scholarly journals Efficient routes to land conservation given risk of covenant failure

2015 ◽  
Author(s):  
Richard Schuster ◽  
Peter Arcese
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Private Land ◽  
Legal Challenges ◽  
Monitoring And Enforcement ◽  
Cost Effective Alternative ◽  
The Cost ◽  
Conservation Investment ◽  
Term Monitoring

Conservation initiatives to protect valued species communities in human-dominated landscapes face challenges linked to their potential costs. Conservation covenants on private land may represent a cost-effective alternative to land purchase, although many questions on the long-term monitoring and enforcement costs of covenants and the risk of violation or legal challenges remain unquantified. We explore the cost-effectiveness of conservation covenants, defined here as the fraction of the high-biodiversity landscape potentially protected via investment in covenants versus land purchase. We show that covenant violation and dispute rates substantially affect the estimated long-term cost-effectiveness of a covenant versus land purchase strategy. Our results suggest the long-term cost-effectiveness of conservation covenants may outperform land purchase as a strategy to protect biodiversity as long as disputes and legal challenges are low, but point to a critical need for monitoring data to reduce uncertainty and maximize conservation investment cost-effectiveness.

scholarly journals Efficient routes to land conservation given risk of covenant failure

2015 ◽  
Author(s):  
Richard Schuster ◽  
Peter Arcese
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Private Land ◽  
Legal Challenges ◽  
Monitoring And Enforcement ◽  
Cost Effective Alternative ◽  
The Cost ◽  
Conservation Investment ◽  
Term Monitoring

Conservation initiatives to protect valued species communities in human-dominated landscapes face challenges linked to their potential costs. Conservation covenants on private land may represent a cost-effective alternative to land purchase, although many questions on the long-term monitoring and enforcement costs of covenants and the risk of violation or legal challenges remain unquantified. We explore the cost-effectiveness of conservation covenants, defined here as the fraction of the high-biodiversity landscape potentially protected via investment in covenants versus land purchase. We show that covenant violation and dispute rates substantially affect the estimated long-term cost-effectiveness of a covenant versus land purchase strategy. Our results suggest the long-term cost-effectiveness of conservation covenants may outperform land purchase as a strategy to protect biodiversity as long as disputes and legal challenges are low, but point to a critical need for monitoring data to reduce uncertainty and maximize conservation investment cost-effectiveness.

The Cost-Effectiveness of an RCT to Establish Whether 5 or 10 Years of Bisphosphonate Treatment Is the Better Duration for Women With a Prior Fracture

2009 ◽  
Vol 29 (6) ◽  
pp. 678-689 ◽  
Author(s):  
Matt D. Stevenson ◽  
Jeremy E. Oakley ◽  
Myfawny Lloyd Jones ◽  
Alan Brennan ◽  
Juliet E. Compston ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Fracture Prevention ◽  
Published Data ◽  
Bisphosphonate Treatment ◽  
Net Benefit ◽  
England And Wales ◽  
Term Efficacy ◽  
The Cost

Purpose. Five years of bisphosphonate treatment have proven efficacy in reducing fractures. Concerns exist that long-term bisphosphonate treatment may actually result in an increased number of fractures. This study evaluates, in the context of England and Wales, whether it is cost-effective to conduct a randomized controlled trial (RCT) and what sample size may be optimal to estimate the efficacy of bisphosphonates in fracture prevention beyond 5 years. Method. An osteoporosis model was constructed to evaluate the cost-effectiveness of extending bisphosphonate treatment from 5 years to 10 years. Two scenarios were run. The 1st uses long-term efficacy data from published literature, and the 2nd uses distributions elicited from clinical experts. Results of a proposed RCT were simulated. The expected value of sample information technique was applied to calculate the expected net benefit of sampling from conducting such an RCT at varying levels of participants per arm and to compare this with proposed trial costs. Results. Without further information, the better duration of bisphosphonate treatment was estimated to be 5 years using the published data but 10 years using the elicited expert opinions, although in both cases uncertainty was substantial. The net benefit of sampling was consistently high when between 2000 and 5000 participants per arm were recruited. Conclusions. An RCT to evaluate the long-term efficacy of bisphosphonates in fracture prevention appears to be cost-effective for informing decision making in England and Wales.

scholarly journals Cost-effective Analysis of Proton Pump Inhibitors in Long-term Management of Gastroesophageal Reflux Disease: A Narrative Review

