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• Patients prefer at-home drug disposal and conventional takeback programs equally. • Product cost is the most salient determinant of patient preference. • Home-use products distributed by pharmacists are most preferred. • Findings support planned US FDA risk evaluation and mitigation policy. Unused opioid medication in the home increases risk of medication diversion, misuse, and unintended harm. The United States Federal Food and Drug Administration is currently considering the implementation of a risk evaluation and mitigation strategy (REMS) program that would require US pharmacists to provide drug disposal products with opioid prescriptions. Still, little is known about consumer preference for drug disposal method. The objective of this study was to identify product and program characteristics associated with consumer preference for at-home drug disposal products. A 2x2x3x3 full-factorial design was employed to text-based vignettes representing opioid analgesic disposal scenarios. Each vignette varied on four characteristics: product cost (free vs paid), ease of use (a mail back envelope, bringing medication to a takeback site, and an at-home drug deactivation pouch), potential environmental impact (incineration), and point of access (pharmacy, community organization, and prescriber). Of the 36 possible vignettes, 12 were removed as they represented a non-realistic combination of vignette characteristics. The remaining 24 were administered to a panel of patients with controlled-substance use in the past six-months. Decision tree modeling and general linear mixed (GLM) models were used sequentially to identify product characteristics associated with patient drug preferences A total of 1,006 participants completed all vignette drug disposal scenarios. Regression tree analysis found that the most important predictor of use was cost followed by ease of access and product design. GLM showed that takeback programs offered at a pharmacy were the most preferred disposal option followed by at-home products (mailed envelope or deactivation system) dispensed with the prescription. Programs that provide disposal resources directly to the patient at no cost with their prescription are likely to optimize willingness to dispose. Findings support the FDA's plan for a REMS program requiring pharmacies to distribute mail-back envelopes to patients when dispensed opioids. [ABSTRACT FROM AUTHOR]

Increasingly, medical writers are being asked to work with health economics and outcomes research (HEOR) information. HEOR uses data from both economic and clinical research to assess the clinical and economic value of new treatments. Many medical writers have the underlying skills required to incorporate HEOR concepts into their work but need more background to do this comfortably. This article provides an introduction to health economics study design, key terms, and commonly used outcomes research approaches. It also describes how health economics writing resembles and differs from traditional medical writing. It briefly explores the present and future role of HEOR in US health policy. [ABSTRACT FROM AUTHOR]

Objectives: Infants born to mothers who are hepatitis B surface antigen (HBsAg) positive are at risk for perinatal hepatitis B infection. As prevention, these infants receive a series of 3 or 4 doses of hepatitis B vaccine starting at birth and postvaccination serologic testing. Infants with antibody levels <10 mIU/mL are considered vaccine nonresponders and should be revaccinated. The objective of this cost analysis was to assess a single-dose revaccination strategy among infant nonresponders. Methods: We used a decision analytic tree to compare the costs of a single-dose revaccination strategy with the costs of a 3-dose revaccination strategy. The analysis consisted of 3 epidemiologic scenarios that varied levels of previous protection among infants indicated for revaccination. We assumed health outcomes in each strategy were the same, and we evaluated costs from the societal perspective using 2016 US dollars. We conducted sensitivity analyses on key variables, including the minimum required efficacy of a single revaccination dose. Results: In all analyses, the single-dose revaccination strategy was a lower-cost option than the 3-dose revaccination strategy. Under the assumption that all revaccination visits were previously unscheduled, single-dose revaccination reduced the cost per infant by $119.81 to $155.72 (depending on the scenario). Across all scenarios, the most conservative estimate for the threshold efficacy (the minimum efficacy required to result in a lower-cost option) value of single-dose revaccination was 67%. Conclusions: For infants who were born to HBsAg-positive mothers and who were not responding to the initial vaccine series, a single-dose revaccination strategy, compared with a 3-dose revaccination strategy, reduced costs across several scenarios. These results helped inform the Advisory Committee on Immunization Practices' vote in February 2017 to recommend single-dose revaccination. [ABSTRACT FROM AUTHOR]

