scholarly journals A Test-and-Not-Treat Strategy for Onchocerciasis Elimination in Loa loa–coendemic Areas: Cost Analysis of a Pilot in the Soa Health District, Cameroon

2019 ◽  
Vol 70 (8) ◽  
pp. 1628-1635 ◽  
Author(s):  
Edeltraud J Lenk ◽  
Henri C Moungui ◽  
Michel Boussinesq ◽  
Joseph Kamgno ◽  
Hugues C Nana-Djeunga ◽  
...  
Keyword(s):  
Large Scale ◽  
Central Africa ◽  
Participation Rate ◽  
Economic Cost ◽  
Health District ◽  
Base Case ◽  
Loa Loa ◽  
Control Programs ◽  
Safe Strategy ◽  
The Cost

Abstract Background Severe adverse events after treatment with ivermectin in individuals with high levels of Loa loa microfilariae in the blood preclude onchocerciasis elimination through community-directed treatment with ivermectin (CDTI) in Central Africa. We measured the cost of a community-based pilot using a test-and-not-treat (TaNT) strategy in the Soa health district in Cameroon. Methods Based on actual expenditures, we empirically estimated the economic cost of the Soa TaNT campaign, including financial costs and opportunity costs that will likely be borne by control programs and stakeholders in the future. In addition to the empirical analyses, we estimated base-case, less intensive, and more intensive resource use scenarios to explore how costs might differ if TaNT were implemented programmatically. Results The total costs of US$283 938 divided by total population, people tested, and people treated with 42% coverage were US$4.0, US$9.2, and US$9.5, respectively. In programmatic implementation, these costs (base-case estimates with less and more intensive scenarios) could be US$2.2 ($1.9–$3.6), US$5.2 ($4.5–$8.3), and US$5.4 ($4.6–$8.6), respectively. Conclusions TaNT clearly provides a safe strategy for large-scale ivermectin treatment and overcomes a major obstacle to the elimination of onchocerciasis in areas coendemic for Loa loa. Although it is more expensive than standard CDTI, costs vary depending on the setting, the implementation choices made by the institutions involved, and the community participation rate. Research on the required duration of TaNT is needed to improve the affordability assessment, and more experience is needed to understand how to implement TaNT optimally.

Cost-Effectiveness of a School-Based Chlamydia Screening Program, Duval County, FL

2019 ◽  
pp. 105984051989002 ◽  
Author(s):  
Li Yan Wang ◽  
Kwame Owusu-Edusei ◽  
J. Terry Parker ◽  
Kristina Wilson
Keyword(s):  
Cost Effectiveness ◽  
Screening Program ◽  
Student Participation ◽  
Participation Rate ◽  
Cost Effective ◽  
Base Case ◽  
Chlamydia Screening ◽  
Program Cost ◽  
Life Years ◽  
The Cost

During the 2015–2016 school year, the Florida Department of Health in Duval County hosted Teen Health Centers (TeenHC) at five high schools of Jacksonville providing HIV/STD screening and pregnancy testing. The purpose of this study was to assess the cost-effectiveness of the TeenHC chlamydia screening program and determine at what student participation level, the program can be cost-effective. We assessed the costs and effectiveness of the chlamydia screening program compared with “no TeenHC”. Cost-effectiveness was measured as cost per quality-adjusted life years (QALY) gained. At a program cost of US$61,001 and 3% participation rate, the cost/QALY gained was $124,328 in the base-case analysis and $81,014–$264,271 in 95% of the simulation trials, all greater than the frequently citied $50,000/QALY benchmark. The cost/QALY gained could be <$50,000/QALY if student participation rate was >7%. The TeenHC chlamydia screening has the potential to be cost-effective. Future program efforts should focus on improving student participation.

scholarly journals Sustained Acoustic Medicine as a Non-surgical and Non-opioid Knee Osteoarthritis Treatment Option: A Health Economic Cost-effectiveness Analysis for Symptom Management 

