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Objectives Real option value (ROV) is created when a drug enables a patient to live long enough to benefit from a future innovation. Few studies have quantified ROV in the real world. We aimed to estimate the ex post ROV for ipilimumab in metastatic melanoma using real-world data (RWD). Methods We developed a framework for calculating ROV using RWD, accounting for the health gain in the standard therapy arm and the uptake of future innovations. A Markov model was developed to estimate the quality-adjusted life-years (QALYs) gained with ipilimumab compared with chemotherapy for patients with or without subsequent cancer immunotherapy (CIT). A nationwide electronic health record-derived, deidentified database was used to estimate survival and uptake of CIT. Results The incremental QALYs gained for ipilimumab compared with chemotherapy without subsequent CIT were 1.74. With subsequent CIT, the incremental QALYs compared with chemotherapy increased by 0.92, 0.60, 0.33, 0.18, 0.10, and 0.02 when CIT became available 0, 3, 6, 9, 12, and 24 months after the initiation of first-line treatment, respectively. The results were most sensitive to the survival benefit of ipilimumab, the survival benefit of subsequent CIT, and the uptake of CIT. Conclusions This is the first study to estimate ex post ROV using RWD. The ex post ROV was between 1% and 54% of conventional value for patients who received a diagnosis within 2 years before CIT availability. Further studies are needed to understand ROV in other disease areas, particularly those with longer survival times.

Gene therapy for hemophilia is designed to produce health gains for patients over many years. Rewarding that value creation on the basis of a one-time treatment implies a large upfront cost. This cost can only be justified by long-term health benefits and being cost-effective compared with conventional treatments. Yet, uncertainties about the long-term benefits make it challenging to assess clinical and economic value of gene therapies at launch. We identify and discuss key methodological challenges in assessing the value of gene therapy for hemophilia, including the immaturity of evidence on the durability of benefits, lack of definition and valuation of cure for chronic diseases, absence of randomized controlled trials, limitations of traditional quality of life measures in hemophilia, approach for qualifying cost-savings compared with current treatments, and choice of perspective. The Institute for Clinical and Economic Review has developed a framework for assessing single or short-term therapies (ICER-SST) and has applied it in hemophilia. After reviewing this framework and its application, we recommend the following when assessing the value of hemophilia gene therapies: (1) leveraging expert clinical opinion to justify assumptions on the durability of benefits; (2) using external synthetic controls and lead-in, self-controlled trials to assess comparative effectiveness; (3) addressing limitations of traditional quality of life measures through the use of modified utility collection approaches; (4) adjusting cost offsets from gene therapies with caution; (5) considering outcome-based contracting to address uncertainties about prices and long-term outcomes; and (6) presenting societal and healthcare system perspectives in parallel.

Objectives To explore the use of data dashboards to convey information about a drug’s value, and reduce the need to collapse dimensions of value to a single measure. Methods Review of the literature on US Drug Value Assessment Frameworks, and discussion of the value of data dashboards to improve the manner in which information on value is displayed. Results The incremental cost per quality-adjusted life-year ratio is a useful starting point for conversation about a drug’s value, but it cannot reflect all of the elements of value about which different audiences care deeply. Data dashboards for drug value assessments can draw from other contexts. Decision makers should be presented with well-designed value dashboards containing various metrics, including conventional cost per quality-adjusted life-year ratios as well as measures of a drug’s impact on clinical and patient-centric outcomes, and on budgetary and distributional consequences, to convey a drug’s value along different dimensions. Conclusions The advent of US drug value frameworks in health care has forced a concomitant effort to develop appropriate information displays. Researchers should formally test different formats and elements.

•The value of patient experience is becoming increasingly recognized by healthcare stakeholders.•Integration of patient experience in health technology assessment is not universally adopted.•This is challenging when assessing complex health technologies and holistic solutions.•New value frameworks can formalize the patient perspective into complex technology assessments.•This paper searched for and summarized current patient experience value frameworks.

Street art murals are an artistic expression strictly interwoven in the urban landscape, and in recent years have received increasing attention as cultural heritage at risk. Today there is intense debate regarding the value assessment and choices related to the conservation of urban art; however, the evaluation of the stability of modern paint materials in outdoor environment is preliminary to any possible preservation strategy. In particular, the identification of the materials constituting a street artwork is critical for the preservation of these non-permanent heritage elements and to define the best restoration approaches. In this work, we performed a set of analyses of microsamples based on spectroscopy, analytical pyrolysis, gas and liquid chromatography, and mass spectrometry to identify paint materials (binders, pigments, additives, degradation products and conservation/restoration materials) of a selection of mural paintings, covering 60 years of history (1953–2014). The goal of this work was to identify the materials used to produce different mural paintings and to relate and compare their different compositions with previous studies in order to describe the evolution of the materials during the last 60 years. The collected knowledge and the limited data available in literature were exploited to increase the scientific background on the materials used by street artists, and to fill the lack of knowledge on this emerging topic.