Background: The clinical manifestations of atherothrombotic disease include ischaemic heart disease (including myocardial infarction [MI]) and cerebrovascular disease (including ischaemic stroke [IS]). Although costs generated by the clinical manifestations of atherothrombotic disease represent an important economic burden for any healthcare system, very few economic comparative data are available.Objective: To: (i) assess management costs of the different practice patterns for acute and chronic phases for MI, IS and peripheral arterial disease (PAD) in eight European countries; and (ii) to simulate the cost of managing a patient with an atherothrombotic disease for 2 years in Europe.Study Perspective: Healthcare system.Methods: Firstly, the medical costs of managing MI and IS were analysed during the acute phase and subsequent 6-month periods over a total of 2 years. In each case, a decision tree was designed to indicate resource use. Assumptions concerning patient management and resource use were based on currently available local and international literature, official national statistics and local expert opinions (Delphi panel). Costs were assessed using diagnosis-related groups (Austria, Italy, Portugal and Sweden), or hospital databases and national tariffs (Belgium, France, Spain and Switzerland). Secondly, these costs were correlated to data from a large randomised clinical trial to estimate the overall cost per patient with atherothrombotic disease over a 2-year period.Results: For MI, there was a 2-fold difference in costs between the eight countries (euro9512-18 293), with 47-76% of costs devoted to acute management, 14-48% to follow-up management during the first year, and 4-17% to follow-up during the second year. For IS, there was a 10-fold difference (euro5607-56 370), with 18-75% devoted to follow-up for the years 1995-1997.Conclusions: There are differences in the overall costs and cost breakdown in the clinical management patterns of MI and IS in Europe. These differences seem to arise as a result of local treatment pattern specificities as well as the availability of specific and well-adapted structures for patients' rehabilitation. Further studies are necessary to fully explain these differences. The assessment of the total medical costs of managing an atherothrombotic patient over a 2-year period (MI, IS, established PAD) has to take into account the risk of ischaemic events in different vascular areas (MI, IS or major leg ischaemia). [ABSTRACT FROM AUTHOR]

The article presents research which analyzed the cost-effectiveness of early and delayed repair for anterior cruciate ligament injuries. Topics covered include the importance of surgical reconstruction to treat tear in anterior cruciate ligament (ACL) as well as use of Markov decision model to assess the repair. Also mentioned is the application of the Multicenter Orthopaedic Outcomes Network (MOON) database in the study.

OBJECTIVE: Individuals living with HIV face challenging employment decisions that have personal, financial, and health impacts. The decision to stay or to leave the work force is much more complicated for an individual with HIV because the financial choices related to potential health benefits are not clearly understood. To assist in the decision-making process for an individual with HIV, we propose to develop a decision model that compares the potential costs and benefits of staying in or leaving the work force. PARTICIPANTS: A hypothetical cohort of HIV-infected individuals was simulated in our decision model. Characteristics of these individuals over a one-year period were extracted from the medical literature and publicly available national surveys. Men and women between the ages of 18 and 59 were included in our simulated cohort. METHODS: A decision tree model was created to estimate the financial impact of an individual's decision on employment. The outcomes were presented as the cost-savings associated with the following employment statuses over a one-year period: 1) staying full-time, 2) switching from full-to part-time, 3) transitioning from full-time to unemployment, and 4) staying unemployed. CD4 T cell counts and employment statuses were stratified by earned income. Employment probabilities were calculated from national databases on employment trends in the United States. Sensitivity analyses were conducted to test the robustness of the effects of the variables on the outcomes. RESULTS: Overall, the decision outcome that resulted in the least financial loss for individuals with HIV was to remain at work. For an individual with CD4 T cell count > 350, the cost difference between staying employed full-time and switching from full-time to part-time status was a maximum of $2,970. For an individual with a CD4 T cell count between 200 and 350, the cost difference was as low as $126 and as great as $2,492. For an individual with a CD4 T cell count < 200, the minimum cost difference was $375 and the maximum cost difference was $2,253. CONCLUSIONS: Based on our simulated model, we recommend an individual with CD4 T cell count > 350 to stay employed full-time because it resulted in the least financial loss. On the other hand, for an individual with a CD4 T cell < 350, the financial cost loss was much more variable. Our model provides an objective decision-making guide for individuals with HIV to weigh the costs and benefits of employment decisions. [ABSTRACT FROM AUTHOR]

