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The value of a quality-adjusted life-year (QALY) and the value of a statistical injury (VSI) are important measures within health economics and transport economics. Several studies have, therefore, estimated people's willingness to pay (WTP) for these estimates, but most results show scale insensitivity. The 'original' chained approach (CA) is a method developed to mitigate this problem by combining the contingent valuation (CV) with standard gamble (SG). In contrast to the version of the CA applied by the previous research of the WTP for a QALY, the original version allows the value of major health gains to be estimated without having the respondents express their WTP directly. The objective of this study was to estimate the value of a QALY and VSI in the context of non-fatal road traffic accidents using the original CA to test if the approach, applied to a wide range of health gains, is able to derive valid estimates and a constant value of a QALY which the previous research has not been able to show. Data were collected from a total of 800 individuals in the Swedish adult general population using two web-based questionnaires. The values of a QALY based on trimmed estimates were close to constant at €300,000 irrespective of the size of the QALY gain. The study shows that the original CA method may be a valid method to estimate the value of a QALY and VSI for major health losses. It also supports the use of a higher threshold value for a QALY than that which is currently applied by several health technology assessment agencies in different countries. [ABSTRACT FROM AUTHOR]

It has been demonstrated that most people have a limited understanding of atmospheric CO2 accumulation. Labeled stock-flow (SF) failure, this phenomenon has even been suggested as an explanation for weak climate policy support. Drawing on a typology of knowledge, we set out to nuance previous research by distinguishing between different types of knowledge of CO2 accumulation among the public and by exploring ways of reasoning underlying SF failure. A mixed methods approach was used and participants (N = 214) were enrolled in an open online course. We find that ostensibly similar SF tasks show seemingly contradictory results in terms of people's understanding of CO2 accumulation. Participants performed significantly better on stock stabilization tasks that explicitly ask about the relationship between stocks and flows, compared with a typical SF task that does not direct the participants' attention to what knowledge they should use. This suggests that people possess declarative and procedural knowledge of accumulation (knowing about the principles of mass balance, i.e., what and how to use them) but lack conditional knowledge of accumulation (knowing when to use these principles). Additionally, through a thematic analysis of answers to an open-ended question, we identified three overarching ways of reasoning when dealing with SF tasks: system, pattern, and phenomenological reasoning, providing additional theoretical insights to explain the large difference in performance between the different SF tasks. These more nuanced perspectives on SF failure can help inform interventions aimed at increasing climate science literacy and point to the need for more detailed explorations of public knowledge needed to leverage climate policy support. [ABSTRACT FROM AUTHOR]

For the assessment of value of new therapies in healthcare, Health Technology Assessment (HTA) agencies often review the cost per quality-adjusted life-year (QALY) gained. Some HTA agencies accept a higher cost per QALY gained when treatment is aimed at prolonging survival for patients with a short expected remaining lifetime, a so-called end-of-life (EoL) premium. The objective of this study is to elicit the existence and size of an EoL premium in cancer. Data was collected from 509 individuals in the Swedish general population 20-80 years old using a web-based questionnaire. Preferences were elicited using subjective risk estimation and the contingent valuation (CV) method. A split-sample design was applied to test for order bias. The mean value of a QALY was MSEK4.8 (€528,000), and there was an EoL premium of 4-10% at 6 months of expected remaining lifetime. Using subjective risk resulted in more robust and valid estimates of the value of a QALY. Order of scenarios did not have a significant impact on the WTP and the result showed scale sensitivity. Our result provides some support for the use of an EoL premium based on individual preferences when expected remaining lifetime is short and below 24 months. Furthermore, we find support for a value of a QALY that is above the current threshold of several HTA agencies. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the economic burden from a societal perspective and the health-related quality of life (HRQOL) of patients with juvenile idiopathic arthritis (JIA) in Europe.Methods: We conducted a cross-sectional study of patients with JIA from Germany, Italy, Spain, France, the United Kingdom, Bulgaria, and Sweden. Data on demographic characteristics, healthcare resource utilization, informal care, labor productivity losses, and HRQOL were collected from the questionnaires completed by patients or their caregivers. HRQOL was measured with the EuroQol 5-domain (EQ-5D-5L) questionnaire.Results: A total of 162 patients (67 Germany, 34 Sweden, 33 Italy, 23 United Kingdom, 4 France, and 1 Bulgaria) completed the questionnaire. Excluding Bulgarian results, due to small sample size, country-specific annual health care costs ranged from €18,913 to €36,396 (reference year: 2012). Estimated direct healthcare costs ranged from €11,068 to €22,138; direct non-healthcare costs ranged from €7837 to €14,155 and labor productivity losses ranged from €0 to €8715. Costs are also shown to differ between children and adults. The mean EQ-5D index score for JIA patients was estimated at between 0.44 and 0.88, and the mean EQ-5D visual analogue scale score was estimated at between 62 and 79.Conclusions: JIA patients incur considerable societal costs and experience substantial deterioration in HRQOL in some countries. Compared with previous studies, our results show a remarkable increase in annual healthcare costs for JIA patients. Reasons for the increase are the inclusion of non-professional caregiver costs, a wider use of biologics, and longer hospital stays. [ABSTRACT FROM AUTHOR]