Resource value assessment, in which competitors adjust behaviours according to the perceived value of a contested resource, is well described in animal contests. Such assessment is usually assumed to be categorical or linear; for example, males fight more aggressively when females are present than absent, or as female fecundity increases. Here, to our knowledge for the first time, we show quadratic resource value assessment, in which resource value is highest at a certain level and decreases in either direction. The mantis shrimp Neogonodactylus bredini occupies coral rubble burrows in a size-assortative manner: individuals of a certain body size inhabit burrows of a certain size. Using mock burrows of various sizes, we tested whether mantis shrimp (1) chose burrows predicted to be the best fit for their body size and (2) were more aggressive during, endured higher costs during and were more likely to win contests over burrows predicted to be best fit. Individuals chose burrows larger than their predicted best fit burrows. In contests, intruders without burrows were more likely to evict burrow residents when the burrow was slightly smaller than the intruder's predicted best fit size. Intruder success decreased as relative burrow size increased or decreased from this value. Intruders won by delivering more strikes and by being aggressive first. In contrast to intruders, burrow residents showed little evidence of resource value assessment. A literature review revealed that quadratic resource value assessment may play a role in contests over resources from territories to parasite hosts. Therefore, our results impact theoretical models of contest behaviour and may lend insight to how contests affect resource distributions.

To assess diagnostic imaging utilization and the proportion of negative appendectomies for pediatric appendicitis at US children's hospitals between 2004 and 2018.This was a retrospective study using data from the Pediatric Health Information System (PHIS) database. Pediatric patients (age: 0-17 years) who underwent an appendectomy at one of 32 children's hospitals from January 1, 2004, through September 30, 2018, were included. Patients were identified based on International Classification of Diseases, 9th revision and International Classification of Diseases, 10th revision procedure codes. Patient demographics, imaging performed, and the frequency of negative appendectomy were analyzed.The final study population consisted of 104,033 children. From 2004 to 2018, CT utilization decreased from 56.8% (2,951 of 5,198) to 18.6% (1,201 of 6,455; P.001). Ultrasound utilization increased from 26.4% (1,371 of 5,198) to 63.4% (4,093 of 6,455; P.001). Radiography utilization remained stable at 16.7% (870 of 5,198) and 15.8% (1,018 of 6,455; P = .160). MRI use increased from 0.1% (6 of 5,198) to 2.2% (143 of 6,455; P.001). During the study period, the negative appendectomy rate slightly decreased, from 3.74% (4,742 of 126,778 in 2004-2011) to 3.14% (4,258 of 135,561 in 2012-2018; P.001).There has been a shift in imaging of children with appendicitis over 15 years in the United States, because the use of CT has decreased and ultrasound use has increased. This shift has likely added value to the health care system without adversely affecting outcomes (negative appendectomy rate).

BACKGROUND: Pulmonary exacerbations (PEx) in cystic fibrosis (CF) patients decrease lung function, increase symptoms and reduce health-related quality of life (HRQoL). We evaluated associations between 8 symptom-based questions from the Cystic Fibrosis Respiratory Symptom Diary - Chronic Respiratory Infection Symptom Score (CFRSD-CRISS) and the 5-level EuroQOL-5 Dimensions (EQ-5D-5L) summary score and hypothesized the CFRSD-CRISS would be a meaningful way to asses quality-of-life in future cost effectiveness studies among CF patients with PEx. METHODS: CF patients who had CFRSD-CRISS and EQ-5D-5L measurements on the day of the initial PEx, 7 days later, and at the end of intravenous antibiotic treatment were included. We examined age-stratified (

This study systematically compares HTA recommendations on a number of disease-modifying therapies for patients with Relapsing-Remitting Multiple Sclerosis. We analysed publicly available HTA reports for nine medicine-indication pairs across seven OECD countries using a methodological framework enabling systematic analysis of HTA recommendations. The analysis was conducted based on a number of value dimensions, including clinical and economic variables, as well as several other dimensions of value beyond cost-effectiveness. The material was qualitatively and quantitatively coded following the different stages of HTA decision-making process. Fifty-seven medicine-indication pairs were assessed across the study countries. Of those, eight medicine indication-pairs reported diverging HTA recommendations. Although HTA recommendations were based on the same evidence submitted in most cases, significant variations were identified in interpretation and acceptance of evidence resulting in different uncertainties raised and different ways of addressing them. Uncertainties arose both in terms of the clinical and the economic evidence, including the design of key trials or the data quality in economic models. Beyond costs and effects, additional dimensions of value had an impact in the direction of recommendations, however with different magnitude across countries. We show that there is heterogeneity across countries in HTA for evaluating DMTs for RRMS with a lack of standardised methods in evaluating clinical and economic evidence and the use of social value judgments to inform decision-making.