2020 ◽  
Author(s):  
Thomas M Best ◽  
Stephanie Petterson ◽  
Kevin Plancher
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Treatment Options ◽  
Economic Cost ◽  
Base Case ◽  
Treatment Pathways ◽  
Knee Oa ◽  
Cost Effective Treatment ◽  
The Cost

Abstract Background: Patients diagnosed with osteoarthritis (OA) and presenting with symptoms are seeking conservative treatment options to reduce pain, improve function, and avoid surgery. Sustained acoustic medicine (SAM), a multi-hour treatment has demonstrated improved clinical outcomes for patients with knee OA. The purpose of this analysis was to compare the costs and effectiveness of multi-hour SAM treatment versus the standard of care (SOC) over a 6-month timeframe for OA symptom management.Methods: A decision tree analysis was used to compare the costs and effectiveness of SAM treatment versus SOC in patients with OA. Probabilities of success for OA treatment and effectiveness were derived from the literature using systematic reviews and meta-analyses. Costs were derived from Medicare payment rates and manufacturer prices. Functional effectiveness was measured as the effect size of a therapy and treatment pathways compared to a SOC treatment pathway. A sensitivity analysis was performed to determine which cost variables had the greatest effect on deciding which option was the least costly. An incremental cost effectiveness plot comparing SAM treatment vs. SOC was also generated using 1,000 iterations of the model. Lastly, the incremental cost effectiveness ratio (ICER) was calculated as the (cost of SAM minus cost of SOC) divided by (functional effectiveness of SAM minus functional effectiveness of SOC). Results: Base case demonstrated that over 6 months, the cost and functional effectiveness of SAM was $8,641 and 0.52 versus SOC at: $6,281 and 0.39, respectively. Sensitivity analysis demonstrated that in order for SAM to be the less expensive option, the cost per 15-minute session of PT would need to be greater than $88, or SAM would need to be priced at less than or equal to $2,276. Incremental cost effectiveness demonstrated that most of the time (84%), SAM treatment resulted in improved functional effectiveness but at a higher cost than SOC.Conclusion: In patients with osteoarthritis, SAM treatment demonstrated improved pain and functional gains compared to SOC but at an increased cost. Based on the SAM treatment ICER score being ≤$50,000, it appears that SAM is a cost-effective treatment for knee OA.

scholarly journals Collateral impact of community-directed treatment with ivermectin (CDTI) for onchocerciasis on parasitological indicators of Loa loa infection

2020 ◽  
Author(s):  
Hugues C Nana Djeunga ◽  
Cédric G Lenou-Nanga ◽  
Cyrille Donfo-Azafack ◽  
Linda Djune-Yemeli ◽  
Floribert Fossuo-Thotchum ◽  
...  
Keyword(s):  
Central Africa ◽  
Cross Sectional Study ◽  
Health District ◽  
Sectional Study ◽  
Loa Loa ◽  
Intensity Of Infection ◽  
Chi Square ◽  
Cross Sectional ◽  
Antiparasitic Activity ◽  
Blood Smears

Abstract Background Ivermectin (IVM) is a broad spectrum endectocide whose initial indication was onchocerciasis. IVM-based preventive chemotherapies (PC), so-called Community-Directed Treatment with Ivermectin (CDTI), have led to the interruption of transmission of onchocerciasis in some foci. Although loiasis is not among its indications, IVM also exhibits antiparasitic activity against Loa loa. Because of the geographic overlap of onchocerciasis and loiasis in Central Africa, one would have expected similar trend for loiasis in co-endemic settings. Surprisingly, a recent study revealed that L. loa entomological indices remained almost unchanged after 13 years of CDTI to fight onchocerciasis. This study then aimed to assess whether parasitological indicators of L. loa infection follow the same trends than the previously described entomological indices. A cross-sectional study was conducted in six communities of the Yabassi Health District where CDTI have been implemented since ~ 20 years to fight onchocerciasis. All volunteers aged ≥ 5 years underwent daytime calibrated thick blood smears to search for L. loa microfilariae (mf), then prevalence and intensity of infection were compared to baseline data. Results A total of 376 individuals (55.9% female), aged 5 to 89 years old, were enrolled in this study. The prevalence of loiasis was 3.7% (95% CI: 2.2–6.2), significantly lower than its baseline (12.4%; 95% CI: 10.1–15.2) (Chi-Square = 21.4; df = 1; p < 0.0001). Similarly, the microfilarial density was significantly low (Mean = 1.8 mf/mL; SD = 13.6; max = 73,600) compared to baseline (Mean = 839.3 mf/mL; SD = 6447.1; max = 130,840) (Wilcoxon W = 179904.5; p < 0.0001). Conclusions This study revealed that the prevalence and intensity of L. loa infection were significantly low compared to their baselines, indicating a significant impact of IVM-based PC on this filarial disease. However, transmission is still ongoing, and heavily infected individuals are still found in communities, supporting why some individuals are still experiencing severe adverse events despite > 2 decades of CDTI in this Health District.

