Miami Downtown People Mover Operations: Initial Segment Versus Full System

2000 ◽  
Vol 1704 (1) ◽  
pp. 53-57
Author(s):  
Murthy V. A. Bondada ◽  
David R. Fialkoff
Keyword(s):  
United States ◽  
Cost Effectiveness ◽  
Initial Segment ◽  
Cost Effective ◽  
The United States ◽  
Operating Costs ◽  
Full System ◽  
Segment Versus

The Miami, Detroit, and Jacksonville downtown people movers (DPM) were implemented in the United States in 1986, 1987, and 1989, respectively. Because capital at that time was insufficient to build full systems, the most feasible initial segments were built. These segments were the first part of larger DPM networks planned for the downtown areas. In 1994, the Miami system was expanded, and the Jacksonville system is now being expanded. These extensions to the Miami and Jacksonville DPMs will complete the systems as originally planned. Compared with the initial segments, the full systems are expected to improve downtown circulation for both the users of the initial segments, and new riders of the expanded systems. The larger systems also are more cost-effective in construction and operation than the smaller systems (initial segments). The Miami DPM, known locally as the Metromover, is the first DPM in the United States. Its initial segment operated for 8 years (1986–1994), and the full system has operated since 1994. The operations of the initial and full systems are compared to assess the increased downtown circulation and cost-effectiveness with respect to capital and operating costs.

Cost-effectiveness of digital cognitive behavioral therapy (Sleepio) for insomnia: a Markov simulation model in the United States

SLEEP ◽  
2020 ◽  
Author(s):  
Michael Darden ◽  
Colin A Espie ◽  
Jenna R Carl ◽  
Alasdair L Henry ◽  
Jennifer C Kanady ◽  
...  
Keyword(s):  
United States ◽  
Cost Effectiveness ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Cost Effective ◽  
The United States ◽  
Cognitive Behavioral ◽  
Life Years ◽  
Insomnia Treatment ◽  
Group Cbt

Abstract Study Objectives To examine the cost-effectiveness and potential net monetary benefit (NMB) of a fully automated digital cognitive behavioral therapy (CBT) intervention for insomnia compared with no insomnia treatment in the United States (US). Similar relative comparisons were made for pharmacotherapy and clinician-delivered CBT (individual and group). Methods We simulated a Markov model of 100,000 individuals using parameters calibrated from the literature including direct (treatment) and indirect costs (e.g. insomnia-related healthcare expenditure and lost workplace productivity). Health utility estimates were converted into quality-adjusted life years (QALYs) and one QALY was worth $50,000. Simulated individuals were randomized equally to one of five arms (digital CBT, pharmacotherapy, individual CBT, group CBT, or no insomnia treatment). Sensitivity was assessed by bootstrapping the calibrated parameters. Cost estimates were expressed in 2019 US dollars. Results Digital CBT was cost beneficial when compared with no insomnia treatment and had a positive NMB of $681.06 (per individual over 6 months). Bootstrap sensitivity analysis demonstrated that the NMB was positive in 94.7% of simulations. Relative to other insomnia treatments, digital CBT was the most cost-effective treatment because it generated the smallest incremental cost-effectiveness ratio (−$3,124.73). Conclusions Digital CBT was the most cost-effective insomnia treatment followed by group CBT, pharmacotherapy, and individual CBT. It is financially prudent and beneficial from a societal perspective to utilize automated digital CBT to treat insomnia at a population scale.

scholarly journals The Cost-Effectiveness of Epilepsy Surgery and Surgical Evaluation in the United States

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Shehryar R Sheikh ◽  
Michael P Steinmetz ◽  
Michael W Kattan ◽  
Mendel Singer ◽  
Belinda Udeh ◽  
...  
Keyword(s):  
United States ◽  
Monte Carlo ◽  
Cost Effectiveness ◽  
Epilepsy Surgery ◽  
Medical Management ◽  
Cost Effective ◽  
The United States ◽  
Effective Strategies ◽  
Surgical Evaluation ◽  
The Cost