Manufacturing companies are moving toward new business models based on Product-Service System (PSS). Academic and scientific literature reveal that there is a lack of suitable methods, tools and methodologies to support early PSS design activities and, in particular, early PSS concepts assessment. This paper focuses on identification and selection of PSS concepts in an Italian product-oriented company working in the automation sector willing to move toward the provision of product-service solutions. The Engineering Value Assessment (EVA) method has been selected and implemented to assess and select PSS concepts able, from one side, to fulfill customer needs and, from the other side, to ensure company profitability and alignment with its long-term strategy.

This is a response to Waddington et al. who argue that there was insufficient public health benefit to justify the relocation of several hundred thousand individuals after the Chernobyl and perhaps Fukushima nuclear accidents. We believe the arguments are not defensible either from a radiological/public health point of view, or from a consideration of costs, and we are skeptical of the use of the “J-value assessment” as a foundation to reach these conclusions. There is debate about the health consequences of exposure to ionizing radiation; data on health impacts are often uncertain and incomplete, and therefore not the basis on which to hesitate to evacuate those affected.

Modern business-to-business firms focus increasingly on understanding and selling value, as a strategic priority and to achieve marketing and sales excellence. Yet many companies struggle to implement their value orientation, without sufficient knowledge of how to translate it into sales practice. This study therefore examines value-based selling (VBS) as an implementation of value-based marketing at the sales force level. The proposed motivation–opportunity–ability framework integrates individual- and organizational-level antecedents, outcomes, and moderators in an attempt to explain the adoption and performance outcomes of VBS in business markets. Multilevel path modeling with cross-sectional survey data from 944 salespeople and managers in 43 sales organizations confirms the prediction that VBS enhances salespeople's performance, beyond that achieved with established selling approaches. However, firms need specific types of salespeople and dedicated organizational support for effective VBS implementation. A salesperson's learning orientation and networking competencies emerge as critical antecedents. Organizational value assessment tools can compensate for individual salespeople's lack of learning orientation; reference marketing efforts also strengthen the performance outcomes of VBS. Finally, VBS is most effective in organizational settings where perceived customers value demandingness is lower, enabling salespeople to use VBS as a proactive selling approach.

Oncology is the initial prime clinical area of precision medicine applications. This paper identifies and discusses key conceptual, implementation, and policy issues in applying value assessment in precision cancer medicine. The economic complementarity of tests and diagnostics is important to recognize because of the challenges it creates in defining their specific contribution to value. There are three key aspects to this: (a) the institutional arrangements, (b) the evidence requirements, and (c) the division of value as between the drug and the diagnostic, such that both receive a value-related price. Controversy over the prices of some cancer medicines makes the possibility of targetting treatments to sub-populations attractive to payers. The value of test-drug combinations goes beyond health gain and health system cost-offsets to include several elements related to the value of knowing, such as the value of reduced uncertainty, of insurance, and of scientific spillovers. The use of flexible value-based pricing for cancer drugs and for diagnostic tests based on incremental value for both is needed to encourage personalized medicine. However, application will become even more challenging in precision medicine given the increasing use of combination therapies and multiple biomarker-based tests. As assessment of the value of a drug-diagnostic combination cannot always be done at launch, payers and providers need diagnostic-specific value-assessment processes as well as drug value-assessment processes that are flexible over time. Evidence on the clinical utility of diagnostics is not easy to generate but is essential. Coverage with evidence development provides one route to obtain this.