2019 ◽  
Vol 55 (5) ◽  
pp. 292-305
Author(s):  
Shazia Jamshed ◽  
Akshaya Srikanth Bhagavathula ◽  
Sheikh Muhammad Zeeshan Qadar ◽  
Umaira Alauddin ◽  
Sana Shamim ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Gastroesophageal Reflux Disease ◽  
Cost Effective ◽  
The Other ◽  
Cost Effectiveness Ratio ◽  
On Demand ◽  
Step Down ◽  
The Cost ◽  
Term Management

Background: Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder that results from regurgitation of acid from the stomach into the esophagus. Treatment available for GERD includes lifestyle changes, antacids, histamine-2 receptor antagonists (H2RAs), proton pump inhibitors (PPIs), and anti-reflux surgery. Aim: The aim of this review is to assess the cost-effectiveness of the use of PPIs in the long-term management of patients with GERD. Method: We searched in PubMed to identify related original articles with close consideration based on inclusion and exclusion criteria to choose the best studies for this narrative review. The first section compares the cost-effectiveness of PPIs with H2RAs in long-term heartburn management. The other sections shall only discuss the cost-effectiveness of PPIs in 5 different strategies, namely, continuous (step-up, step-down, and maintenance), on-demand, and intermittent therapies. Results: Of 55 articles published, 10 studies published from 2000 to 2015 were included. Overall, PPIs are more effective in relieving heartburn in comparison with ranitidine. The use of PPIs in managing heartburn in long-term consumption of nonsteroidal anti-inflammatory drug (NSAID) has higher cost compared with H2RA. However, if the decision-maker is willing to pay more than US$174 788.60 per extra quality-adjusted life year (QALY), then the optimal strategy is traditional NSAID (tNSAID) and PPIs. The probability of being cost-effective was also highest for NSAID and PPI co-therapy users. On-demand PPI treatment strategy showed dominant with an incremental cost-effectiveness ratio of US$2197 per QALY gained and was most effective and cost saving compared with all the other treatments. The average cost-effectiveness ratio was lower for rabeprazole therapy than for ranitidine therapy. Conclusion: Our review revealed that long-term treatment with PPIs is effective but costly. To achieve long-term cost-effective approach, we recommend on-demand approach to treat heartburn symptoms, but if the symptoms persist, treatment with continuous step-down therapy should be applied.

scholarly journals Cost-Effectiveness of an Obesity Management Program for 6- to 15-Year-Old Children in Poland: Data from Over Three Thousand Participants

Obesity Facts ◽  
2020 ◽  
Vol 13 (5) ◽  
pp. 487-498
Author(s):  
Ewa Bandurska ◽  
Michał Brzeziński ◽  
Paulina Metelska ◽  
Marzena Zarzeczna-Baran
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Management Program ◽  
Obesity And Overweight ◽  
School Programs ◽  
Overweight Group ◽  
Research Findings ◽  
Public Health Challenge ◽  
The Cost

<b><i>Background:</i></b> Obesity and overweight, including childhood obesity and overweight, pose a public health challenge worldwide. According to the available research findings, long-term interventions focusing on dietary behavior, physical activity, and psychological support are the most effective in reducing obesity in children aged 6–18 years. There are limited studies showing the financial effectiveness of such interventions. <b><i>Objective:</i></b> The objective of the present study was to evaluate cost-effectiveness of the 6-10-14 for Health weight management program using pharmacoeconomic indicators, i.e., cost-effectiveness analysis using the incremental cost-effectiveness ratio. <b><i>Methods:</i></b> We used anthropometric data of 3,081 children included in a 1-year-long intervention with a full financial cost assessment. <b><i>Results:</i></b> The cost of removing a child from the overweight group (BMI &#x3e;85th percentile) was PLN 27,758 (EUR 6,463), and the cost of removing a child from the obese group (BMI &#x3e;95th percentile) was slightly lower, i.e., PLN 23,601 (EUR 5,495). Given the obesity-related medical costs calculated in the life-long perspective, these results can be considered encouraging. At the same time, when comparing the total costs per participant with the costs of other interventions, it can be noted that they are similar to the costs of school programs containing more than 1 type of intervention. <b><i>Conclusions:</i></b> The 6-10-14 for Health program can be considered cost-effective. As a result of committing financial resources in the approximate amount of EUR 1,790 per child, around half of the children participating in the program have improved their weight indicators.

