Search

In this study, we examine the peer effect on climate risk information disclosure by analyzing A-share listed companies in China. We find that industry peers influence target firms’ climate risk information disclosure through active (passive) imitation resulting from cost–benefit considerations (institutional pressures). Leader companies are more likely to be emulated by within-industry follower companies and target firms prefer to learn from similar within-industry firms. Executive overconfidence and performance pressure negatively affect target firms’ willingness to emulate their peers. Finally, the peer effect of climate risk information disclosure demonstrates a regional aspect. Our findings have implications for reasonable climate risk information disclosure at the micro level and effective regulation to move toward achieving carbon peak/neutrality at the macro level.

Copper tailings are a category of solid waste discharged after the beneficiation process in mining plants. The significant concern raising stringent environmental issues give impetus to explore the multi-channel utilization of copper tailings in a sustainable manner. Concerning the fact that no study has systematically compared properties of copper tailings filled (CTP) asphalt mastic with conventional limestone filler mastic (LP) at different filler-to-asphalt ratios, multiscale and multi-dimensional comparisons between the characteristics of CTP-asphalt and LP-asphalt mastics were made in this study to thoroughly explore the feasibility and potential of recycling CTP as alternative filler in asphalt materials. Four ratios from 0.3 to 1.2 were used to manufacture asphalt mastics. The in-service pavement performance of asphalt mastics including resistances to rutting, low-temperature cracking and moisture damage was explored. Finally, the environmental and economic perspectives regarding the recycling of copper tailings are analyzed. Results indicate that CTP possesses a rougher surface, a larger specific surface area, and a more uniform pore size distribution than LP, particularly across the mesopores range. These characteristics could promote the adsorption of asphalt on its particle surface, potentially leading to enhanced filler-particle interaction. Regarding pavement performance, CTP-asphalt mastic outperforms LP-asphalt mastic in terms of high-temperature performance. Meanwhile, its low-temperature performance and moisture stability are only limitedly declined with the acceptable performance. Further, heavy metals leaching tests suggest that the risk for the substantial utilization of CTP in paving asphalt is absent. The related outcomes have verified the promising potential of CTP as an alternative candidate to substitute the conventional filler in paving asphalt from comprehensive consideration of in-service performance, and environmental and economic benefits.

The study aimed to assess the impact of different combinations of cultivar mixtures on finger millet blast epidemics without affecting yield. The research employed Disease Progress Curves (DPCs) such as AUDPC, rAUDPC, and sAUDPC to evaluate leaf, neck and finger blast epidemics' severity at various time intervals. Treatments involved mixtures of pre-released cultures and commercial varieties, combined with resistant cultivars in ratios of 1:1 and 2:1 to combat blast disease. These mixtures were compared with monoculture performances (resistant and susceptible checks) and fungicide treatments. The mixture of pre-released cultures (TNEc 1285 + TNEc 1294 + TNEc 1310) combined with the resistant cultivar GE4449 at a 1:1 ratio demonstrated the most significant impact in reducing the Area Under Disease Progressive Curve (AUDPC) values for all three blast types while maintaining consistent yield. This treatment exhibited results comparable to fungicide (Tricyclazole 75% WP) sprays across trials conducted from September to December in both 2020 and 2021. Economically, the cost-benefit ratio favoured the culture composite despite its delayed onset and slower progression during disease epidemics under field conditions. The mixture of cultures demonstrated sustainable yield without requiring significant additional input costs or frequent fungicidal application in both trial periods. This suggests a promising and cost-effective approach to managing finger millet blast epidemics while maintaining yield stability in agricultural practices.

This paper studies a dynamic vaccination game model embedded with vaccine cost-effectiveness and dyadic game during an epidemic, assuming the appearance of cooperation among individuals from an evolutionary perspective. The infection dynamics of the individuals' states follow a modified S/VIS (susceptible/vaccinated-infected-susceptible) dynamics. Initially, we assume that the individuals are unsure about their infection status. Thus, they make decisions regarding their options based on their neighbors' perceptions, the prevalence of the disease, and the characteristics of the available vaccines. We then consider the strategy updating process IBRA (individuals-based risk assessment) concerning an individual's committing vaccination based on a neighbor's decision. In the perspective of social dilemma, it presents the idea of social efficiency deficit to find the gap between social optimum and Nash equilibrium point based on dilemma strength by considering vaccine decision. The cost and cooperative behavior depend on disease severity, neighbor's attitude, and vaccine properties to obtain a reduced-order optimal solution to control infectious diseases. Vaccine factors (efficiency, cost, and benefit) are crucial in changing human vaccine decisions and cooperative behavior. It turns out that, even in the prisoner's dilemma case, where all defection attitude occurs, vaccine uptake (cooperation) increases. Finally, extensive numerical studies were presented that illustrate interesting phenomena and investigate the ultimate extent of the epidemic, vaccination coverage, average social benefits, and the social efficiency deficit concerning optimal strategies and the dynamic vaccine attitudes of individuals.PACS numbers.Theory and modeling; computer simulation, 87.15. Aa; Dynamics of evolution, 87.23. Kg.