Background Several organizations have developed frameworks to systematically assess the value of new drugs. These organizations include the American Society of Clinical Oncology (ASCO), the European Society for Medical Oncology (ESMO), the Institute for Clinical and Economic Review (ICER), and the National Comprehensive Cancer Network (NCCN). Objectives To understand the extent to which these four tools can facilitate value-based treatment decisions in oncology. Methods In this pilot study, eight panelists conducted value assessments of five advanced lung cancer drugs using the ASCO, ESMO, and ICER frameworks. The panelists received instructions and published clinical data required to complete the assessments. Published NCCN framework scores were abstracted. The Kendall's W coefficient was used to measure convergent validity among the four frameworks. Intraclass correlation coefficients were used to measure inter-rater reliability among the ASCO, ESMO, and ICER frameworks. Sensitivity analyses were conducted. Results Drugs were ranked similarly by the four frameworks, with Kendall's W of 0.703 ( P = 0.006) across all the four frameworks. Pairwise, Kendall's W was the highest for ESMO-ICER ( W = 0.974; P = 0.007) and ASCO-NCCN ( W = 0.944; P = 0.022) and the lowest for ICER-NCCN ( W = 0.647; P = 0.315) and ESMO-NCCN ( W = 0.611; P = 0.360). Intraclass correlation coefficients (confidence interval [CI]) for the ASCO, ESMO, and ICER frameworks were 0.786 (95% CI 0.517–0.970), 0.804 (95% CI 0.545–0.973), and 0.281 (95% CI 0.055–0.799), respectively. When scores were rescaled to 0 to 100, the ICER framework provided the narrowest band of scores. Conclusions The ASCO, ESMO, ICER, and NCCN frameworks demonstrated convergent validity, despite differences in conceptual approaches used. The ASCO inter-rater reliability was high, although potentially at the cost of user burden. The ICER inter-rater reliability was poor, possibly because of its failure to distinguish differential value among the sample of drugs tested. Refinements of all frameworks should continue on the basis of further testing and stakeholder feedback.

Revealing the value of ecosystem services is a prerequisite for economic decision-making to maintain life-support functions, yet how to make the valuating process more universally and extensively applicable remains poorly defined. Herein, we developed a public appraisal method (PAM) to let ecosystem services be appraised by the public directly. Inspired by cultural relic identification, the PAM included four steps: categorize real services, build a virtual market, conduct the public appraisal, and produce a valuation list. Taking the Wuyishan forest ecosystem as a study case, we verified the effectiveness of PAM by comparing it with the traditional comprehensive method (TCM). The total value of ecosystem services assessed by PAM was ¥181.6 billion/year, compared with ¥222.3 billion/year for TCM. A new index, called environmental risk perception (ERP), was introduced. The ERP model was used to analyze the differences in the valuation results, as well as to improve the accuracy of PAM valuation. By building a virtual market for real services, we provide a simple valuation method that can be widely applied for value assessment and importance ranking of multiple ecosystem services.

Value assessments are made on new drugs before they even enter the market. Regulators at the Center for Drug Evaluation and Research (CDER) at the US Food and Drug Administration make a clinical benefit-risk assessment to determine whether to approve a new drug. Benefits of a drug are typically quantified directly, as an assessment of efficacy. CDER defines risk as the intersection of the severity of possible harm and the probability of that harm. For a novel drug to be approved, its benefits and risks must be well understood, and the trade-off between the two must be acceptable. To assist with these benefit-risk value assessments, CDER has two ongoing initiatives: the Patient-Focused Drug Development Initiative that aims to substantially increase the role of patient voice in the regulatory process, and a transparency initiative that focuses on creating a structured framework for benefit-risk assessment.

A reasonable value assessment method plays an important role in both companies’ internal management and their external transactions. Traditional value assessment methods like the relative valuation method need historical financial indicators and some market multipliers but ignore non-financial information included in the text. Startup companies are usually listed before they start to make a profit, which means traditional value assessment methods are unable to access reliable financial information. This study firstly investigates companies’ non-financial information and proposes a text-based Enterprise Value Assessment System (EVAS) to extract features. Then, two neural network-based models are constructed to predict one essential factor K in order to improve the P/B relative valuation method. Our experiment in China's National Equities Exchange and Quotations (NEEQ) shows an impressive result on companies’ value assessment compared to the traditional value assessment model. The result concludes that introducing non-financial text information into value assessment based on our system improves the accuracy of value assessment for startup companies.