Cost- und Monitoring-Projekt: Zwei neue forstliche Meinungsumfragen im Vergleich | The Cost- and Monitoring-Projects: A Comparison of Two New Forestry Opinion Polls

2000 ◽  
Vol 151 (1) ◽  
pp. 1-10 ◽  
Author(s):  
Stephan Wild-Eck ◽  
Willi Zimmermann
Keyword(s):  
Large Scale ◽  
Forest Policy ◽  
Forest Economics ◽  
Positive Attitudes ◽  
Federal Institute ◽  
Swiss Confederation ◽  
Institute Of Technology ◽  
The Cost ◽  
Near Future ◽  
Opinion Polls

Two large-scale surveys looking at attitudes towards forests, forestry and forest policy in the second half ofthe nineties have been carried out. This work was done on behalf of the Swiss Confederation by the Chair of Forest Policy and Forest Economics of the Federal Institute of Technology (ETH) in Zurich. Not only did the two studies use very different methods, but the results also varied greatly as far as infrastructure and basic conditions were concerned. One of the main differences between the two studies was the fact that the first dealt only with mountainous areas, whereas the second was carried out on the whole Swiss population. The results of the studies reflect these differences:each produced its own specific findings. Where the same (or similar) questions were asked, the answers highlight not only how the attitudes of those questioned differ, but also views that they hold in common. Both surveys showed positive attitudes towards forests in general, as well as a deep-seated appreciation ofthe forest as a recreational area, and a positive approach to tending. Detailed results of the two surveys will be available in the near future.

Waste minimization program in Shuaiba Industrial Area

1999 ◽  
Vol 39 (10-11) ◽  
pp. 289-295
Author(s):  
Saleh Al-Muzaini
Keyword(s):  
Solid Waste ◽  
Power Plants ◽  
Large Scale ◽  
Industrial Area ◽  
Waste Minimization ◽  
Regulatory Body ◽  
Eastern Sector ◽  
Western Sector ◽  
Petroleum Companies ◽  
The Cost

The Shuaiba Industrial Area (SIA) is located about 50 km south of Kuwait City. It accommodates most of the large-scale industries in Kuwait. The total area of the SIA (both eastern and western sectors) is about 22.98 million m2. Fifteen plants are located in the eastern sector and 23 in the western sector, including two petrochemical companies, three refineries, two power plants, a melamine company, an industrial gas corporation, a paper products company and, two steam electricity generating stations, in addition to several other industries. Therefore, only 30 percent of the land in the SIA's eastern sector and 70 percent of land in the SIA's western sector is available for future expansion. Presently, industries in the SIA generate approximately 204,000 t of solid waste. With future development in the industries in the SIA, the estimated quantities will reach 240,000 t. The Shuaiba Area Authority (SAA), a governmental regulatory body responsible for planning and development in the SIA, has recognized the problem of solid waste and has developed an industrial waste minimization program. This program would help to reduce the quantity of waste generated within the SIA and thereby reduce the cost of waste management. This paper presents a description of the waste minimization program and how it is to be implemented by major petroleum companies. The protocols employed in the waste minimization program are detailed.

scholarly journals Equity and the distribution of rehabilitation personnel in one health district in the Western Cape