Background: Several studies have compared short-term catheterization approaches and have demonstrated no difference in patient satisfaction, but no study has evaluated their costs.Objective: To evaluate the costs of 3 pathways for short-term catheter management in patients diagnosed with urinary retention following pelvic surgery.Study Design: We utilized a Markov decision tree to model costs from the society's perspective. In pathway 1, patients have an indwelling catheter and return to the office for a voiding trial. In pathway 2, patients have an indwelling catheter and discontinue the catheters at home. In pathway 3, patients are taught clean intermittent catheterization postoperatively. We accounted for office visits, emergency department visits, urinary tract infection testing and treatment, transportation, caregiver time, teaching time, and supplies.Results: Clean intermittent catheterization is the least costly catheterization method at $79 per patient, followed by self-removal of the catheter ($128) and office voiding trial ($185). One-way sensitivity analyses showed that the distance between the patient and office and the rates of spontaneous voiding following catheterization had the greatest impact. When patients need to travel >5 miles to the office for catheter removal, self-removal of a catheter is less costly than an office voiding trial. Once it has been determined that patients have urinary retention and require catheterization, clean intermittent catheterization is the most cost-saving option only if the patients are taught clean intermittent catheterization postoperatively. If all patients were to be taught clean intermittent catheterization routinely before surgery, it becomes the most costly option. Based on annual surgical volume, if even $30 were saved per patient with postoperative urinary retention, the estimated total societal savings would be $420,000 to $7.2 million.Conclusion: Clean intermittent catheterization as initial management of urinary retention following pelvic surgery is the most cost-saving option when it is only taught postoperatively to patients after determining the need for catheterization. When this is not possible, self-removal of an indwelling catheter is the most cost-saving option, especially as the distance between the patient and provider increases. Choosing the optimal management guided by patient and provider factors can lead to substantial cost savings annually in the United States. [ABSTRACT FROM AUTHOR]

Objective: To develop a user-friendly tool for managing the transfer of economic evaluation results.Methods: Factors that may influence the transfer of health economic study results were systematically identified and the way they impact on transferability was investigated. A transferability decision chart was developed that includes: knock-out criteria; a checklist based on the transferability factors; and methods for improving transferability and for assessing the uncertainty of transferred results. This approach was tested on various international cost-effectiveness studies in the areas of interventional cardiology, vaccination and screening.Results: The transfer of study results is possible pending the outcomes of the transferability check and necessary adjustments. Transferability factors can be grouped into areas of methodological, healthcare system and population characteristics. Different levels of effort are required for analysis of factors, ranging from very low (e.g. discount rate) to very high (e.g. practice variation). The impact of differences of most transferability factors can be estimated via the key health economic determinants: capacity utilisation, effectiveness, productivity loss and returns to scale. Depending on the outcomes of the transferability check a correction of the study results for inflation and for differences related to currencies or purchasing power might be sufficient. Otherwise, modelling-based adjustments might be necessary, requiring the (re-)building and sometimes structural modification of the study model. For determination of the most essential adjustments, a univariate sensitivity analysis seems appropriate. If not all relevant study parameters can be substituted with country-specific ones, multivariate or probabilistic sensitivity analysis seems to be a promising way to quantify the uncertainty associated with a transfer. If study results cannot be transferred, the transfer of study models or designs should be investigated as this can significantly save time when conducting a new study.Conclusions: Our transferability decision chart is a transparent and user-friendly tool for assessing and improving the transferability of economic evaluation results. A state of the art description of the methodology in a study, providing detailed components for calculation, is not only essential for determining its transferability but also for improving it via modelling adjustments. [ABSTRACT FROM AUTHOR]

While the market for medium- and heavy-duty battery-electric vehicles (MHD EVs) is still nascent, a growing number of these vehicles are being deployed across the U.S. This study used over 2.3 million miles of operational data from multiple types of MHD EVs across various regions and operating conditions to address knowledge gaps in total cost of ownership and operational range. First, real-world energy cost savings were determined: MHD fleets should experience energy cost savings each year from 2021 to 2035, regardless of vehicle platform, with the greatest savings seen in transit buses (up to USD 4459 annually) and HD trucks (up to USD 3284 annually). Second, to help fleets across various geographies throughout the U.S. assess the suitability of EVs for their year-round operating needs, operational range was modeled using the XGBoost algorithm (R2: 70%) given 22 input features relevant to vehicle efficiency. Finally, this paper recommends (1) that MHD fleets apply energy-saving practices to minimize the impacts of cold temperatures and high congestion levels on vehicle efficiency and range, and (2) that local hauling fleets select trucks with a nominal range nearly double the expected maximum daily range to account for range losses under local, urban driving conditions. [ABSTRACT FROM AUTHOR]

