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Objective: The study aim was to review the economic evaluation literature of commercially available and effective nonsurgical weight‐loss interventions to investigate whether there is evidence to support claims of cost‐effectiveness (i.e., good value for money) or cost savings (i.e., a positive return on investment). Methods: Relevant databases were systematically reviewed to identify economic evaluations of commercially available weight‐loss products and services shown to result in clinically significant weight loss. Five weight‐loss medications (orlistat, liraglutide, naltrexone‐bupropion, semaglutide, and phentermine‐topiramate), two meal replacement programs (Jenny Craig, Optifast), and one behavioral intervention (Weight Watchers [WW]) that met inclusion criteria were identified. After screening, 32 relevant comparisons of cost‐effectiveness or cost savings across 20 studies were identified. Results: Ten of twenty pharmaceutical comparisons showed evidence of cost‐effectiveness based on established thresholds. Four of twelve nonpharmaceutical comparisons provided evidence of cost‐effectiveness, and five made claims of cost savings. However, methodological concerns cast doubt on the robustness of these claims. Conclusions: Evidence of cost‐effectiveness for commercially available, evidence‐based, nonsurgical weight‐loss interventions is mixed. There is no evidence for cost‐saving weight‐loss medications and only weak evidence for behavioral and weight‐loss interventions. Results provide a call to action to generate more robust evidence of the economic value proposition for these interventions. [ABSTRACT FROM AUTHOR]

Alveolar ridge preservation is routinely indicated in clinical practice with the purpose of attenuating postextraction ridge atrophy. Over the past two decades numerous clinical studies and reviews on this topic have populated the literature. In recent years the focus has primarily been on analyzing efficacy outcomes pertaining to postextraction dimensional changes, whereas other relevant facets of alveolar ridge preservation therapy have remained unexplored. With this premise, we carried out a comprehensive evidence‐based assessment of the complications associated with different modalities of alveolar ridge preservation and modeled the cost‐effectiveness of different therapeutic modalities as a function of changes in ridge width and height. We conclude that, among allogeneic and xenogeneic bone graft materials, increased expenditure does not translate into increased effectiveness of alveolar ridge preservation therapy. On the other hand, a significant association between expenditure on a barrier membrane and reduced horizontal and vertical ridge resorption was observed, though only to a certain degree, beyond which the return on investment was significantly diminished. [ABSTRACT FROM AUTHOR]

The Heckman Curve characterizes the rate of return to public investments in human capital as rapidly diminishing with age. For the disadvantaged, it describes investments early in the life course as having significantly higher rates of return compared to later in life. This paper assesses the Heckman Curve using estimates of program benefit cost ratios from the Washington State Institute for Public Policy. We find no support for the claim that social policy programs targeted early in the life course have the largest benefit cost ratios, or that on average the benefits of adult programs are less than the cost of the intervention. [ABSTRACT FROM AUTHOR]