Abstract INTRODUCTION Surgery is an effective treatment for many pharmacoresistant temporal lobe epilepsy patients, but incurs considerable cost. It is unknown whether surgery and surgical evaluation are cost-effective strategies in the United States. We aim to evaluate whether 1) surgery is cost-effective for patients who have been deemed surgical candidates when compared to continued medical management, 2) surgical evaluation is cost-effective for patients who have drug-resistant temporal epilepsy and may or may not ultimately be deemed surgical candidates METHODS We use a Monte Carlo simulation method to assess the cost-effectiveness of surgery and surgical evaluation over a lifetime horizon. Patients transition between two health states (‘seizure free’ and ‘having seizures’) as part of a Markov process, based on literature estimates. We adopt both healthcare and societal perspectives, including direct healthcare costs and indirect costs such as lost earnings by patients and care providers. We estimate variability of model predictions using probabilistic and deterministic sensitivity analyses. RESULTS 1) Epilepsy surgery is cost effective in surgically eligible patients by virtue of being cost saving and more effective than medical management in the long run, with 95% of 10 000 Monte Carlo simulations favoring surgery. From a societal perspective, surgery becomes cost effective within 3 yr. At 5 yr, surgery has an incremental cost-effectiveness ratio (ICER) of $31,600, which is significantly below the societal willingness-to-pay (∼ $100,000/quality-adjusted life years (QALY)) and comparable to hip/knee arthroplasty. 2) Surgical evaluation is cost-effective in pharmacoresistant patients even if the probability of being deemed a surgical candidate is low (5%-10%). Even if the probability of surgical eligibility is only 10%, surgical referral has an ICER of $96,000/QALY, which is below societal willingness-to-pay. CONCLUSION Epilepsy surgery and surgical evaluation are both cost-effective strategies in the United States. Pharmacoresistant temporal lobe epilepsy patients should be referred for surgical evaluation without hesitation on cost-effectiveness grounds.

scholarly journals Clinical Impact and Cost-effectiveness of Genotype Testing at Human Immunodeficiency Virus Diagnosis in the United States

2019 ◽  
Vol 70 (7) ◽  
pp. 1353-1363 ◽  
Author(s):  
Emily P Hyle ◽  
Justine A Scott ◽  
Paul E Sax ◽  
Lucia R I Millham ◽  
Caitlin M Dugdale ◽  
...  
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
The United States ◽  
Clinical Impact ◽  
Reverse Transcriptase Inhibitors ◽  
First Line ◽  
Immunodeficiency Virus ◽  
Quality Adjusted Life

AbstractBackgroundUS guidelines recommend genotype testing at human immunodeficiency virus (HIV) diagnosis (“baseline genotype”) to detect transmitted drug resistance (TDR) to nonnucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs), and protease inhibitors. With integrase strand inhibitor (INSTI)-based regimens now recommended as first-line antiretroviral therapy (ART), the of baseline genotypes is uncertain.MethodsWe used the Cost-effectiveness of Preventing AIDS Complications model to examine the clinical impact and cost-effectiveness of baseline genotype compared to no baseline genotype for people starting ART with dolutegravir (DTG) and an NRTI pair. For people with no TDR (83.8%), baseline genotype does not alter regimen selection. Among people with transmitted NRTI resistance (5.8%), baseline genotype guides NRTI selection and informs subsequent ART after adverse events (DTG AEs, 14%). Among people with transmitted NNRTI resistance (7.2%), baseline genotype influences care only for people with DTG AEs switching to NNRTI-based regimens. The 48-week virologic suppression varied (40%–92%) depending on TDR. Costs included $320/genotype and $2500–$3000/month for ART.ResultsCompared to no baseline genotype, baseline genotype resulted in <1 additional undiscounted quality-adjusted life-day (QALD), cost an additional $500/person, and was not cost-effective (incremental cost-effectiveness ratio: $420 000/quality-adjusted life-year). In univariate sensitivity analysis, clinical benefits of baseline genotype never exceeded 5 QALDs for all newly diagnosed people with HIV. Baseline genotype was cost-effective at current TDR prevalence only under unlikely conditions, eg, DTG-based regimens achieving ≤50% suppression of transmitted NRTI resistance.ConclusionsWith INSTI-based first-line regimens in the United States, baseline genotype offers minimal clinical benefit and is not cost-effective.