Background: Tuberculosis (TB) infection screening of high-risk groups is an important strategy for achieving End TB targets. A TB infection screening program was implemented for quarry workers from a Portuguese high-incidence area in 2018-2022. We aimed to calculate the cost-benefit of the screening program from the societal perspective., Methods: We calculated medical and non-medical direct and indirect screening costs and compared them with the cost savings from averted cases of TB disease. We estimated the number of potentially averted TB disease cases based on the risk of progression of TB infection to TB disease found in the literature., Results: During the screening program, 997 workers were screened. TB infection was diagnosed in 215 workers, 150 of those initiated preventive treatment. Screening program total costs were €136,295. Twenty-nine TB cases were potentially prevented, what would have costed €152,386. Savings of €16,091 were obtained (€4516, €40898, and -€29322 from the workers, employers, and NHS, respectively)., Conclusions: The monetary benefit of a TB infection screening program directed to quarry workers in a high-incidence area was greater than its cost. Companies and workers saved substantially more money. TB infection tests that are better predictors of progression to TB disease could reduce NHS costs., Competing Interests: Declaration of competing interest The authors have no declarations of interest to declare., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Shigellosis is a leading cause of diarrhea and dysentery in young children from low to middle-income countries and adults experiencing traveler’s diarrhea worldwide. In addition to acute illness, infection by Shigella bacteria is associated with stunted growth among children, which has been linked to detrimental long-term health, developmental, and economic outcomes. On March 24 and 29, 2021, PATH convened an expert panel to discuss the potential impact of Shigella vaccines on these long-term outcomes. Based on current empirical evidence, this discussion focused on whether Shigella vaccines could potentially alleviate the long-term burden associated with Shigella infections. Also, the experts provided recommendations about how to best model the burden, health and vaccine impact, and economic consequences of Shigella infections. This international multidisciplinary panel included 13 scientists, physicians, and economists from multiple relevant specialties.According to the panel, while the relationship between Shigella infections and childhood growth deficits is complex, this relationship likely exists. Vaccine probe studies are the crucial next step to determine whether vaccination could ameliorate Shigella infection-related long-term impacts. Infants should be vaccinated during their first year of life to maximize their protection from severe acute health outcomes and ideally reduce stunting risk and subsequent negative long-term developmental and health impacts. With vaccine schedule crowding, targeted or combination vaccination approaches would likely increase vaccine uptake in high-burden areas. Shigella impact and economic assessment models should include a wider range of linear growth outcomes. Also, these models should produce a spectrum of results—ones addressing immediate benefits for usual health care decision-makers and others that include broader health impacts, providing a more comprehensive picture of vaccination benefits. While many of the underlying mechanisms of this relationship need better characterization, the remaining gaps can be best addressed by collecting data post-vaccine introduction or through large trials.

COVID-19 has shown that the consequences of a pandemic are wider-reaching than cases and deaths. Morbidity and mortality are important direct costs, but infectious diseases generate other direct and indirect benefits and costs as the economy responds to these shocks: some people lose, others gain and people modify their behaviours in ways that redistribute these benefits and costs. These additional effects feedback on health outcomes to create a complicated interdependent system of health and non-health outcomes. As a result, interventions primarily intended to reduce the burden of disease can have wider societal and economic effects and more complicated and unintended, but possibly not anticipable, system-level influences on the epidemiological dynamics themselves. Capturing these effects requires a systems approach that encompasses more direct health outcomes. Towards this end, in this article we discuss the importance of integrating epidemiology and economic models, setting out the key challenges which such a merging of epidemiology and economics presents. We conclude that understanding people’s behaviour in the context of interventions is key to developing a more complete and integrated economic-epidemiological approach; and a wider perspective on the benefits and costs of interventions (and who these fall upon) will help society better understand how to respond to future pandemics.

We propose an innovative approach to provide climate service by using the geographic distributions of natural disasters, assets exposed to disasters, and nighttime lights to estimate the potential benefit of climate-change adaptation through the economic loss avoided. We use a quasi-experimental panel data approach to assess the economic loss pre-and post-natural disaster reflected by changes in nighttime lights. Annual data from 1992 to 2012 in the Philippines is used as an example for illustration. We find that the potential benefits of climate-change adaptation might be much higher than those implied in the previous literature based on the Philippines data. We also show that the benefits would increase with the frequency of natural disasters. Our approach provides a cost-effective, transparent, and timely alternative to the conventional approach.

Background and objective: There is an increase in the global prevalence of the human immunodeficiency virus (HIV). While it has been proven that pharmacist interventions improve the health outcomes of people living with HIV/AIDS (PLWHA), the economic impact of these initiatives is uncertain. Consequently, we aim to systematically review and synthesize the evidence surrounding the economic impact of pharmacist care in PLWHA. Methods: PubMed, EMBASE, Scopus, IPA via ProQuest, the Cochrane Library, and the CINAHL Plus databases were systematically searched. Original studies evaluating the economic effect of pharmacist-managed services for PLWHA were included in the review. The quality of the economic studies was assessed using the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) checklist. Results: A search of databases yielded 4206 citations, four of which met the eligibility criteria. Three studies were conducted in a hospital-based outpatient facility, while one study was conducted in a community pharmacy setting. The types of “pharmacist-managed services” included targeted motivational education, pharmaceutical care, health screening for opportunistic infections, and referral to specialists. Two of the four economic evaluation studies had complete economic analyses and were rated as moderate in quality. In comparison with usual care, pharmacist services led to cost savings of (51.29 to 165.74 in 2021 USD$) per person per year, saving 18.5 h per patient per year, and a lower cost of generating 12 years of quality-adjusted life years. In addition, the benefit-to-cost ratio of the pharmacist service was 2.51:1. Conclusions: The pharmacist-managed services demonstrated the benefits of improving overall PLWHA health outcomes in economic viability. However, future real world controlled, high-quality economic studies are required to determine the long-term cost-effectiveness of these services, given the pharmacist's growing role in the health care team managing PLWHA.

The net benefit from investing in any technology is a function of the cost of implementation and the expected return in revenue. The objective of the present study was to quantify, using deterministic equations, the net monetary benefit from investing in genotyping of commercial females. Three case studies were presented reflecting dairy cows, beef cows and ewes based on Irish population parameters; sensitivity analyses were also performed. Parameters considered in the sensitivity analyses included the accuracy of genomic evaluations, replacement rate, proportion of female selection candidates retained as replacements, the cost of genotyping, the sire parentage error rate and the age of the female when it first gave birth. Results were presented as an annualised monetary net benefit over the lifetime of an individual, after discounting for the timing of expressions. In the base scenarios, the net benefit was greatest for dairy, followed by beef and then sheep. The net benefit improved as the reliability of the genomic evaluations improved and, in fact, a negative net benefit of genotyping was less frequent when the reliability of the genomic evaluations was high. The impact of a 10% point increase in genomic reliability was, however, greatest in sheep, followed by beef and then dairy. The net benefit of genotyping female selection candidates reduced as replacement rate increased. As genotyping costs increased, the net benefit reduced irrespective of the percentage of selection candidates kept, the replacement rate or even the population considered. Nonetheless, the association between the genotyping cost and the net benefit of genotyping differed by the percentage of selection candidates kept. Across all replacement rates evaluated, retaining 25% of the selection candidates resulted in the greatest net benefit when genotyping cost was low but the lowest net benefit when genotyping cost was high. Genotyping breakeven cost was non-linearly associated with the percentage of selection candidates retained, reaching a maximum when 50% of selection candidates were retained, irrespective of replacement rate, genomic reliability or the population. The genotyping breakeven cost was also non-linearly associated with replacement rate. The approaches outlined within provide the back-end framework for a decision support tool to quantify the net benefit of genotyping, once parameterised by the relevant population metrics.