Understanding the visual value of landscapes is a key issue for environmental decision makers and planners because it is directly related to people's perceptions. In this study, the relationships of seven aesthetic criteria (vegetation composition, complexity, existential factor, coherence, stewardship, physiographic, and environmental factors) and 19 scenic aesthetic indicators with visual value of different rangeland landscapes were assessed. The visual value of different rangeland landscapes was assessed based on stakeholders and managers perceptions using photos and questionnaires. The results showed that existential factor, vegetation composition, and complexity were the most important factors for visual value assessment respectively. Structural equation modeling revealed that all criteria had significant direct impacts on visual value except for stewardship (p

An automatic 3-variety computer vision orange fruit pH value assessment system in the visible-range is presented, including each 100 different color images from Bam, Blood and Thomson orange of which the true pH has been measured and is known in advance. A total of 452 features are extracted from segmented orange color images. Results with repeated trials include: true versus estimated mean pH values, true minus estimated pH values boxplots, fitness regression dispersion plots and various error measure boxplots, for both single orange variety as well as the three-orange varieties altogether (test set), showing consistent results over all three orange varieties. Regression coefficient for pH estimation in Bam, Blood and Thomson orange varieties, were 0.950, 0.935 and 0.957, respectively. Results show that the hybrid ANN-ABC estimates pH values in orange quite similarly among orange varieties, implying that properly pH values estimation is possible for different orange varieties, regardless of orange type.

Authenticity of cow, goat, ewe and buffalo milk is a common concern worldwide for true labeling and value assessment. Because of their high economic value, these milk species are frequently adulterated with cow milk. Recently, non-invasive and rapid spectroscopic methods have been preferred instead of DNA and protein based methods. In this context, the goal of the present study was to discriminate cow, goat, ewe and buffalo milk species by using synchronous fluorescence spectroscopy (SFS) method. The principal of the method is based on differences in the types and quantities of fluorophore compounds in milk species. With this aim, SF spectra of milk species were recorded between 250 and 550 nm excitation range with Δλ of 20–100 nm, in steps of 10 nm. The data obtained from all Δλ = 20–100 nm were used in partial least square discriminant analysis (PLS-DA) in order to classify three groups of samples which are: pure-mixed milk, milk species and type of binary mixture. After determination of the binary mixture type (buffalo-cow; ewe-cow; goat-cow), partial least square (PLS) models were developed for quantification of cow milk in other milk species. Limit of detection values of the method were calculated as 3.52%, 4.06% and 3.52% for goat-cow, ewe-cow and buffalo-cow's milk, respectively. The study demonstrated that SF spectroscopy is a promising tool and has potential to become a rapid and nondestructive analytical technique for identification of milk species.

In the design phase of a high-rise residential building, stakeholders should adopt the proper external wall system by considering energy performance and IEQ as well as construction cost and structural stability. The energy related performance and construction cost of external walls affect the life cycle cost. Therefore, also a value analysis of the LCC in terms of the energy performance is required. The purpose of this study was to evaluate the energy related performance and construction cost of external walls in high-rise residential buildings, which are the currently staple external walls, using reinforced concrete (RC), glass fiber reinforced concrete (GFRC) and cellulose fiber reinforced cement (CFRC). All the wall systems have the same doors and windows in their bodies for equal comparison of energy efficiency and construction cost. The energy efficiency of the CFRC external walls was high while the construction cost for RC external walls was low. The value assessment considering the LCC and the residents’ health revealed that RC external walls were most satisfactory up to 6 years after construction, GFRC from 6 years to 26 years, and CFRC thereafter, respectively. The findings of this research will be valuable for stakeholders deciding on an external wall system.

We use a 15-year panel of property value assessment data from 351 Massachusetts municipalities. Appraised values grow more slowly in municipalities with elected assessors. When municipalities pass, via referenda, large increases in the cap on tax revenues, value assessments grow faster under appointed assessors and slower under elected assessors. Appraisals grow slower when alternative revenue sources are available.

In order to review the effect on the bilingual teaching courses aided by computer, the comprehensive evaluation on the bilingual teaching course and research results of the bilingual teaching is required in the university. A full range system for bilingual teaching course performance assessment that is a novel quantized method is researched in this paper. Furthermore, the comprehensive evaluation processing and evaluation model have been accomplished. The application results for bilingual teaching course performance review assessment which is developed as a computer management system demonstrated its high operability and achieved accurate can be convenient for the same requirements.

This paper describes an integrated GIS-based methodology for conservation value assessment using the traditional species-based and a habitat-based multi-criteria evaluation. The methodology was applied to 49 small islands and islets in the East Aegean area, belonging to a SCI Natura 2000 site. The species-based (botanical approach) conservation status assessment attributes a specific weight to the parameter of endemism, while the multi-criteria evaluation (MCE) approach emphasises the criteria of diversity, rarity, naturalness, replaceability and threat on each habitat type in combination with the number of significant taxa. The conservation values attained from the two approaches are significantly correlated, but the multi-criteria approach is more effective as it includes all the habitat types within the study area in the 25% of the polygons with the highest conservation values. Furthermore, results from the multi-criteria analysis were more in line with subjective assessments of the conservation value of the habitat types than the ones obtained by the botanical approach.