scholarly journals Cost-Effectiveness of a Problem-Solving Intervention Aimed to Prevent Sickness Absence among Employees with Common Mental Disorders or Occupational Stress

2020 ◽  
Vol 17 (14) ◽  
pp. 5234
Author(s):  
Marijke Keus Van De Poll ◽  
Gunnar Bergström ◽  
Irene Jensen ◽  
Lotta Nybergh ◽  
Lydia Kwak ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Problem Solving ◽  
Mental Disorders ◽  
Sickness Absence ◽  
Common Mental Disorders ◽  
Cost Benefit ◽  
Cost Effective ◽  
Production Loss ◽  
The Cost

The cost-benefit and cost-effectiveness of a work-directed intervention implemented by the occupational health service (OHS) for employees with common mental disorders (CMD) or stress related problems at work were investigated. The economic evaluation was conducted in a two-armed clustered RCT. Employees received either a problem-solving based intervention (PSI; n = 41) or care as usual (CAU; n = 59). Both were work-directed interventions. Data regarding sickness absence and production loss at work was gathered during a one-year follow-up. Bootstrap techniques were used to conduct a Cost-Benefit Analysis (CBA) and a Cost-Effectiveness Analysis (CEA) from both an employer and societal perspective. Intervention costs were lower for PSI than CAU. Costs for long-term sickness absence were higher for CAU, whereas costs for short-term sickness absence and production loss at work were higher for PSI. Mainly due to these costs, PSI was not cost-effective from the employer’s perspective. However, PSI was cost-beneficial from a societal perspective. CEA showed that a one-day reduction of long-term sickness absence costed on average €101 for PSI, a cost that primarily was borne by the employer. PSI reduced the socio-economic burden compared to CAU and could be recommended to policy makers. However, reduced long-term sickness absence, i.e., increased work attendance, was accompanied by employees perceiving higher levels of production loss at work and thus increased the cost for employers. This partly explains why an effective intervention was not cost-effective from the employer’s perspective. Hence, additional adjustments and/or support at the workplace might be needed for reducing the loss of production at work.

Cost-effectiveness of nab-paclitaxel plus gemcitabine versus erlotinib plus gemcitabine in metastatic pancreatic cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 353-353 ◽  
Author(s):  
E. Gabriela Chiorean ◽  
Scott Whiting ◽  
Gary Binder ◽  
George Dranitsaris ◽  
Victoria Manax
Keyword(s):  
Pancreatic Cancer ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Phase Iii ◽  
Metastatic Pancreatic Cancer ◽  
Payer Perspective ◽  
The Us ◽  
Recent Phase ◽  
Cost Effective Alternative ◽  
The Cost

353 Background: In a recent phase III trial nab-paclitaxel (albumin-bound paclitaxel) + gemcitabine (nab-P/G) demonstrated a 1.8 month, or 27%, improvement in median overall survival (OS) (HR = 0.72, P < 0.001) vs gemcitabine (G) in first-line metastatic pancreatic cancer (mPC). nab-P/G had higher 1 year OS (35% vs 22%) and improved PFS by 1.8 months (HR = 0.69, P < 0.01). nab-P/G is the first taxane based therapy to show a significant OS improvement in a phase III mPC trial. Erlotinib + gemcitabine (E/G) has also demonstrated activity in mPC, with a 0.3 month OS benefit vs G (HR = 0.82, P = 0.04), a 1 year OS of 23% vs 17%, and 0.2 months PFS benefit (HR = 0.77, P = 0.004) vs G. A cost-effectiveness analysis measuring the cost per life year (LY) gained for nab-P/G and E/G was conducted from the US payer perspective. Methods: Costs and clinical outcomes were evaluated fromnab-P/G vs G and E/G vs G trials of mPC. Health care resource use and the management of grade III/IV adverse events (AE) were collected from a large multisite US oncology clinic, expert opinion, and literature (2012 US dollars). Drug cost per cycle was multiplied by the median cycles delivered from the trials for nab-P/G and E/G. Results: Duration of therapy was 4 months for nab-P/G vs 3.9 months for E/G. Total cost for nab-P/G was $24,984 vs $23,044 for E/G, including drug, administration and AE management. AE costs were similar between the two therapies (Table). Differences of > 5% were noted in neutropenia (rates: nab-P/G = 33%; E/G = 24%), neuropathy (nab-P/G = 17%; E/G = 1%), and rash (nab-P/G = 0%; E/G = 6%). The net survival advantage for nab-P/G vs E/G was 1.5 incremental life months gained. Nab-P/G was cost-effective relative to E/G, at a cost of $15,522 per incremental life year gained. Conclusions: nab-P/G is a cost-effective alternative to E/G in mPC, bringing more months of OS at < $16,000 cost per incremental life year gained. [Table: see text]

scholarly journals Cost Effectiveness Analysis of Candesartan Therapy in Comparison to Candesartan-Amlodipine Therapy on Hypertensive Outpatients