Opioid-dependence is a comprehensive, relapsing disorder with negative individual, - family, - and societal consequences. Recovery is difficult to achieve. Research has shown reduced substance use and improved health- and psychosocial factors with extended-release naltrexone (XR-NTX) treatment. Pharmacological treatment should include psychosocial interventions to improve longer-term recovery. This study explores how voluntary monthly treatment with extended-release naltrexone hydrochloride (Vivitrol®) will influence longer-term recovery, health and psychosocial relationships in opioid-dependent patients. Close relatives’ experiences and societal costs will be assessed. This Norwegian naturalistic, multicenter, open-label study includes 150 opioiddependent patients. Patients are assessed every four weeks for 24 weeks, with 28 weeks optional follow-up treatment-period, and at three, six and 12 months posttreatment. Controls are opioid-dependent patients enrolled in Opioid Maintenance Treatment programs (n = 150). Data on recovery will be collected from participants, close relatives, and community health service providers. Genetic analyses of major signaling pathways and national registries on prescriptions and health care use will be analyzed. Recruitment period is September 2018 to September 2020. The assessment of medical, psychological, relational and societal factors may provide novel in-depth knowledge on the complexity of personal recovery-processes. The results are expected to have impact on priorities in treatment and follow-up for opioid dependent patients.

The value of an investigative lead corresponds directly to the increase of the speed at which that lead is provided. A cost-benefit model using sexual assault cases demonstrates the preventative savings of quicker forensic DNA analytical response times by calculating the cost of additional crime committed while cases sit awaiting analysis to commence. Calculations are provided per analyst day and with estimated U.S. nationwide impacts. With the elimination of the awaiting analysis backlog, crimes could be prevented, as well as justice better served to those wrongfully suspected. A case study demonstrates the value of timely forensic DNA analysis for sexual assault cases. A wrongfully accused individual identified by eyewitness testimony was eliminated by forensic analysis, while a very similar appearing recidivist perpetrator was included in a subsequent DNA comparison.

The mission of forensic laboratories is to maximize the value of evidence. As price and quality are relatively fixed for consumers of forensic analysis, the main measure of service effectiveness is timeliness. Resources have been demonstrated as the means to improve timeliness. However, as the availability of governmental resources is also relatively fixed, to optimize resource distribution, there must be an evaluation as to the most effective allocation. Cost-benefit analysis or determination of the return on investment has been demonstrated as an objective means to compare various competing options as targets for resource deployment. Therefore, a cost-benefit analysis of forensic science will be conducted to evaluate the option of applying additional resources to maximize the value of forensic analysis through optimal timeliness of service. A case study will be provided using historical data to examine the net benefit from forensic investigative leads.

Abstract Objective: To perform a comprehensive economic evaluation of border closure for an island nation in the face of severe pandemic scenarios. Methods: The costing tool developed by the New Zealand (NZ) Treasury (CBAx) was used for the analyses. Pandemic scenarios were as per previous work;1 epidemiological data were from past New Zealand influenza pandemics. Results: The net present value of successful border closure was NZ$7.86 billion for Scenario A (half the mortality rate of the 1918 influenza pandemic) and $144 billion for preventing a more severe pandemic (10 times the mortality of scenario A). Cost–utility analyses found border closure was relatively cost‐effective, at $14,400 per QALY gained in Scenario A, and cost‐saving for Scenario B (taking the societal perspective). Conclusions: This work quantifies the economic benefits and costs from border closure for New Zealand under specific assumptions in a generic but severe pandemic threat (e.g. influenza, synthetic bioweapon). Preparing for such a pandemic response seems wise for an island nation, although successful border closure may only be feasible if planned well ahead. Implications for public health: Policy makers responsible for generic pandemic planning should explore how border closure could be implemented, including practical and legal frameworks.

Nitrate in drinking water is a contaminant which can affect human health and has been associated with an increased risk of, amongst other diseases, colorectal cancer. Based on epidemiologic data from Denmark on the association between drinking water nitrate and colorectal cancer, the health and economic consequences of lowering the standard of nitrate in drinking water from 50 mg/L to 9.25 mg/L and 3.87 mg/L, respectively are analyzed. The drinking water nitrate attributable number of cases was estimated using the risk in the exposed and unexposed population based on current nationwide exposure distributions. The analysis shows that a lower limit of 9.25 mg/L would decrease the annual number of colorectal cancer cases by 72 (95 % confidence interval: 34-114) and by an additional 55 (95 % CI: 10-100) for a stricter limit of 3.87 mg/L. The resulting avoided health-related costs are $179 million per year for the 9.25 mg/L nitrate limit and another $138 million per year for a further reduction to 3.87 mg/L nitrate. The new requirements would incur costs linked to either i) changes in land use management, ii) well reallocation or iii) use of treatment technologies. The additional costs are estimated to $0.03-1.84 per m 3 abstracted water from public water companies, which together with costs for owners of private wells, will result in an average additional cost of $9 and $6 million per year for the two levels. The economic health benefits are higher than the costs for both limits with net gains of $170 million (9.25 mg/L) and additionally $132 million (3.87 mg/L) a year. Even in a worst-case scenario (lowest health-related benefits and highest mitigation costs), there is a likely economic gain for society from lowering the limit to 9.25 mg/L, but this might not be the case for the lower limit of 3.87 mg/L., Competing Interests: Declaration of competing interest The authors declare no competing interests. The funding source had no role in the conduct of this research., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Considering the soil cadmium pollution problem, the Chinese government proposed to estimate the costs and practicality "to completely improve the soil quality by the middle of this century". This study analyzed the challenges in achieving this goal using biophysical data from 10 typical demonstration soil phytoextraction projects. The current annual phytoextraction efficiency was determined as 14.8-490 g ha -1 a -1 at 319 RMB g -1 cadmium. A total of 798 billion RMB and 5 years were required for remediation of cadmium contamination, which was 22 times the investment in soil remediation during 2016-2022. The break-even point of phytoextraction projects was 29 years. The heavy financial burden was considered the primary challenge in improving the environmental quality of such soil. The cost could be reduced by 5.5-35.3 % through optimization measures such as resourcefulness of hyperaccumulator harvests, large-scale breeding, and mechanized management. The break-even point could be shortened to 6-15 years by intercropping/rotating crops, contributing to the goal. Active exploration of phytoextraction efficiency-more efficient accumulators, optimized agronomic measures-is worth practicing., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier B.V.)