The objective of this paper was to address the importance of dealing systematically and comprehensively with uncertainty in a budget impact analysis (BIA) in more detail. The handling of uncertainty in health economics was used as a point of reference for addressing the uncertainty in a BIA. This overview shows that standard methods of sensitivity analysis, which are used for standard data set in a health economic model (clinical probabilities, treatment patterns, resource utilisation and prices/tariffs), cannot always be used for the input data for the BIA model beyond the health economic data set for various reasons. Whereas in a health economic model, only limited data may come from a Delphi panel, a BIA model often relies on a majority of data taken from a Delphi panel. In addition, the dataset in a BIA model also includes forecasts (e.g. annual growth, uptakes curves, substitution effects, changes in prescription restrictions and guidelines, future distribution of the available treatment modalities, off-label use). As a consequence, the use of standard sensitivity analyses for BIA data set might be limited because of the lack of appropriate distributions as data sources are limited, or because of the need for forecasting. Therefore, scenario analyses might be more appropriate to capture the uncertainty in the BIA data set in the overall BIA model. [ABSTRACT FROM AUTHOR]

Aims: We compared the prevalence of noise-related artefacts and lesion perception on three-dimensional (3D) CT colonography (CTC) at standard and low radiation doses.Methods: Forty-eight patients underwent CTC (64 x 0.625 mm collimation; tube rotation time 0.5 s; automatic tube current modulation: standard dose 40-160 mA, low dose 10-50 mA). Low- and standard-dose acquisitions were performed in the supine position, one after the other. The presence of artefacts (cobblestone and snow artefacts, irregularly delineated folds) and the presence of polyps were evaluated by five radiologists on 3D images at standard dose, the original low dose and a modified low dose, i.e. after manipulation of opacity on 3D.Results: The mean effective dose was 3.9 +/- 1.3 mSv at standard dose and 1.03 +/- 0.4 mSv at low dose. The number of images showing cobblestone artefacts and irregularly delineated folds at original and modified low doses was significantly higher than at standard dose (P < 0.0001). Most of the artefacts on modified low-dose images were mild. No significant difference in sensitivity between the dose levels was found for polyps > or =6 mm.Conclusions: Reduction of the effective dose to 1 mSv significantly affects image quality on 3D CTC, but the perception of > or =6 mm lesions is not significantly impaired. [ABSTRACT FROM AUTHOR]

The economic benefits of a multi-gas approach to climate change mitigation are clear. However, there is still a debate on how to make the trade-off between different greenhouse gases (GHGs). The trade-off debate has mainly centered on the use of Global Warming Potentials (GWPs), governing the trade-off under the Kyoto Protocol, with results showing that the cost-effective valuation of short-lived GHGs, like methane (CH4), should be lower than its current GWP value if the ultimate aim is to stabilize the anthropogenic temperature change. However, contrary to this, there have also been proposals that early mitigation mainly should be targeted on short-lived GHGs. In this paper we analyze the cost-effective trade-off between a short-lived GHG, CH4, and a long-lived GHG, carbon dioxide (CO2), when a temperature target is to be met, taking into consideration the current uncertainty of the climate sensitivity as well as the likelihood that this will be reduced in the future. The analysis is carried out using an integrated climate and economic model (MiMiC) and the results from this model are explored and explained using a simplified analytical economic model. The main finding is that the introduction of uncertainty and learning about the climate sensitivity increases the near-term cost-effective valuation of CH4 relative to CO2. The larger the uncertainty span, the higher the valuation of the shortlived gas. For an uncertainty span of ±1°C around an expected climate sensitivity of 3°C, CH4 is cost-effectively valued 6.8 times as high as CO2 in year 2005. This is almost twice as high as the valuation in a deterministic case, but still significantly lower than its GWP100 value. [ABSTRACT FROM AUTHOR]