2001 ◽  
Vol 57 (4) ◽  
pp. 4-8
Author(s):  
P. Struthers
Keyword(s):  
One Health ◽  
District Level ◽  
Health District ◽  
Western Cape ◽  
Community Based ◽  
State Institutions ◽  
Community Based Rehabilitation ◽  
Recurrent Cost ◽  
The Cost ◽  
Rehabilitation Personnel

This paper describes a situation analysis of the rehabilitation personnel, employed by the state and non-governmental organisations, and the services available for people with disabilities in one health district in Cape Town. The recurrent cost of employing the rehabilitation personnel is analysed to determine how funding is allocated within the district. The results indicate that most expenditure on personnel is at two state institutions in the district, with 76% of the expenditure at the regional psychiatric hospital and its residential facility for people with a profound intellectual disability. The balance - 24% of expenditure - is the cost of employing rehabilitation personnel who provide a district level service. Seventy percent of this district level expenditure is at one special school that accepts 6% of children with disabilities in the district. A high percentage of intellectually disabled children and adults, with or without physical disabilities, do not have access to rehabilitation. There is minimal expenditure on employing rehabilitation personnel at the community heath centre. The only expenditure on community based rehabilitation is provided by the non-governmental organisation. The study demonstrates the inequitable distribution of funding for rehabilitation services within one relatively well-resourced health district and makes recommendations to facilitate change.

An Out-of-Core Dataflow Middleware to Reduce the Cost of Large Scale Iterative Solvers

2012 ◽  
Author(s):  
Zheng Zhou ◽  
Erik Saule ◽  
Hasan Metin Aktulga ◽  
Chao Yang ◽  
Esmond G. Ng ◽  
...  
Keyword(s):  
Large Scale ◽  
Iterative Solvers ◽  
The Cost

scholarly journals Autism Tsunami: the Impact of Rising Prevalence on the Societal Cost of Autism in the United States

2021 ◽  
Author(s):  
Mark Blaxill ◽  
Toby Rogers ◽  
Cynthia Nevison
Keyword(s):  
Forecast Model ◽  
The United States ◽  
Population Projections ◽  
Base Case ◽  
Prevention Strategies ◽  
Total Base ◽  
Cost Categories ◽  
The Cost ◽  
The Impact ◽  
First Time

AbstractThe cost of ASD in the U.S. is estimated using a forecast model that for the first time accounts for the true historical increase in ASD. Model inputs include ASD prevalence, census population projections, six cost categories, ten age brackets, inflation projections, and three future prevalence scenarios. Future ASD costs increase dramatically: total base-case costs of $223 (175–271) billion/year are estimated in 2020; $589 billion/year in 2030, $1.36 trillion/year in 2040, and $5.54 (4.29–6.78) trillion/year by 2060, with substantial potential savings through ASD prevention. Rising prevalence, the shift from child to adult-dominated costs, the transfer of costs from parents onto government, and the soaring total costs raise pressing policy questions and demand an urgent focus on prevention strategies.

The Cost of Being ‘Backward’ in India: Socio-religious Discrimination in the Labour Market

2021 ◽  
pp. 097370302110296
Author(s):  
Soumyajit Chakraborty ◽  
Alok K. Bohara
Keyword(s):  
Labour Market ◽  
Economic Cost ◽  
National Sample ◽  
Sample Survey ◽  
Religious Discrimination ◽  
Capital Endowment ◽  
Scheduled Castes ◽  
Sample Survey Data ◽  
The Cost ◽  
Human Capital Endowment

Being from backward castes, classes and Muslims in India has an economic cost associated with the nature of institutional discrimination. Using the 2011–2012 National Sample Survey data, this study identifies that caste and religion still rule the modern Indian labour market. We find that discrimination is evident in the socio-religious earnings gaps. While the parametric decompositions suggest that most of these gaps are due to differential human capital endowment, the nonparametric method almost evenly attributes inequality to discrimination and endowment. The results presented in this study suggest that discrimination against Scheduled Castes and Scheduled Tribes, Muslims and Other Backward Classes should be included in policy designs to promote equity in the Indian labour market.

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