Overactive bladder is a common condition, with recent findings estimating the prevalence in adults at about 15%. Symptoms, including urinary urgency, high voiding frequency and urge incontinence, have been shown to decrease patients' quality of life. Given its high prevalence, the economic burden of overactive bladder is also substantial, with a recent estimate placing the annual cost in the US at 9.1 billion US dollars (year 2000 values). The objective of this review is to provide a critical appraisal of published economic evaluations of pharmacological and non-pharmacological treatments for overactive bladder. Published economic evaluations of treatments for overactive bladder have focused entirely on pharmacological treatments -- mainly on the two most commonly used drugs, oxybutynin and tolterodine, each of which is available in immediate- and extended-release formulations. Ten economic evaluations (more than half are cost-effectiveness studies) have been published. Modelling with decision trees or Markov models has been the predominant method. Evaluations comparing drug therapy with no treatment have concluded that drug therapy is cost effective. Analyses comparing the formulations of oxybutynin and tolterodine have produced highly inconsistent results, largely due to the sources of data employed for effectiveness and treatment discontinuation rates. There are no evaluations of drugs relative to non-pharmacological treatment, and there are other significant gaps in the economic evaluations of treatment to date. These include gaps resulting from a lack of reliable data on the performance of these drugs in real-world settings, particularly data on long-term persistence with treatment. A more definitive pharmacoeconomic comparison of oxybutynin and tolterodine formulations, incorporating all available clinical data, and other treatment options would help direct treatment. [ABSTRACT FROM AUTHOR]

Objectives: Government public health expenditure data sets require time- and labor-intensive manipulation to summarize results that public health policy makers can use. Our objective was to compare the performances of machine-learning algorithms with manual classification of public health expenditures to determine if machines could provide a faster, cheaper alternative to manual classification. Methods: We used machine-learning algorithms to replicate the process of manually classifying state public health expenditures, using the standardized public health spending categories from the Foundational Public Health Services model and a large data set from the US Census Bureau. We obtained a data set of 1.9 million individual expenditure items from 2000 to 2013. We collapsed these data into 147 280 summary expenditure records, and we followed a standardized method of manually classifying each expenditure record as public health, maybe public health, or not public health. We then trained 9 machine-learning algorithms to replicate the manual process. We calculated recall, precision, and coverage rates to measure the performance of individual and ensembled algorithms. Results: Compared with manual classification, the machine-learning random forests algorithm produced 84% recall and 91% precision. With algorithm ensembling, we achieved our target criterion of 90% recall by using a consensus ensemble of≥6 algorithms while still retaining 93% coverage, leaving only 7% of the summary expenditure records unclassified. Conclusions: Machine learning can be a time- and cost-saving tool for estimating public health spending in the United States. It can be used with standardized public health spending categories based on the Foundational Public Health Services model to help parse public health expenditure information from other types of health-related spending, provide data that are more comparable across public health organizations, and evaluate the impact of evidence-based public health resource allocation. [ABSTRACT FROM AUTHOR]

Wyoming’s Green Mountain Common Allotment is public land providing livestock forage, wildlife habitat, and unfenced solitude, amid other ecological services. It is also the center of ongoing debate over USDI Bureau of Land Management’s (BLM) adjudication of land uses. Monitoring resource use is a BLM responsibility, but conventional monitoring is inadequate for the vast areas encompassed in this and other public-land units. New monitoring methods are needed that will reduce monitoring costs. An understanding of data-set relationships among old and new methods is also needed. This study compared two conventional methods with two remote sensing methods using images captured from two meters and 100 meters above ground level from a camera stand (a ground, image-based method) and a light airplane (an aerial, image-based method). Image analysis used SamplePoint or VegMeasure software. Aerial methods allowed for increased sampling intensity at low cost relative to the time and travel required by ground methods. Costs to acquire the aerial imagery and measure ground cover on 162 aerial samples representing 9000 ha were less than $3000. The four highest correlations among data sets for bare ground—the ground-cover characteristic yielding the highest correlations (r)—ranged from 0.76 to 0.85 and included ground with ground, ground with aerial, and aerial with aerial data-set associations. We conclude that our aerial surveys are a cost-effective monitoring method, that ground with aerial data-set correlations can be equal to, or greater than those among ground-based data sets, and that bare ground should continue to be investigated and tested for use as a key indicator of rangeland health. [ABSTRACT FROM AUTHOR]

The article focuses on a study which conducted a cost analysis of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) implemented in the U.S. in 2003 and 2004. It analyzed the cost of screening services provided to women under the program. It found that the median cost of screening women for breast cancer is $94. The study concluded that cost estimates are significant to administering NBCCEDP.