Despite the growing interest, limited studies have been conducted on LID spatial allocation optimization (SAO) at neighborhood scale, and no study has applied modifications to the optimization algorithm to improve its performance. In this study, such a new LID SAO system was proposed, which integrated a hydrological computing engine (SWMM) with an optimization algorithm (PICEA-g) using a programming language (MATLAB) as the platform. The specific modifications to the PICEA-g algorithm include: new methodologies for initializing candidate solutions, defining goal vector boundaries and enhanced genetic operators. The new LID SAO system was tested in a typical urban residential neighborhood in western Canada, and optimal solutions for LID implementation (bioretention, rain garden, permeable pavement and green roof) were obtained. The results showed that promising hydrologic benefits of reducing peak flow rate and total volume of stormwater runoff from the catchment, can be achieved with a relatively low cost. The LID SAO system provides users with flexibility and feasibility for a variety of drainage locations, scales and objectives (e.g., water quality)., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Food waste (FW) is a primary constituent of solid waste and its adequate management is a global challenge. Instead of disposal in landfills, integrated treatment of FW with wastewater (WW) can diminish both environmental and economic burdens. Utilizing steady-state modelling and life cycle assessment techniques, this study investigated the prospects of FW integration with biological WW treatment in terms of WW treatment performance, net energy and carbon footprint and economics of the process. The explored scenarios include co-disposal and treatment with WW by using FW disposers and anaerobic co-digestion with sewage sludge in Hong Kong. Compared to the existing WW and FW treatment, the integrated scenarios significantly improved the energy balance (~83-126%), net greenhouse gas emissions (~90%), and economics of operation, with permissible impact on WW treatment performance. Therefore, utilizing the surplus capacity of the existing WW treatment facilities, these integrated scenarios are a promising solution for sustainable development., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Purpose: To evaluate whether the additional cost of providing increasingly faster genomic results in pediatric critical care is outweighed by reductions in health care costs and increases in personal utility., Methods: Hospital costs and medical files from a cohort of 40 children were analyzed. The health economic impact of rapid and ultra-rapid genomic testing, with and without early initiation, relative to standard genomic testing was evaluated., Results: Shortening the time to results led to substantial economic and personal benefits. Early initiation of ultra-rapid genomic testing was the most cost-beneficial strategy, leading to a cost saving of AU$26,600 per child tested relative to standard genomic testing and a welfare gain of AU$12,000 per child tested. Implementation of early ultra-rapid testing of critically ill children is expected to lead to an annual cost saving of AU$7.3 million for the Australian health system and an aggregate welfare gain of AU$3.3 million, corresponding to a total net benefit of AU$10.6 million., Conclusion: Early initiation of ultra-rapid genomic testing can offer substantial economic and personal benefits. Future implementation of rapid genomic testing programs should focus not only on optimizing the laboratory workflow to achieve a fast turnaround time but also on changing clinical practice to expedite test initiation., Competing Interests: Conflict of Interest The authors declare no conflicts of interest., (Copyright © 2022 American College of Medical Genetics and Genomics. Published by Elsevier Inc. All rights reserved.)

As evaluators and economists expand their domains of research, consulting, teaching, and publication, they find themselves needing each other more and yet increasingly at odds. Often surprised at the resistance they encounter from one another, sometimes dismissive of contributions the other can make, all should consider adaptations and transformations of roles, approaches, methods, analyses, and decision-making algorithms that would allow better collaboration. The particularly multidisciplinary area of cost-inclusive evaluation requires (a) changes in approaches and methods used by evaluators and economists, (b) changes that evaluators need to make when working with economists, and (c) changes that economists need to make when working with evaluators. Some of the changes needed are illustrated with examples drawn from proposals and manuscripts for contemporary cost-inclusive evaluations. A key reframing needed is that cost-effectiveness and cost-benefit analyses are "and" rather than "or" activities: cost-inclusive evaluation works best, and perhaps only really works, when evaluators and economists interweave their efforts to support and learn from each other. So may most future endeavors to which multiple disciplines contribute., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objectives: Area under the time-concentration curve (AUC) -guided dosing provides better estimates of exposure than vancomycin trough concentrations. Though clinical benefits have been reported, the costs of AUC-guided dosing are uncertain. The objective of this study was to quantify the costs of single-sample Bayesian or two-sample AUC strategies versus trough-guided dosing., Methods: A cost-benefit analysis from the institutional perspective was conducted using a decision tree to model the probabilities and costs of acute kidney injury (AKI) associated with vancomycin administered over 48 hours up to 21+ days. Costs included vancomycin concentrations, Bayesian software and AKI hospitalization costs, and probabilities were obtained from primary literature. Robustness was assessed via both one-way and probabilistic sensitivity analyses., Results: In the base-case model, two-sample AUC versus trough dosing saved an average of US$ 846 per patient encounter, and single-sample Bayesian AUC versus trough dosing saved an average of US$ 2065 per patient encounter. This translates into annual cost-savings of US$ 846 810 and US$ 2 065 720 for two-sample and single-sample Bayesian methods versus trough dosing, respectively, assuming 1000 vancomycin-treated patients per year. Assuming a budget of US$ 100 000 per year for Bayesian software, an institution would need to treat ≥41 patients with vancomycin for at least 48 hours to break even., Conclusions: There are significant institutional cost benefits using two-sample AUC or single-sample Bayesian methods over trough dosing, even after accounting for the annual costs of Bayesian programs. The potential to decrease rates of AKI, improve clinical outcomes and reduce costs to the institution strongly warrants consideration of improved dosing methods for vancomycin., (Copyright © 2020 European Society of Clinical Microbiology and Infectious Diseases. All rights reserved.)