scholarly journals The Clinical Impact and Cost-effectiveness of Measles-Mumps-Rubella Vaccination to Prevent Measles Importations Among International Travelers From the United States

2018 ◽  
Vol 69 (2) ◽  
pp. 306-315 ◽  
Author(s):  
Emily P Hyle ◽  
Naomi F Fields ◽  
Amy Parker Fiebelkorn ◽  
Allison Taylor Walker ◽  
Paul Gastañaduy ◽  
...  
Keyword(s):  
United States ◽  
Cost Effectiveness ◽  
Hot Spots ◽  
Cost Effective ◽  
The United States ◽  
Clinical Impact ◽  
Sensitivity Analyses ◽  
Best Value ◽  
Measles Outbreaks ◽  
The Impact

Abstract Background Measles importations and the subsequent spread from US travelers returning from abroad are responsible for most measles cases in the United States. Increasing measles-mumps-rubella (MMR) vaccination among departing US travelers could reduce the clinical impact and costs of measles in the United States. Methods We designed a decision tree to evaluate MMR vaccination at a pretravel health encounter (PHE), compared with no encounter. We derived input parameters from Global TravEpiNet data and literature. We quantified Riskexposure to measles while traveling and the average number of US-acquired cases and contacts due to a measles importation. In sensitivity analyses, we examined the impact of destination-specific Riskexposure, including hot spots with active measles outbreaks; the percentage of previously-unvaccinated travelers; and the percentage of travelers returning to US communities with heterogeneous MMR coverage. Results The no-encounter strategy projected 22 imported and 66 US-acquired measles cases, costing $14.8M per 10M travelers. The PHE strategy projected 15 imported and 35 US-acquired cases at $190.3M per 10M travelers. PHE was not cost effective for all international travelers (incremental cost-effectiveness ratio [ICER] $4.6M/measles case averted), but offered better value (ICER <$100 000/measles case averted) or was even cost saving for travelers to hot spots, especially if travelers were previously unvaccinated or returning to US communities with heterogeneous MMR coverage. Conclusions PHEs that improve MMR vaccination among US international travelers could reduce measles cases, but are costly. The best value is for travelers with a high likelihood of measles exposure, especially if the travelers are previously unvaccinated or will return to US communities with heterogeneous MMR coverage.

scholarly journals Cost-Effectiveness of Olaratumab in Combination with Doxorubicin for Patients with Soft Tissue Sarcoma in the United States

Sarcoma ◽  
2018 ◽  
Vol 2018 ◽  
pp. 1-14 ◽  
Author(s):  
Santiago Zuluaga-Sanchez ◽  
Lisa M. Hess ◽  
Sorrel E. Wolowacz ◽  
Yulia D’yachkova ◽  
Emma Hawe ◽  
...  
Keyword(s):  
United States ◽  
Cost Effectiveness ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Meta Analysis ◽  
Single Agent ◽  
Cost Effective ◽  
Standard Of Care ◽  
The United States ◽  
Life Years