Threats to biodiversity and the integrity of ecological systems are escalating globally, both within and outside of protected areas. Decision makers have inadequate resources to manage all threats and typically lack information on the likely outcomes and cost‐effectiveness of possible management strategies. Priority Threat Management (PTM) is an emerging approach designed to address this challenge, by defining and appraising cost‐effective strategies for mitigating threats to biodiversity across regions. The scientific and practical impacts of PTM are increasing, with a growing number of case study applications across the globe.Here, we provide guidance and resource material for conducting the PTM process based on our experience delivering six large‐scale projects across Australia and Canada. Our handbook describes the four stages of PTM: scoping and planning; defining and collecting key elements; analysing the cost‐effectiveness of strategies; and communicating and integrating recommendations. We summarise critical tips, strengths, and limitations and scope for possible enhancements of the approach.Priority Threat Management harnesses scientific and expert‐derived information to prioritise management strategies based on their benefit to biodiversity, management costs and feasibility. The approach involves collaboration with key experts and stakeholders in a region to improve knowledge sharing and conservation support. The PTM approach identifies sets of regional level strategies that together provide the greatest benefits for multiple species under a limited budget, which can be used to inform existing processes for decision‐making.The PTM approach applies some generalisations in management strategies and resolution, in order to address complex challenges. Further developments of the approach include testing in a greater range of socioecological systems with adaptations that cater for multiobjective decisions.Synthesis and applications. Priority Threat Management is a decision science approach that brings people together to define and prioritise strategies for managing threats to biodiversity across broad regions. It delivers a prospectus for investment in the biodiversity of a region that is transparent, repeatable, participatory, and based on the best available information. Our handbook provides the necessary guidance and resources for expanding the Priority Threat Management approach to new locations, contexts, and challenges. Priority Threat Management is a decision science approach that brings people together to define and prioritise strategies for managing threats to biodiversity across broad regions. It delivers a prospectus for investment in the biodiversity of a region that is transparent, repeatable, participatory, and based on the best available information. Our handbook provides the necessary guidance and resources for expanding the Priority Threat Management approach to new locations, contexts, and challenges. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To evaluate potential health and economic returns from implementing smoking cessation interventions in Hungary. Methods: The EQUIPTMOD, a Markov‐based economic model, was used to assess the cost‐effectiveness of three implementation scenarios: (a) introducing a social marketing campaign; (b) doubling the reach of existing group‐based behavioural support therapies and proactive telephone support; and (c) a combination of the two scenarios. All three scenarios were compared with current practice. The scenarios were chosen as feasible options available for Hungary based on the outcome of interviews with local stakeholders. Life‐time costs and quality‐adjusted life years (QALYs) were calculated from a health‐care perspective. The analyses used various return on investment (ROI) estimates, including incremental cost‐effectiveness ratios (ICERs), to compare the scenarios. Probabilistic sensitivity analyses assessed the extent to which the estimated mean ICERs were sensitive to the model input values. Results: Introducing a social marketing campaign resulted in an increase of 0.3014 additional quitters per 1 000 smokers, translating to health‐care cost‐savings of €0.6495 per smoker compared with current practice. When the value of QALY gains was considered, cost‐savings increased to €14.1598 per smoker. Doubling the reach of existing group‐based behavioural support therapies and proactive telephone support resulted in health‐care savings of €0.2539 per smoker (€3.9620 with the value of QALY gains), compared with current practice. The respective figures for the combined scenario were €0.8960 and €18.0062. Results were sensitive to model input values. Conclusions: According to the EQUIPTMOD modelling tool, it would be cost‐effective for the Hungarian authorities introduce a social marketing campaign and double the reach of existing group‐based behavioural support therapies and proactive telephone support. Such policies would more than pay for themselves in the long term. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To assess the cost‐effectiveness of alternative smoking cessation scenarios from the perspective of the Spanish National Health Service (NHS). Design: We used the European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD), a Markov‐based state transition economic model, to estimate the return on investment (ROI) of: (a) the current provision of smoking cessation services (brief physician advice and printed self‐helped material + smoking ban and tobacco duty at current levels); and (b) four alternative scenarios to complement the current provision: coverage of proactive telephone calls; nicotine replacement therapy (mono and combo) [prescription nicotine replacement therapy (Rx NRT)]; varenicline (standard duration); or bupropion. A rate of 3% was used to discount life‐time costs and benefits. Setting: Spain. Participants: Adult smoking population (16+ years). Measurements: Health‐care costs associated with treatment of smoking attributable diseases (lung cancer, coronary heart disease, chronic obstructive pulmonary infection and stroke); intervention costs; quality‐adjusted life years (QALYs). Costs and outcomes were summarized using various ROI estimates. Findings: The cost of implementing the current provision of smoking cessation services is approximately €61 million in the current year. This translates to 18 quitters per 1000 smokers and a life‐time benefit–cost ratio of 5, compared with no such provision. All alternative scenarios were dominant (cost‐saving: less expensive to run and generated more QALYs) from the life‐time perspective, compared with the current provision. The life‐time benefit–cost ratios were: 1.87 (proactive telephone calls); 1.17 (Rx NRT); 2.40 (varenicline‐standard duration); and bupropion (2.18). The results remained robust in the sensitivity analysis. Conclusions: According to the EQUIPTMOD modelling tool it would be cost‐effective for the Spanish authorities to expand the reach of existing GP brief interventions for smoking cessation, provide pro‐active telephone support, and reimburse smoking cessation medication to smokers trying to stop. Such policies would more than pay for themselves in the long run. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To evaluate costs, effects and cost‐effectiveness of increased reach of specific smoking cessation interventions in Germany. Design: A Markov‐based state transition return on investment model (EQUIPTMOD) was used to evaluate current smoking cessation interventions as well as two prospective investment scenarios. A health‐care perspective (extended to include out‐of‐pocket payments) with life‐time horizon was considered. A probabilistic analysis was used to assess uncertainty concerning predicted estimates. Setting: Germany. Participants: Cohort of current smoking population (18+ years) in Germany. Interventions: Interventions included group‐based behavioural support, financial incentive programmes and varenicline. For prospective scenario 1 the reach of group‐based behavioral support, financial incentive programme and varenicline was increased by 1% of yearly quit attempts (= 57 915 quit attempts), while prospective scenario 2 represented a higher reach, mirroring the levels observed in England. Measurements: EQUIPTMOD considered reach, intervention cost, number of quitters, quality‐of‐life years (QALYs) gained, cost‐effectiveness and return on investment. Findings: The highest returns through reduction in smoking‐related health‐care costs were seen for the financial incentive programme (€2.71 per €1 invested), followed by that of group‐based behavioural support (€1.63 per €1 invested), compared with no interventions. Varenicline had lower returns (€1.02 per €1 invested) than the other two interventions. At the population level, prospective scenario 1 led to 15 034 QALYs gained and €27 million cost‐savings, compared with current investment. Intervention effects and reach contributed most to the uncertainty around the return‐on‐investment estimates. At a hypothetical willingness‐to‐pay threshold of only €5000, the probability of being cost‐effective is approximately 75% for prospective scenario 1. Conclusions: Increasing the reach of group‐based behavioural support, financial incentives and varenicline for smoking cessation by just 1% of current annual quit attempts provides a strategy to German policymakers that improves the population's health outcomes and that may be considered cost‐effective. [ABSTRACT FROM AUTHOR]