Introduction: Portable chest radiography through glass (TG-CXR) is a novel technique, particularly useful during the COVID-19 (Coronavirus disease 2019) pandemic. The purpose of this study was to understand the cost and benefit of adopting TG-CXR in quantifiable terms., Methods: Portable or bedside radiographs are typically performed by a team of two technologists. The TG-CXR method has the benefit of allowing one technologist to stay outside of the patient room while operating the portable radiography machine, reducing PPE use, decreasing the frequency of radiography machine sanitization and decreasing technologists' exposures to potentially infectious patients. The cost of implementing this technique during the current COVID-19 pandemic was obtained from our department's operational database. The direct cost of routinely used PPE and sanitization materials and the cost of the time taken by the technologists to clean the machine was used to form a quantitative picture of the benefit associated with TG-CXR technique., Results: Technologists were trained on the TG-CXR method during a 15 min shift change briefing. This translated to a one-time cost of $424.88 USD. There was an average reduction of portable radiography machine downtime of 4 min and 48 s per study. The benefit of adopting the TG-CXR technique was $9.87 USD per patient imaged. This will result in a projected net cost savings of $51,451.84 USD per annum., Conclusion: Adoption of the TG-CXR technique during the COVID-19 pandemic involved minimal one-time cost, but is projected to result in a net-benefit of over $51,000 USD per annum in our emergency department., (Copyright © 2021. Published by Elsevier Inc.)

We present a comprehensive study on the impacts and associated changes in costs resulting from the implementation of Environmental Speed Limits (ESLs), as a measure to reduce PM 10 and associated health effects. We present detailed modelled emissions (i.e., CO 2 , NO x , PM 2.5 and PM 10 ), concentration levels (i.e., PM 2.5 and PM 10 ) and population exposure to PM 2.5 and PM 10 under three scenarios of ESL implementation for the Metropolitan Area of Oslo. We find that whilst emissions of NO x and CO 2 do not seem to show significant changes with ESL implementation, PM 10 emissions are reduced by 6-12% and annual concentration levels are reduced up to 8%, with a subsequent reduction in population exposure. The modelled data is used to carry out a detailed analysis to quantify the changes in private and social costs for the roads in Oslo where ESL are implemented today. This involves assessments related to human health, climate, fuel consumption, time losses and the incidence of traffic accidents. For a scenario using actual speed data from ESL implementation, our study shows a net benefit associated with the implementation of ESLs, whilst for a theoretical scenario with strict speed limit compliance we find a net increase in costs. This is largely due to variation in costs due to time losses between the scenarios, although uncertainties are high., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