The possibility of adopting national targets for carbon dioxide (CO2) emissions from tropical deforestation in a future international climate treaty has received increasing attention recently. This attention has been prompted by proposals to this end and more intensified talks on possible commitments for developing countries beyond the United Nations Framework Convention on Climate Change Kyoto Protocol. We analyze four main scientific and political challenges associated with national targets for emissions from tropical deforestation: (1) reducing the uncertainties in emission inventories, (2) preserving the environmental integrity of the treaty, (3) promoting political acceptance and participation in the regime, and (4) providing economic incentives for reduced deforestation. We draw the following conclusions. (1) Although there are large uncertainties in carbon flux from deforestation, these are in the same range as for other emissions included in the current Kyoto protocol (i.e., non-CO2 GHGs), and they can be reduced. However, for forest degradation processes the uncertainties are larger. A large challenge lies in building competence and institutions for monitoring the full spectrum of land use changes in developing countries. (2 and 3) Setting targets for deforestation is difficult, and uncertainties in future emissions imply a risk of creating 'tropical hot air'. However, there are proposals that may sufficiently deal with this, and these proposals may also have the advantage of making the targets more attractive, politically speaking. Moreover, we conclude that while a full carbon accounting system will likely be politically unacceptable for tropical countries, the current carbon accounting system should be broadened to include forest degradation in order to safeguard environmental integrity. (4) Doubts can be cast over the possible effect a climate regime alone will have on deforestation rates. [ABSTRACT FROM AUTHOR]

The metric governing the trade-off between different greenhouse gases in the Kyoto Protocol, the Global Warming Potentials (GWPs), has received ample critique from both scientific and economic points of view. Here we use an integrated climate-economic optimization model to estimate the cost-effective trade-off between CO2, CH4 and N2O when meeting a temperature stabilization target. We then estimate the increased cost from using GWPs when meeting the same temperature target. Although the efficient valuation of the gases differs significantly from their respective GWPs, the potential economic benefit of valuing them in a more correct way amounts to 3.8 percent of the overall costs of meeting the temperature stabilization target in the base case. In absolute value, this corresponds to an additional net present value cost of US$2000100 billion. To corroborate our findings we perform a Monte Carlo-analysis where several key parameters are randomly varied simultaneously. The result from this exercise shows that our main result is robust to a wide range of changes in the key parameter values, giving a median economic loss from using GWPs of 4.2 percent. [ABSTRACT FROM AUTHOR]

A retrospective chart review was performed at 3 Swedish hospitals to evaluate the utilization, outcomes, and cost of using epoetin alfa or darbepoetin alfa to treat cancer patients with chemotherapy-related anemia. Data on dosage, duration of treatment, hematologic response, red blood cell transfusions, and healthcare resource consumption were collected and analyzed at various time points following the initiation of drug therapy. A significantly faster hematologic response and increase in hemoglobin were observed in patients treated with epoetin alfa. Dosages used in clinical practice appeared to be lower than those recommended by Swedish treatment guidelines. There were no significant differences in resource utilization or healthcare costs between the 2 treatment groups. By day 112, the mean treatment cost per patient, in Swedish kronors (SEK), was SEK74,701 (approximately US$9800 or approximately 8300) with epoetin alfa and SEK85,285 (approximately US$11,000 or approximately 9500) with darbepoetin alfa. Drug acquisition and administration accounted for 81% and 67% of the total cost of epoetin alfa and darbepoetin alfa therapy, respectively; the remainder of the total cost was for hospitalization and transfusions. [ABSTRACT FROM AUTHOR]

Summary:The article presents views and recommendations of the World Marrow Donor Association regarding the need for donor and liability insurance for hematopoietic stem cell donor registries, and donor and collection centers.Bone Marrow Transplantation (2004) 33, 467-470. doi:10.1038/sj.bmt.1704387 Published online 22 December 2003 [ABSTRACT FROM AUTHOR]

