnessed a rapid growth in mental health economics, but major knowledge gaps remain. Across the lifespan, clearer evidence exists in the areas of perinatal depression identification-plus-treatment; risk-reduction of mental health problems in childhood and adolescence; scaling up treatment, particularly psychotherapy, for depression; community-based early intervention and employment support for psychosis; and cognitive stimulation and multicomponent carer interventions for dementia. From this discussion, we pull out the main challenges that are faced when trying to take evidence from research and translating it into policy or practice recommendations, and from there to actual implementation in terms of better treatment and care.
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Affiliation(s)
- Martin Knapp
- Care Policy and Evaluation Centre (CPEC), London School of Economics and Political ScienceLondonUK,School for Social Care Research, National Institute for Health ResearchUK
| | - Gloria Wong
- Department of Social Work and Social Administration, University of Hong KongHong Kong
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Fowler PJ, Marcal KE, Chung S, Brown DS, Jonson-Reid M, Hovmand PS. Scaling Up Housing Services Within the Child Welfare System: Policy Insights From Simulation Modeling. Child Maltreat 2020; 25:51-60. [PMID: 31096774 DOI: 10.1177/1077559519846431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Housing insecurity and homelessness contribute to risk of maltreatment among one in five of the nearly 3.5 million children annually investigated for maltreatment in the United States. The Family Unification Program (FUP)-a federal initiative-connects inadequately housed families involved in child welfare with long-term rental subsidies to avoid foster placement. However, FUP remains understudied and underutilized with funding levels that serve only a fraction of eligible households. The present study uses system dynamics modeling to inform decision-making by testing policies for scaling FUP. METHOD Simulations model delivery of FUP within child welfare from a feedback perspective. Calibrated on national data, models replicate trends in child welfare involvement from 2013 through 2016, and analyses forecast rates through 2019. Experiments test policies that enhance FUP. Outcomes track system-wide rates of family separation and returns on investment of expanded housing interventions. RESULTS Dramatic expansions of FUP benefit more families and improve marginal return on investment. Yet, scale-up fails to reduce system-wide rates of family separation or generates substantial cost-savings. CONCLUSIONS Simulations demonstrate structural challenges for scaling FUP. Constant demand for affordable housing constrains sustainable improvements in child protection. Child welfare responses to homelessness require innovations that reduce demand for housing services through prevention and earlier intervention.
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Affiliation(s)
| | | | - Saras Chung
- Brown School, Washington University, St. Louis, MO, USA
| | - Derek S Brown
- Brown School, Washington University, St. Louis, MO, USA
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Stergiopoulos S, Michaels DL, Kunz BL, Getz KA. Measuring the Impact of Patient Engagement and Patient Centricity in Clinical Research and Development. Ther Innov Regul Sci 2020; 54:103-116. [PMID: 32008233 DOI: 10.1007/s43441-019-00034-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 11/13/2018] [Indexed: 10/25/2022]
Abstract
BACKGROUND Recently, drug development companies have sought out patient feedback to improve overall drug development. However, characterization of the overall impact and return on engaging with patients have not been determined. METHODS The Drug Information Association (DIA), the Tufts Center for the Study of Drug Development (Tufts CSDD), and 17 other stakeholder organizations collaborated on a study to (1) quantify and define patient-centric initiatives (PCIs) utilized in clinical research and development and (2) to define evidence-based metrics and performance indicators that demonstrate return on engagement (ROE) of specific PCIs. We conducted a literature review, industry surveys, and in-depth interviews to determine and measure the impact of adopted PCIs. RESULTS We identified and defined 30 PCIs used to engage with patients. We analyzed 121 case studies and created a comprehensive list of metrics assessing overall return to the organization and to patients. Advocacy Group Support and Involvement, Conducting Patient Advisory Panels, and Focus Groups were examples of PCIs with the lowest cost and largest impact with respect to quality, speed, and impact on the patient relative to other PCIs. CONCLUSION The results from the literature review and use cases provide drug development teams with evidence and insights to help facilitate the adoption of specific PCIs within their organization and to help select those initiatives that would provide the highest impact to patients and development organizations. It is also hoped that the biopharmaceutical industry will apply the standardized metrics in the toolkit to systematically assess the overall return on engagement.
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Affiliation(s)
- Stella Stergiopoulos
- Tufts Center for the Study of Drug Development, Tufts University School of Medicine, 75 Kneeland Street, Suite 1100, Boston, MA, 02111, USA.
| | - Debra L Michaels
- Drug Information Association, DIA Global Center, Washington, DC, USA
| | | | - Kenneth A Getz
- Tufts Center for the Study of Drug Development, Tufts University School of Medicine, 75 Kneeland Street, Suite 1100, Boston, MA, 02111, USA
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