Research Question: Natural fecundity and the success of IVF and intracytoplasmic sperm injection (ICSI) rate both decrease with age. For this reason, in women older than 35 years, it is generally recommended to start the infertility work-up after only 6 months. This assumption, however, may expose couples to over-diagnosis and over-treatment., Design: A theoretical model aimed at assessing the effects of starting the infertility work-up after 6 rather than 12 months of trying to conceive naturally was developed. The assumptions of the model were as follows: infertile women are treated with IVF/ICSI for up to three cycles; IVF/ICSI success rate at first cycle linearly declines with age (3% per year between the ages of 35 and 45 years); the drop-out rate after the first and second cycle is 18% and 25%, respectively; the relative reduction of the success rate at second and third cycle is 16% and 26%, respectively., Results: Early initiation of treatment moderately improved the cumulative chances of live birth resulting from a full IVF/ICSI programme. This improvement is dependent on age. Specifically, it increased from 2.0% at age 35 years to 3.0% at age 43 years. Conversely, the incremental success rate per single IVF cycle was mainly stable, varying only from 1.4% at age 35 years to 1.3% at age 43 years., Conclusions: In women older than 35 years, early initiation of the infertility work-up is associated with only a modest increase in the rate of success of IVF/ICSI. In most scenarios, this advantage may compare unfavourably with the chances of natural conception during the 6-month period., (Copyright © 2019 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Study Objective: To establish the best dose regimen for tranexamic acid (TXA) in total hip replacement surgery., Design: Secondary analysis based on data from a multicenter double-blind randomized clinical trial., Setting: Two hospitals in Spain., Interventions: TXA (2 doses) versus placebo., Patients: Consecutive adults who underwent uncemented unilateral total replacement hip surgery., Measurements: We estimated the costs associated with TXA use (including consumables, drugs and nurse time) and allogeneic and autologous blood transfusions. For the cost-benefit analysis, we considered the spending on controls to estimate the benefits and the spending on patients in the intervention arms to estimate the costs. The net cost-benefit of TXA administration was calculated by subtracting the costs incurred per patient given TXA from the costs per patient given placebo., Main Results: The median total costs per patient were €2.7 (2.4-3.0) in the single-dose group, €6.5 (6.5-7.1) in the two-dose group and €0 (0-190) in the control group (p = 0.001). The blood transfusion costs were €1607.8, €1041.8 and €3115.3 in the single-dose, two-dose and control groups, respectively. The administration of two doses of TXA achieved a greater net cost-benefit than a single dose, the difference being €566 in terms of overall costs., Conclusions: The administration of TXA is cost-effective, especially in the case of the two-dose regimen studied., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Decision making requires consideration of both the benefits of a given choice and the costs, which can include risk, delay, and effort. Previous research has examined the developmental trajectory of adolescent decision making regarding risk and delay; however, the effects of effort on adolescent decision making remain largely unexplored. In the present study, we pilot tested a novel, developmentally-appropriate task designed to examine developmental differences in the willingness to expend effort during goal pursuit in adolescents (ages 13-16, n = 23) versus young adults (ages 18-23, n = 25). Self-reported reward responsivity correlated with task-related parameter estimates for effort and reward, providing evidence of task validity. Adolescents exhibited reduced sensitivity to physical effort costs compared to adults, effects which did not appear to be driven by differences in subjective task motivation or awareness of the effort requirements. These findings provide preliminary evidence that adolescence may be a time of increased willingness to expend effort during goal pursuit. Effort-based decision making is an understudied but exciting avenue for developmental research, as the willingness to engage in effortful pursuit of new experiences during adolescence may help to facilitate the path to independence., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: As one strategy to improve the health and survival of people who inject drugs, the King County Heroin & Opioid Addiction Task Force recommended the establishment of supervised injection facilities (SIF) where people can inject drugs in a safe and hygienic environment with clinical supervision. Analyses for other sites have found them to be cost-effective, but it is not clear whether these findings are transferable to other settings., Methods: We utilized local estimates and other data sources deemed appropriate for our setting to implement a mathematical model that assesses the impact of a hypothetical SIF on overdose deaths, non-fatal overdose health service utilization, skin and soft tissue infections, bacterial infections, viral infections, and enrollment in medication assisted treatment (MAT). We estimated the costs and savings that would occur on an annual basis for a small-scale pilot site given current overdose rates, as well as three other scenarios of varying scale and underlying overdose rates., Results: Assuming current overdose rates, a hypothetical Seattle SIF in a pilot phase is projected to annually reverse 167 overdoses and prevent 6 overdose deaths, 45 hospitalizations, 90 emergency department visits, and 92 emergency medical service deployments. Additionally, the site would facilitate the enrollment of 41 SIF clients in medication assisted treatment programs. These health benefits correspond to a monetary value of $5,156,019. The annual estimated cost of running the SIF is $1,222,332. The corresponding cost-benefit ratio suggests that the pilot SIF would generate $4.22 for every dollar spent on SIF operational costs. The pilot SIF is projected to save the healthcare system $534,453. If Seattle experienced elevated overdose rates and Seattle SIF program were scaled up, the health benefits and financial value would be considerably greater., Conclusion: This analysis suggests that a SIF program in Seattle would save lives and result in considerable health benefits and cost savings., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Lead exposure represents a significant human health concern that often occurs with little warning to the consumer. Water lead levels can be mitigated by point-of-use (POU) devices such as reverse osmosis, distillation, or activated carbon with lead reduction media., Objectives: This study assessed a partial cost-benefit of residential installation of POU devices to reduce lead concentrations in drinking water and examined the economic impact at the community level based on exposures reported in Flint, Michigan., Methods: We calculated the individual consumer breakeven point for each lead abatement option by subtracting the lifetime cost of device installation and maintenance from the lifetime cost of lead exposure through its impact on intelligence (IQ) and lifetime earnings. This approach was then extrapolated to the community level based on reported lead exposures in Flint, Michigan., Results: Based on operating POU device costs, lead absorption from water, and economic losses associated with reduced IQ, initial water lead levels associated with consumer breakeven points for reverse osmosis (7.31 µg/L), activated carbon (3.73 µg/L), and distillation (12.0 µg/L) were calculated. For example, an individual consuming water with 25 µg/L of lead, similar to the 90th percentile of concentrations measured in Flint, Michigan, would have an expected blood lead level of 1.25 µg/dL, a corresponding loss of 0.641 IQ points, and a lifetime economic earnings loss of $14,284. Over 70 years of continued use, activated carbon with lead reduction media is the least expensive device to maintain and operate as compared to reverse osmosis and distillation., Conclusions: Infrastructure failures related to drinking water are unpredictable and exposure to contaminates can have significant economic ramifications. POU devices represent a cost-effective option to reduce the impact of lead exposure, particularly when water lead concentrations exceed regulated levels., (Copyright © 2019 Elsevier Inc. All rights reserved.)

This study evaluated the epidemiological behavior of the hepatitis A in Paraná state and compared the costs of the disease and the vaccination. This is an epidemiological descriptive study including a pharmacoeconomy analysis. We collected information in the national database reported cases (SINAN), in the mortality information system (SIM) and in the hospital information system (AIH) among 2000/2003 (Paraná State Public Health Department). We estimated the probability of one cohort of children to acquire hepatitis A during their lifetime and the costs with their treatment. We compared those costs with the cost of vaccinating the children. 14,682 hepatitis A cases were registered during the period studied, and 12,102 (82.4%) occurred in the 0-15 years-old age group. The annual incidence in the general population was 37.5/100,000. We observed 20 deaths caused by this disease; 7 of those occurred by liver failure. The estimated costs with the disease included the hospital costs, liver transplantation, liver failure treatment, and laboratory tests were high. The price of the vaccine is 10 USD/dose. Two doses are necessary to get the protection. The results showed a positive cost - benefit relation when we vaccinate children. We save 2.26 USD in treatment for each dollar invested in the vaccine. Paraná record high number of hepatitis A cases each year. We confirmed the positive cost - benefit relation when we vaccinate children against hepatitis A, reducing suffering, hospitalization, death and social costs. Vaccination against hepatitis A should be recommended in the routine of immunization program in Paraná state.