Objective: The primary objective of this study was to estimate the cost effectiveness of treating diabetic foot ulcers with becaplermin (Regranex) plus good wound care (GWC) compared with GWC alone in a variety of European healthcare settings. A secondary objective was to analyse the effect of different treatment practices on the economics of caring for diabetic foot ulcers.Design and Setting: Markov-based simulation study from the perspective of a national health system.Methods: A 12-month Markov computer simulation model was used to assess the cost effectiveness in 4 European countries of treating diabetic foot ulcers with becaplermin plus GWC versus GWC alone. Transition probabilities were taken from a prospective study of 183 patients and becaplermin efficacy was based on 20-week healing rates in a recent meta-analysis of clinical trials involving 449 patients. Country-specific treatment cost data were collected in collaboration with local economic consultations and combined with the disease model to estimate the incremental cost per ulcer-free month gained. The model was then run using hypothetical low- and high-intensity resource usage profiles to investigate the economics of caring for diabetic foot ulcers.Results: Over the course of 1 year, individuals who received becaplermin plus GWC were, on average, predicted to spend an additional 0.81 months (24% longer) free of ulcers and to experience a 9% lower risk of undergoing a lower extremity amputation than individuals who received GWC alone. Consequently, becaplermin plus GWC was estimated to be net cost saving in Sweden, Switzerland and the UK. In France, the addition of becaplermin was estimated to add $US19 (1999 values) for each additional ulcer-free month gained. There were substantial intercountry differences in treatment practices and the costs of treating diabetic foot ulcers.Conclusions: Becaplermin may be a cost-effective treatment for neuropathic diabetic foot ulcers in a wide range of European settings. In Sweden, Switzerland and the UK, becaplermin may even be cost saving. Substantial intercountry differences in resource patterns appear, at least partly, to be the logical outcome of differences in unit costs. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis is a major cause of morbidity and mortality in the elderly and, in particular, among postmenopausal women. Hormone replacement therapy (HRT) has been shown to protect against fractures, as well as to alleviate climacteric symptoms related to menopause. Unfortunately, HRT has a number of adverse effects and many patients are noncompliant. Tibolone, a synthetic steroid with tissue-specific estrogenic, progestogenic and androgenic effects, has been shown to prevent the loss of bone mass as well as to relieve climacteric symptoms in postmenopausal women, with fewer accompanying adverse effects. Objective: To estimate the economic impact in Sweden of administering tibolone 2.5 mg/day to postmenopausal women at risk for osteoporosis-related bone fractures relative to a policy of no intervention. Design and Setting: Modelling study performed from the national health system perspective in Sweden. Methodology: Disease modelling was used to simulate the risks of osteoporosis-related hip, vertebral and forearm fractures over time in hypothetical cohorts of postmenopausal women. The occurrence of fractures was predicted using risk functions estimated with data from actual cohorts of women in Sweden as well as the USA. Sweden-specific cost data were then used to estimate the economic impact with cost-effectiveness tools. Results: The model predicts that 22% of hip fractures and 13% of combined hip, vertebral and forearm fractures can be avoided over a 25-year time-period by administering tibolone to osteoporotic women. Depending on the severity of loss in bone mass and the values assumed for key parameters, estimates of the cost effectiveness of treatment range from cost saving to incremental costs per quality-adjusted life-year (QALY) gained of around SEK200 000. Delaying treatment to late menopause tends to decrease cost effectiveness. Conclusion: Our findings suggest that, relative to no treatment, tibolone is a cost-effective treatment in Sweden for the prevention of fractures in women with low bone mass, especially when treatment is initiated around the onset of menopause and is administered for 5 years. [ABSTRACT FROM AUTHOR]

In October 1995 the World Marrow Donor Association (WMDA) was restructured in order to facilitate its primary function of establishing guidelines in relation to international bone marrow and blood stem cell transplants - transplants in which the donor is in one country and the patient is in another country. Five new working groups were established - Donor Registries, Ethics, Quality Assurance, Finances, and Stem Cells. This paper, prepared by members of the Donor Registries Working Group, in consultation with the Quality Assurance Working Group, provides recommendations for the 'donor work-up'. This term covers events that start when the definitive donor has been identified, includes the harvesting (collection) and transportation of the stem cell product and ends when the product reaches the transplant centre. The paper includes examples of the documentation intended to ensure compliance with the recommendations at all key points in the sequence. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about the destructive forest fires in different parts of the world, published in the January 6, 2005 issue of the journal "Nature."