Background. Standard first-line treatments for advanced soft tissue sarcoma (STS) have changed little for 40 years, and outcomes have been poor. Recently, the United States (US) Food and Drug Administration conditionally approved olaratumab in combination with doxorubicin (Olara + Dox) based on a randomized phase II trial that reported a significant 11.8-month improvement in median survival versus single-agent doxorubicin (Dox). The present study investigated the cost-effectiveness of Olara + Dox compared with Dox and five other standard-of-care regimens from the US payer perspective. Methods. An economic model was constructed to estimate costs and outcomes over patients’ lifetimes from start of therapy. Progression-free and overall survival were based on survival analysis of patient-level data and a meta-analysis. Adverse-event rates were based on trials. Costs were from published sources. Results. Olara + Dox resulted in an estimated additional 1.27 life-years (LYs) compared with Dox, with an increase in total expected lifetime costs of $133,653. The incremental cost-effectiveness ratio (ICER) was estimated at $105,408 per LY gained; in a fully incremental analysis, all other regimens were dominated (higher costs and lower LYs or a higher ICER). Conclusion. Olara + Dox is cost-effective for STS treatment compared with Dox and other standard-of-care regimens at willingness-to-pay thresholds of $150,000 per LY and above.

scholarly journals Cost-effectiveness analysis of BNT162b2 COVID-19 booster vaccination in the United States

2021 ◽  
Author(s):  
Rui Li ◽  
Hanting Liu ◽  
Christopher Kit Fairley ◽  
Zhuoru Zou ◽  
Li Xie ◽  
...  
Keyword(s):  
United States ◽  
Older Adults ◽  
Cost Effectiveness ◽  
Booster Vaccination ◽  
Cost Effective ◽  
The United States ◽  
Cost Ratio ◽  
System Perspective ◽  
Benefit Cost Ratio ◽  
The Cost

Background: Over 86% of older adults aged ≥65 years are fully vaccinated against SARS-COV-2 in the United States (US). Waning protection of the existing vaccines promotes the new vaccination strategies, such as providing a booster shot for those fully vaccinated. Methods: We developed a decision-analytic Markov model of COVID-19 to evaluate the cost-effectiveness of a booster strategy of Pfizer-BioNTech BNT162b2 (administered 6 months after 2nd dose) in those aged ≥65 years, from a healthcare system perspective. Findings: Compared with 2-doses of BNT162b2 without a booster, the booster strategy in a 100,000 cohort of older adults would incur an additional cost of $3.4 million, but save $6.7 million in direct medical costs in 180 days. This corresponds to a benefit-cost ratio of 1.95 and a net monetary benefit of $3.4 million. Probabilistic sensitivity analysis indicates that with a COVID-19 incidence of 9.1/100,000 person-day, a booster strategy has a high chance (67%) of being cost-effective. The cost-effectiveness of the booster strategy is highly sensitive to the population incidence of COVID-19, with a cost-effectiveness threshold of 8.1/100,000 person-day. This threshold will increase with a decrease in vaccine and booster efficacies. Doubling the vaccination cost or halving the medical cost for COVID-19 treatment alone would not alter the conclusion of cost-effectiveness, but certain combinations of the two might render the booster strategy not cost-effective. Interpretation: Offering BNT162b2 boosters to older adults aged ≥65 years in the US is likely to be cost-effective. Less efficacious vaccines and boosters may still be cost-effective in settings of high SARS-COV-2 transmission. Funding: National Natural Science Foundation of China. Berlina and Bill Gates Foundation

scholarly journals Cost-Effectiveness Analysis of Local Treatment in Oligometastatic Disease

2021 ◽  
Vol 11 ◽  
Author(s):  
Dirk Mehrens ◽  
Marcus Unterrainer ◽  
Stefanie Corradini ◽  
Maximilian Niyazi ◽  
Farkhad Manapov ◽  
...  
Keyword(s):  
United States ◽  
Cost Effectiveness ◽  
Local Treatment ◽  
Cost Effective ◽  
The United States ◽  
Trial Duration ◽  
Oligometastatic Disease ◽  
Incremental Qalys ◽  
Term Analysis