Aims: This narrative review aimed to collate recent evidence on the cost-effectiveness and cost-benefit of antimicrobial stewardship (AMS) programmes, to address the question 'is AMS cost-effective?', while providing resources and guidance for future research in this area., Sources: PubMed was searched for studies assessing the cost-effectiveness, cost-utility or cost-benefit of AMS interventions in humans, published from January 2000 to March 2017, with no setting inclusion/exclusion criteria specified. Reference lists of retrieved reviews were searched for additional articles., Content: Recent evidence on the cost-effectiveness and cost-benefit of AMS is described, studies suggest persuasive and structural AMS interventions may provide health economic benefits to the hospital setting. However, overall, cost-effectiveness evidence for AMS is severely limited, especially for the community setting. Recommendations for future research in this area are therefore provided, including discussion of appropriate health economic methodological choice., Implications: Health systems have a finite and decreasing resource, decision makers currently do not have necessary evidence to assess whether AMS programmes provide sufficient benefits. Although the evidence-base of the cost-effectiveness of AMS is increasing, it remains inadequate for investment decision-making. Robust health economics research needs to be completed to enhance the generalizability and usability of cost-effectiveness results., (Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. All rights reserved.)

Background: The reported 54 mm median intervention diameter for endovascular aneurysm repair (EVAR) in the Vascular Quality Initiative and European data from the Pharmaceutical Aneurysm Stabilisation Trial (PHAST) implies that in real life the majority of abdominal aortic aneurysm (AAA) repairs occur at diameters smaller than the consensus intervention threshold of 55 mm. This study explores the potential consequences of this practice., Methods: The differences between real life AAA repair and consensus based intervention threshold were explored in reported data from vascular quality initiatives and PHAST. The subsequent consequences of advancement of endovascular aneurysm repair (EVAR) were estimated using a multistate model based on life tables for the EVAR Medicare population., Results: There appears an approximate 5 mm difference in AAA diameter between real life practice and consensus intervention threshold. Assuming a 2.5 mm annual growth rate, this results in an approximately 2 year advancement of AAA repair. According to the model used, early repair reduces overall small aneurysm patient mortality by 2.3%, it results in 21.9% more EVAR procedures, more EVAR related deaths, and 42.3% and 36.8% more open and endovascular re-interventions, respectively. Cost-benefit estimates imply 482 fewer AAA related deaths, but 140 extra EVAR related deaths for a population of more than 30,000 AAA patients, and a 300 million USD increase in health costs for the 8 year observation period in the Medicare population., Conclusions: In the real life situation a large proportion of EVAR procedures appear to occur before reaching the consensus threshold. Although this reduces mortality, it comes at a cost of approximately 1 million USD per prevented rupture related death., (Copyright © 2017 European Society for Vascular Surgery. All rights reserved.)

Background: The 2009 A/H1N1 influenza pandemic generated additional data and triggered new studies that opened debate over the optimal strategy for handling a pandemic. The lessons-learned documents from the World Health Organization show the need for a cost estimation of the pandemic response during the risk-assessment phase. Several years after the crisis, what conclusions can we draw from this field of research?, Objective: The main objective of this article was to provide an analysis of the studies that present cost-effectiveness or cost-benefit analyses for A/H1N1 pandemic interventions since 2009 and to identify which measures seem most cost-effective., Methods: We reviewed 18 academic articles that provide cost-effectiveness or cost-benefit analyses for A/H1N1 pandemic interventions since 2009. Our review converts the studies' results into a cost-utility measure (cost per disability-adjusted life-year or quality-adjusted life-year) and presents the contexts of severity and fatality., Results: The existing studies suggest that hospital quarantine, vaccination, and usage of the antiviral stockpile are highly cost-effective, even for mild pandemics. However, school closures, antiviral treatments, and social distancing may not qualify as efficient measures, for a virus like 2009's H1N1 and a willingness-to-pay threshold of $45,000 per disability-adjusted life-year. Such interventions may become cost-effective for severe crises., Conclusions: This study helps to shed light on the cost-utility of various interventions, and may support decision making, among other criteria, for future pandemics. Nonetheless, one should consider these results carefully, considering these may not apply to a specific crisis or country, and a dedicated cost-effectiveness assessment should be conducted at the time., (Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.)

Background: Shorter infusions of infliximab for inflammatory bowel disease seem to be as tolerated as standard procedures and nurses may be able to manage them safely., Aims: To test tolerability and effectiveness of a fast nurse-led infusion procedure and the related patients' satisfaction., Methods: We retrospectively compared three different regimens adopted in our outpatient infusion unit from 2010 to 2013: Group 1, a standard procedure with two-hour infusions, preceded by hydrocortisone medication (87 patients, 311 infusions); Group 2, a similar regimen without physician supervision (130 patients, 464 infusions); Group 3, a one-hour nurse-led procedure without routine premedication (176 patients, 1356 infusions). Disease characteristics, infusion reactions, infusions per month and patients' satisfaction were recorded., Results: There were significantly fewer infusion reactions in Group 3 than Group 1 (2.2% versus 5.8% respectively; p=0.001). The only significant risk factor for side effects was premedication (odds ratio 4.71, 95% confidence interval 2.21-10.02, p<0.001) which was related to the presence of previous side effects. Number of infusions per month increased by 27% (83 versus 61, p<0.001) without increasing nurses' workload and patients were satisfied., Conclusions: Our fast nurse-led procedure was well tolerated, effective and satisfactory for patients., (Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Background: The relationship of clinical variables for cognitive functioning and other variables such as multiple neuropsychiatric symptoms and quality of life are usually analyzed bivariately and multivariately. In randomized controlled trials analyses are mostly performed on individual outcome variables. To unravel interdependencies of determinants and outcome variables, Structural Equation Modeling (SEM) was applied., Methods: Using SEM, we explored interdependencies of clinical determinants (MMSE, BI, and NPI-sum severity) and quality of life (EQ5D) in psychogeriatric patients (including dementia) suffering from cognitive problems and multiple neuropsychiatric symptoms., Results: MMSE and BI showed direct and indirect impact on EQ5D, but the association with NPI-sum severity was minor. The identified model showed that R(2) of EQ5D varied from 0.21 to 0.48., Discussion: This clinical-empirical study showed that SEM could be utilized to unravel and identify a model of complex direct and indirect effects of MMSE and BI on EQ5D. In relation to NPI-sum severity, however, the validity of EQ5D seemed insufficient in psychogeriatric patients. Consequently, the cost-benefit analyses and cost-effectiveness analyses using quality-adjusted life-year measures of an intervention in psychogeriatric patients with multiple neuropsychiatric symptoms, based on EQ5D, are considered questionable. Construction of a quality of life instrument that is more sensitive with regard to multiple neuropsychiatric symptoms in psychogeriatric patients is highly recommended., (Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)