2019 ◽  
Vol 7 (22) ◽  
pp. 3837-3840
Author(s):  
Faridah Baroroh ◽  
Andriana Sari ◽  
Noviana Masruroh
Keyword(s):  
Blood Pressure ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
Significant Difference ◽  
Hypertension Therapy ◽  
The Mean ◽  
The Cost

BACKGROUND: he achievement of optimal hypertension therapy requires cost-effective medicine. The treatment of hypertensive patients needs for long-term medication have made medical costs a prime issue in health economics. AIM: This study aims to determine the cost effectiveness of candesartan therapy compared to candesartan-amlodipine therapy on hypertensive outpatients. METHODS: This is a prospective cohort study that compares candesartan therapy to candesartan-amlodipine therapy at a public hospital from payers’ perspective. The outcome is the percentage of targeted blood pressure decrease after three months of therapy. The cost effectiveness analysis uses the Incremental Cost Effectiveness Ratio (ICER) based on the ratio of cost difference to the outcome in both therapy groups. RESULTS: As many as 111 patients participated in this research, comprising 40 candesartan therapy patients and 71 patients with the combination of candesartan-amlodipine. Of the participants, 63.96% were female, 57.66% were aged 60 or older, and 56.32% had diabetes mellitus as the most common complication. Results show that the average direct medical cost per patient for a therapy of three months with candesartan was IDR 1,050,536 ± 730,007 and IDR 760,040 ± 614,290 for a candesartan-amlodipine therapy. The mean decline of systolic and diastolic blood pressure under candesartan therapy is less than that of candesartan-amlodipine, although without any significant difference (p > 0.05). It follows that the effectiveness of candesartan (85%) is greater than that of the candesartan-amlodipine combination (84.50%). Candesartan therapy is thereby more cost-effective with an ICER value of IDR 580,993/%. CONCLUSION: Hypertension therapy by candesartan is more cost-effective than candesartan-amlodipine therapy with a cost addition of IDR 580,993.

Cost effectiveness of subaxial fusion—lateral mass screws versus transarticular facet screws

2012 ◽  
Vol 33 (1) ◽  
pp. E14 ◽  
Author(s):  
Wilson Z. Ray ◽  
Vijay M. Ravindra ◽  
Gregory F. Jost ◽  
Erica F. Bisson ◽  
Meic H. Schmidt
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Cost Comparison ◽  
Lateral Mass ◽  
Fixation Technique ◽  
Institutional Experience ◽  
Cost Effective Alternative ◽  
Lateral Mass Screws ◽  
The Cost ◽  
Theoretical Cost

As health care reform continues to evolve, demonstrating the cost effectiveness of spinal fusion procedures will be of critical value. Posterior subaxial cervical fusion with lateral mass screw and rod instrumentation is a well-established fixation technique. Subaxial transarticular facet fixation is a lesser known fusion technique that has been shown to be biomechanically equivalent to lateral mass screws for short constructs. Although there has not been a widespread adoption of transarticular facet screws, the screws potentially represent a cost-effective alternative to lateral mass rod and screw constructs. In this review, the authors describe an institutional experience with the use of lateral mass screws and provide a theoretical cost comparison with the use of transarticular facet screws.

Cost-Effectiveness of Posaconazole vs Fluconazole in the Prevention of Invasive Fungal Infections among Patients with Graft-Versus-Host Disease (GVHD) in the US.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3336-3336 ◽  
Author(s):  
Amy K. O’Sullivan ◽  
Milton C. Weinstein ◽  
Ankur Pandya ◽  
David Thompson ◽  
Amelia Langston ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Graft Versus Host Disease ◽  
Fungal Infections ◽  
Cost Effective ◽  
Graft Versus Host ◽  
Life Years ◽  
The Us ◽  
The Cost ◽  
Long Term Mortality