BackgroundIn certain malignancies, patients with oligometastatic disease benefit from radical ablative or surgical treatment. The SABR-COMET trial demonstrated a survival benefit for oligometastatic patients randomized to local stereotactic ablative radiation (SABR) compared to patients receiving standard care (SC) alone. Our aim was to determine the cost-effectiveness of SABR.Materials and MethodsA decision model based on partitioned survival simulations estimated costs and quality-adjusted life years (QALY) associated with both strategies in a United States setting from a health care perspective. Analyses were performed over the trial duration of six years as well as a long-term horizon of 16 years. Model input parameters were based on the SABR-COMET trial data as well as best available and most recent data provided in the published literature. An annual discount of 3% for costs was implemented in the analysis. All costs were adjusted to 2019 US Dollars according to the United States Consumer Price Index. SABR costs were reported with an average of $11,700 per treatment. Deterministic and probabilistic sensitivity analyses were performed. Incremental costs, effectiveness, and cost-effectiveness ratios (ICER) were calculated. The willingness-to-pay (WTP) threshold was set to $100,000/QALY.ResultsBased on increased overall and progression-free survival, the SABR group showed 0.78 incremental QALYs over the trial duration and 1.34 incremental QALYs over the long-term analysis. Treatment with SABR led to a marginal increase in costs compared to SC alone (SABR: $304,656; SC: $303,523 for 6 years; ICER $1,446/QALY and SABR: $402,888; SC: $350,708 for long-term analysis; ICER $38,874/QALY). Therapy with SABR remained cost-effective until treatment costs of $88,969 over the trial duration (i.e. 7.6 times the average cost). Sensitivity analysis identified a strong model impact for ongoing annual costs of oligo- and polymetastatic disease states.ConclusionOur analysis suggests that local treatment with SABR adds QALYs for patients with certain oligometastatic cancers and represents an intermediate- and long-term cost-effective treatment strategy.

scholarly journals Cost-effectiveness of the anti-fibrotics for the treatment of idiopathic pulmonary fibrosis in the United States

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Timothy M. Dempsey ◽  
Viengneesee Thao ◽  
James P. Moriarty ◽  
Bijan J. Borah ◽  
Andrew H. Limper
Keyword(s):  
United States ◽  
Cost Effectiveness ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Symptom Management ◽  
Treatment Strategies ◽  
Clinical Effectiveness ◽  
Cost Effective ◽  
The United States ◽  
Effectiveness Analysis

Abstract Background The anti-fibrotic medications nintedanib and pirfenidone were approved in the United States for use in patients with idiopathic pulmonary fibrosis several years ago. While there is a growing body of evidence surrounding their clinical effectiveness, these medications are quite expensive and no prior cost-effectiveness analysis has been performed in the United States. Methods A previously published Markov model performed in the United Kingdom was replicated using United States data to project the lifetime costs and health benefits of treating idiopathic pulmonary fibrosis with: (1) symptom management; (2) pirfenidone; or (3) nintedanib. For the cost-effectiveness analysis, strategies were ranked by increasing costs and then checked for dominating treatment strategies. Then an incremental cost-effectiveness ratio was calculated for the dominant therapy. Results The anti-fibrotic medications were found to cost more than $110,000 per year compared to $12,291 annually for symptom management. While pirfenidone was slightly more expensive than nintedanib and provided the same amount of benefit, neither medication was found to be cost-effective in this U.S.-based analysis, with an average cost of $1.6 million to gain one additional quality-adjusted life year over symptom management. Conclusions Though the anti-fibrotics remain the only effective treatment option for patients with idiopathic pulmonary fibrosis and the data surrounding their clinical effectiveness continues to grow, they are not considered cost-effective treatment strategies in the United States due to their high price.

scholarly journals Treatment of moderate to severe respiratory COVID-19: a cost-utility analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Stephen E. Congly ◽  
Rhea A. Varughese ◽  
Crystal E. Brown ◽  
Fiona M. Clement ◽  
Lynora Saxinger
Keyword(s):  
United States ◽  
Health Care ◽  
Cost Effectiveness ◽  
Supportive Care ◽  
Health Care System ◽  
Cost Effective ◽  
The United States ◽  
Cost Effective Treatment ◽  
Severe Infections ◽  
Care System