Objective: To calculate the monetary value of the time factor per minute and per year for emergency services., Methods: The monetary values for ambulance emergency services were calculated for two different time factors, response time, which is the time from when a call is received by the emergency medical service call-taking center until the response team arrives at the emergency scene, and operational time, which includes the time to the hospital. The study was performed in two steps. First, marginal effects of reduced fatalities and injuries for a 1-minute change in the time factors were calculated. Second, the marginal effects and the monetary values were put together to find a value per minute., Results: The values were found to be 5.5 million Thai bath/min for fatality and 326,000 baht/min for severe injury. The total monetary value for a 1-minute improvement for each dispatch, summarized over 1 year, was 1.6 billion Thai baht using response time., Conclusions: The calculated values could be used in a cost-benefit analysis of an investment reducing the response time. The results from similar studies could for example be compared to the cost of moving an ambulance station or investing in a new alarm system., (Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.)

Over 80% of UK peatlands are degraded to some extent and their widespread restoration could contribute to meeting various climate change, water quality and biodiversity policy challenges. Economic analysis of costs and benefits is, however, hampered by scientific uncertainty and a lack of data on biophysical conditions as well as the impacts and costs of restoration. This paper presents a simple 'ready-reckoner' of possible net economic benefits under different combinations of simplifying 'what if?' assumptions for key restoration parameters. The results strongly suggest that even a narrow focus on carbon benefits alone is sufficient to justify restoration in many cases, and the inclusion of possible additional non-carbon benefits reinforces this. However, results are sensitive to assumptions and better data for, in particular, restoration costs associated with modest emission savings from lightly degraded sites would be helpful. Some other areas for further research are also identified., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) incur significant costs. We aimed to examine the cost and cost-benefit of infection control interventions against MRSA and to examine factors affecting economic estimates. We performed a systematic review of studies assessing infection control interventions aimed at preventing spread of MRSA in hospitals and reporting intervention costs, savings, cost-benefit or cost-effectiveness. We searched PubMed and references of included studies with no language restrictions up to January 2012. We used the Quality of Health Economic Studies tool to assess study quality. We report cost and savings per month in 2011 US$. We calculated the median save/cost ratio and the save-cost difference with interquartile range (IQR) range. We examined the effects of MRSA endemicity, intervention duration and hospital size on results. Thirty-six studies published between 1987 and 2011 fulfilled inclusion criteria. Fifteen of the 18 studies reporting both costs and savings reported a save/cost ratio >1. The median save/cost ratio across all 18 studies was 7.16 (IQR 1.37-16). The median cost across all studies reporting intervention costs (n = 31) was 8648 (IQR 2025-19 170) US$ per month; median savings were 38 751 (IQR 14 206-75 842) US$ per month (23 studies). Higher save/cost ratios were observed in the intermediate to high endemicity setting compared with the low endemicity setting, in hospitals with <500-beds and with interventions of >6 months. Infection control intervention to reduce spread of MRSA in acute-care hospitals showed a favourable cost/benefit ratio. This was true also for high MRSA endemicity settings. Unresolved economic issues include rapid screening using molecular techniques and universal versus targeted screening., (© 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.)

In major depression, when a first antidepressant does not cause remission of symptoms (60%-75%), there are several options for continuing treatment in the next step. This study is a cost-utility analysis (CUA) of different second-line approaches. In a simulated trial outpatients with MDD were treated with citalopram for 13 weeks (level 1), then based on two alternative algorithms implemented from the Sequenced Treatment Alternatives to Relieve Depression (STAR(*)D) study. Algorithm A: citalopram was continued until study endpoint (week 26). Algorithm B: patients who remitted during level 1 continued citalopram. Those who did not remit could opt for switching to another antidepressant (venlafaxine; sertraline) (b1) or adding bupropion to citalopram treatment (augmentation; b2). Algorithm B increased remission rate by 10.6% over Algorithm A (number needed to treat: 9.9; sensitivity range: 9.1-12.5). As a comparison, differences between active antidepressants and placebo are associated with NNT values of 6 to 8. In CUA Algorithm B was dominant with an ICER of $11,813 (sensitivity range=$1783 - $21,784), which is <1GDP per capita cost-effectiveness threshold (USA=$47,193). Among Algorithm B options, switching (b1) dominated Algorithm A with a smaller number of responders than augmentation approach (b2) (NNT 11 vs. 7.7), whereas ICER values were similar (b1: $14,738; b2: $15,458). However we cannot exclude a bias in selecting second treatment. This cost-utility analysis shows (in line with current guidelines) a benefit in modifying antidepressant treatment if response to first-line agent does not occur within 3 months, but not a clear-cut evidence in terms of NNT., (© 2013 Elsevier B.V. and ECNP. All rights reserved.)

Screening for primary liver cancer means surveillance for hepatocellular carcinoma (HCC), which is one of the most common cancers worldwide. Detection of HCC for curative treatment is increased by surveillance, but target population, optimal periodicity and cost-effectiveness aspects are still debated issues. The aim of surveillance is to obtain a reduction in HCC-related mortality and this is usually achieved through an early diagnosis that increases both applicability and cost-effectiveness of curative treatments. The aim of the present review is to analyse economic aspects of HCC surveillance. Articles that assessed cost-effectiveness of surveillance for HCC, published between 1996 and February 2013, were reviewed in order to verify the cost-effectiveness of surveillance, its optimal periodicity, the target population and the role of alternative surveillance strategies. International guidelines are currently based on the results of such cost-effectiveness analyses, highlighting the importance of the release of cost-effectiveness-guided guidelines for HCC management., (Copyright © 2013 Elsevier Ltd. All rights reserved.)