Abstract: This article argues that in cost–benefit analysis government should adopt the opportunity cost of capital as represented by the alternative project rate of return as the social discount rate rather than the private or social time discount rate or a weighted cost of funds rate that reflects estimated proportions of investment and consumption foregone. The appropriate metric for the alternative project rate of return is average market return allowing for non‐diversifiable risk but not for diversifiable project risk. The article concludes that the appropriate social discount rate for Australia, for all sectors and states and territories, is approximately 6.5 per cent. [ABSTRACT FROM AUTHOR]

In conservation, as in most other subjects, there is a division of expenditure into problem identification, solution testing, and practice. However, research concentrates on problem identification rather than solution testing. We calculate the return on the investment of research (a PhD thesis) examining the effectiveness of conservation interventions for birds of prey in three European countries. We show that the economic return from investing in a PhD thesis could be substantial, in the order of hundreds of thousands euros over 10 years or a return on investment of between 292% and 326% over that period. We derived the values of return on investment by first setting a common biological target (the total number of raptor fledglings produced per year). We then compared overall costs in achieving such target via the wide implementation of the results from the thesis (i.e., allocating resources to the most effective intervention) versus a business as usual scenario. We identify other theses that also show considerable benefits in improving effectiveness. We suggest that further research examining effectiveness would be cost-effective in improving practice. [ABSTRACT FROM AUTHOR]

In response to our paper, we understand that James Heckman communicated to the journal Editors states that the Heckman Curve does not describe how the average return on investment of programs differs by the age of recipients. This clarification is useful as many people in the policy community have understood the Heckman Curve in this manner. [ABSTRACT FROM AUTHOR]

Fences that exclude alien invasive species are used to reduce predation pressure on reintroduced threatened wildlife. Planning these continuously managed systems of reserves raises an important extension of the Single Large or Several Small (SLOSS) reserve planning framework: the added complexity of ongoing management. We investigate the long-term costefficiency of a single large or two small predator exclusion fences in the arid Australian context of reintroducing bilbies Macrotis lagotis, and we highlight the broader significance of our results with sensitivity analysis. A single fence more frequently results in a much larger net cost than two smaller fences. We find that the cost-efficiency of two fences is robust to strong demographic and environmental uncertainty, which can help managers to mitigate the risk of incurring high costs over the entire life of the project. [ABSTRACT FROM AUTHOR]