AbstractDespite COVID-19’s significant morbidity and mortality, considering cost-effectiveness of pharmacologic treatment strategies for hospitalized patients remains critical to support healthcare resource decisions within budgetary constraints. As such, we calculated the cost-effectiveness of using remdesivir and dexamethasone for moderate to severe COVID-19 respiratory infections using the United States health care system as a representative model. A decision analytic model modelled a base case scenario of a 60-year-old patient admitted to hospital with COVID-19. Patients requiring oxygen were considered moderate severity, and patients with severe COVID-19 required intubation with intensive care. Strategies modelled included giving remdesivir to all patients, remdesivir in only moderate and only severe infections, dexamethasone to all patients, dexamethasone in severe infections, remdesivir in moderate/dexamethasone in severe infections, and best supportive care. Data for the model came from the published literature. The time horizon was 1 year; no discounting was performed due to the short duration. The perspective was of the payer in the United States health care system. Supportive care for moderate/severe COVID-19 cost $11,112.98 with 0.7155 quality adjusted life-year (QALY) obtained. Using dexamethasone for all patients was the most-cost effective with an incremental cost-effectiveness ratio of $980.84/QALY; all remdesivir strategies were more costly and less effective. Probabilistic sensitivity analyses showed dexamethasone for all patients was most cost-effective in 98.3% of scenarios. Dexamethasone for moderate-severe COVID-19 infections was the most cost-effective strategy and would have minimal budget impact. Based on current data, remdesivir is unlikely to be a cost-effective treatment for COVID-19.

scholarly journals Cost-effectiveness of Universal Hepatitis C Virus Screening of Pregnant Women in the United States

2019 ◽  
Vol 69 (11) ◽  
pp. 1888-1895 ◽  
Author(s):  
Antoine Chaillon ◽  
Elizabeth B Rand ◽  
Nancy Reau ◽  
Natasha K Martin
Keyword(s):  
United States ◽  
Hepatitis C Virus ◽  
Cost Effectiveness ◽  
Hepatitis C ◽  
Pregnant Women ◽  
Cost Effective ◽  
The United States ◽  
Lifetime Horizon ◽  
Hcv Screening ◽  
The Cost

Abstract Background Hepatitis C virus’ (HCV) chronic prevalence among pregnant women in the United States doubled nationally from 2009–2014 (~0.7%), yet many cases remain undiagnosed. Screening pregnant women is not recommended by the Society of Maternal-Fetal Medicine or the Centers for Disease Control and Prevention, despite new American Association For the Study of Liver Diseases (AASLD)/Infectious Diseases Society of America (IDSA) guidelines recommending screening for this group. We assessed the cost-effectiveness of HCV screening for pregnant women in the United States. Methods An HCV natural history Markov model was used to evaluate the cost-effectiveness of universal HCV screening of pregnant women, followed by treatment after pregnancy, compared to background risk-based screening from a health-care payer perspective. We assumed a HCV chronic prevalence of 0.73% among pregnant women, based on national data. We assumed no Medicaid reimbursement restrictions by fibrosis stage at baseline, but explored differing restrictions in sensitivity analyses. We assessed costs (in US dollars) and health outcomes (in quality-adjusted life-years [QALYs]) over a lifetime horizon, using new HCV drug costs of $25 000/treatment. We assessed mean incremental cost-effectiveness ratios (ICERs) under a willingness-to-pay threshold of $50 000/QALY gained. We additionally evaluated the potential population impact. Results Universal antenatal screening was cost-effective in all treatment eligibility scenarios (mean ICER &lt;$3000/QALY gained). Screening remained cost-effective at a prevalence of 0.07%, which is the lowest estimated prevalence in the United States (in Hawaii). Screening the ~5.04 million pregnant women in 2018 could result in the detection and treatment of 33 000 women, based on current fibrosis restrictions. Conclusions Universal screening for HCV among pregnant women in the United States is cost-effective and should be recommended nationally.

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