Abstract Trial data suggest that posaconazole is similar to fluconazole in preventing invasive fungal infections (IFIs) among allogeneic progenitor cell transplant recipients with graft-versus-host disease (GVHD). We estimated the cost-effectiveness of posaconazole versus fluconazole in this population in the US. A decision-analytic model was developed to estimate the average per patient treatment costs, IFIs avoided, life-years gained, and incremental cost per life-year gained of prophylaxis (2006 US$). The model extrapolates the trial results to a lifetime horizon to include long-term mortality due to GVHD. In the model, patients are assumed to receive posaconazole or fluconazole; efficacy data were obtained from the clinical trial. Long-term mortality and prophylaxis drug and IFI treatment costs were estimated from secondary sources. One-way and probabilistic sensitivity analyses were conducted. Posaconazole is associated with fewer IFIs (0.05 vs. 0.09), increased life years (7.87 vs. 7.66), and higher IFI-related costs (prophylaxis and IFI treatment) ($8,750 vs. $5,530) per patient relative to fluconazole. Costs for treatment of IFIs comprised 95% of the total cost for fluconazole and 35% for posaconazole. The incremental cost-effectiveness of posaconazole versus fluconazole is estimated to be $15,700 per life-year saved. Results are most sensitive to changes in the cost of treating an IFI and the efficacy of prophylaxis. Results from the probabilistic analysis indicate that there is an 88% probability that posaconazole is cost-effective at a $50,000 per life year saved threshold. We conclude that posaconazole is a cost-effective strategy for the prevention of IFIs in patients with GVHD.

scholarly journals 1604. Cost-Effectiveness of Ceftazidime-Avibactam for Patients with Hospital-Acquired Pneumonia Caused by Multi-Drug Resistant Enterobacteriaceae or Pseudomonas in China

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S797-S798
Author(s):  
Wesley Furnback ◽  
YiXi Chen ◽  
Peng Dong ◽  
Bruce Wang ◽  
Wajeeha Ansari ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
High Dose ◽  
Drug Resistant ◽  
Double Blind ◽  
Hospital Acquired Pneumonia ◽  
Cost Effective Alternative ◽  
Resistance Rates ◽  
The Cost ◽  
Hospital Acquired

Abstract Background To estimate the cost-effectiveness of ceftazidime-avibactam (CAZ-AVI) for the treatment of hospital-acquired pneumonia (HAP) including ventilator-associated pneumonia (VAP) caused by multi-drug resistant enterobacteriaceae (MDRE) or MDR pseudomonas aeruginosa (MDRPA) in China. Methods A previously published patient-level simulation model was localized to China to estimate the cost-effectiveness of first-line CAZ-AVI compared to meropenem from a healthcare perspective. Patients flowed through the model which evaluates resistance status, response, and adverse events (AEs), which can all lead to a treatment switch. Second-line therapy of colistin plus high dose meropenem was used for both arms. Resistance rates were 0.7% (CAZ-AVI) and 7.6% (meropenem) for MDRE, and 10.7% (CAZ-AVI) and 35.5% (meropenem) for MDRPA. Effectiveness rates for CAZ-AVI and meropenem were based on a randomized, double-blind, phase 3 clinical trial. All cost data, including drugs, AEs, and hospitalization were localized to China. Utility values were based on response and sourced from the literature. Costs and benefits were discounted at 5% over the five year time horizon. Results At a cost-effectiveness threshold of three-times GDP per capita, CAZ-AVI was cost-effective compared to meropenem for HAP/VAP caused by both MDRE and MDRPA with ICERs of ¥147,500 and ¥30,496, respectively. Specifically, CAZ-AVI had ¥13,699 and 0.09 additional total costs and QALYs, respectively, within MDRE; ¥5,207 and 0.17 additional total costs and QALYs, respectively, within MDRPA. Length of stay was reduced by 0.65 days and 1.37 in the CAZ-AVI arms of the MDRE and MDRPA analyses, respectively. Conclusion CAZ-AVI is a cost-effective alternative to meropenem in the treatment of HAP/VAP caused by MDRE or MDRPA in China. Disclosures Wesley Furnback, BA, Pfizer (Consultant) YiXi Chen, MSc, Pfizer (Employee) Peng Dong, PhD, Pfizer (Employee) Bruce Wang, PhD, Pfizer (Consultant) Wajeeha Ansari, MSc, Pfizer (Employee) Claudie Charbonneau, PhD, Pfizer (Employee) Hengjing Dong, MD, Pfizer (Other Financial or Material Support, Honorarium)

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