Conservation practitioners, faced with managing multiple threats to biodiversity and limited funding, must prioritize investment in different management actions. From an economic perspective, it is routine practice to invest where the highest rate of return is expected. This return-on-investment (ROI) thinking can also benefit species conservation, and researchers are developing sophisticated approaches to support decision-making for costeffective conservation. However, applied use of these approaches is limited. Managers may be wary of ''black-box'' algorithms or complex methods that are difficult to explain to funding agencies. As an alternative, we demonstrate the use of a basic ROI analysis for determining where to invest in cost-effective management to address threats to species. This method can be applied using basic geographic information system and spreadsheet calculations. We illustrate the approach in a management action prioritization for a biodiverse region of eastern Australia. We use ROI to prioritize management actions for two threats to a suite of threatened species: habitat degradation by cattle grazing, and predation by invasive red foxes (Vulpes vulpes). We show how decisions based on cost-effective threat management depend upon how expected benefits to species are defined and how benefits and costs co-vary. By considering a combination of species richness, restricted habitats, species vulnerability, and costs of management actions, small investments can result in greater expected benefit compared with management decisions that consider only species richness. Furthermore, a landscape management strategy that implements multiple actions is more efficient than managing only for one threat, or more traditional approaches that don't consider ROI. Our approach provides transparent and logical decision support for prioritizing different actions intended to abate threats associated with multiple species; it is of use when managers need a justifiable and repeatable approach to investment. [ABSTRACT FROM AUTHOR]

Abstract: Background and Aims: Although clear benefits are associated with reducing smoking, there is increasing pressure on public health providers to justify investment in tobacco control measures. Decision‐makers need tools to assess the Return on Investment (ROI)/cost‐effectiveness of programmes. The EQUIPT project adapted an ROI tool for England to four European countries (Germany, the Netherlands, Spain and Hungary). EQUIPTMOD, the economic model at the core of the ROI tool, is designed to assess the efficiency of packages of smoking cessation interventions. The objective of this paper is to describe the methods for EQUIPTMOD and identify key outcomes associated with continued and cessation of smoking. Methods: EQUIPTMOD uses a Markov model to estimate life‐time costs, quality‐adjusted life years (QALYs) and life years associated with a current and former smoker. It uses population data on smoking prevalence, disease prevalence, mortality and the impact of smoking combined with associated costs and utility effects of disease. To illustrate the tool's potential, costs, QALYs and life expectancy were estimated for the average current smoker for five countries based on the assumptions that they continue and that they cease smoking over the next 12 months. Costs and effects were discounted at country‐specific rates. Results: For illustration, over a life‐time horizon, not quitting smoking within the next 12 months in England will reduce life expectancy by 0.66, reduce QALYs by 1.09 and result in £4961 higher disease‐related health care costs than if the smoker ceased smoking in the next 12 months. For all age–sex categories, costs were lower and QALYs higher for those who quit smoking in the 12 months than those who continued. Conclusions: EQUIPTMOD facilitates assessment of the cost effectiveness of smoking cessation strategies. The demonstrated results indicate large potential benefits from smoking cessation at both an individual and population level. [ABSTRACT FROM AUTHOR]

Abstract: In theory, biosugar for conversion to bioproducts can be produced economically from a variety of biomass types in many different technological, co‐production, and biorefinery siting contexts. In this paper, process modeling and financial analysis were conducted for all permutations of biochemical conversion pathways, global biomass types, co‐product options, and biorefinery siting contexts for biosugar production. Minimum sugar revenue (MSR) required to achieve a 15% internal rate of return values for scenarios examined ranged from $150–$748 per tonne. The scenarios with the lowest MSRs were sugarcane in South America and Asia, assuming hot water cook and co‐location or repurpose siting contexts. Another financially optimized scenario is corn grain, also assuming hot water cook, co‐producing distiller’s dry grains and solubles (DDGS), in a repurpose siting context. Against a benchmark sugar price of $408 per metric tonne, an internal rate of return on investment of >15% can typically only be achieved via previously demonstrated conversion pathways using sugar cane and corn grain. Major cost drivers were feedstock cost per metric tonne of carbohydrate, sugar yield, capital investment per annual metric tonne of sugar produced, residue value, and siting context. Near‐term promising technologies include autohydrolysis and dilute acid pathways. Generally, scenarios are financially enhanced by co‐location or repurposing, reducing capital expenditure (CAPEX) by about 33% and 50%, respectively, with negligible impact on cash cost. Conversion process complexity drives capital investment, making some scenarios infeasible despite high sugar yields. Any of the five major cost drivers can impact the order of financial attraction of scenarios, with the outcome of the analysis typically not obvious in advance. © 2018 Society of Chemical Industry and John Wiley & Sons, Ltd [ABSTRACT FROM AUTHOR]