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The fundamental legal, normative, and politico-economic assumptions underpinning both competition law and administrative governance are in a period of considerable flux (Harris and Varellas 2020, 3; Britton-Purdy et al. 2020, 1801-02; Khan 2019; Rahman 2018). Past calls for a renewed economic analysis of law are striking a chord with present scholars. In this issue of the Journal of Law and Political Economy, we commence a specially edited series of articles focused on the value, shortcomings, and potential improvement of quantitative analysis in competition law and regulatory decision-making. This multi-year project aims to provide guidance and insight to advocates, judges, and regulators on the proper nature and scope of quantitative methods in several important areas of law and policy.

The Biden administration’s initiative to modernize regulatory review, while attempting to incorporate various criticisms of cost-benefit analysis (CBA), was hobbled by an insufficient theoretical analysis. Specifically, the administration failed to address its implicit naturalization of the economic subject, under which subjects and their preferences are regarded as exogenous givens. The justification for CBA is that it can use information regarding individual “willingness to pay” (WTP) or “willingness to accept” (WTA) to discern these preferences, and thereby create efficient policy. But if the naturalized subject is fictional, then there is nothing to discern. Subjects and their preferences are not waiting to be found; rather, they are endogenously shaped. Recognition of this endogeneity would allow for preferences, or values, constituted through democratic spaces to be no less salient to policy than those ostensibly exogenous to the market. Further, it would allow for regulatory institutions themselves to serve as those democratic spaces.

IntroductionDespite recommendations from the WHO, antenatal care (ANC) coverage remains low in many low-income and middle-income countries (LMICs). Community health workers (CHWs) can play an important role in expanding ANC coverage through pregnancy identification, provision of health education, screening for complications, delivery of therapeutic care and referral to higher levels of care. However, despite the success of CHW programmes in various countries, WHO has called for additional research to develop evidence-based models that optimise CHW service delivery and that can be replicated across geographies.MethodsThe ProCCM Trial was a cluster-randomised controlled trial to compare proactive home visits by CHWs (intervention, 69 village clusters) to the provision of CHW care at community fixed sites only (control, 68 village clusters) in the Bankass health district in Central Mali. In this study, we conducted a cost-effectiveness analysis of proactive CHW home visits in improving ANC utilisation, a secondary outcome of the ProCCM trial. We analysed five ANC outcomes: (1) number of ANC contacts, (2) at least one ANC contact, (3) at least four ANC contacts, (4) at least eight ANC contacts and (5) ANC initiated in the first trimester. We assumed two perspectives, a CHW programme's and the Full ANC programme's perspective, which included facility-based as well as community-based ANC. We estimated programme costs, incremental cost-effectiveness ratios (ICERs) and probabilities of the intervention being more cost-effective than the control at different willingness-to-pay (WTP) thresholds.ResultsProactive home visits were cost-saving from the CHW programme's perspective (ICERs: -$21.39 to -$79.20 per ANC utilisation outcome) and from the Full ANC programme perspective (ICERs: -$1.70 to -$6.30 per ANC utilisation outcome) compared with the fixed-site CHW care. The likelihood of the intervention being more cost-effective than the control was 100% at WTP thresholds $0 per ANC utilisation outcome and between $12.5 and $50.00 per ANC utilisation outcome in the CHW- and Full ANC programme perspectives, respectively.ConclusionOur results provide evidence that proactive home visits produce more value per dollar spent as a means of improving the uptake of ANC services compared with fixed-site CHW services.Trial registration numberNCT02694055.

PurposeWe aimed to estimate health state utility values (HSUVs) for the key health states found in opioid use disorder (OUD) cost-effectiveness models in the published literature.MethodsData obtained from six trials representing 1,777 individuals with OUD. We implemented mapping algorithms to harmonize data from different measures of quality of life (the SF-12 Versions 1 and 2 and the EQ-5D-3 L). We performed a regression analysis to quantify the relationship between HSUVs and the following variables: days of extra-medical opioid use in the past 30 days, injecting behaviors, treatment with medications for OUD, HIV status, and age. A secondary analysis explored the impact of opioid withdrawal symptoms.ResultsThere were statistically significant reductions in HSUVs associated with extra-medical opioid use (-0.002 (95% CI [-0.003,-0.0001]) to -0.003 (95% CI [-0.005,-0.002]) per additional day of heroin or other opiate use, respectively), drug injecting compared to not injecting (-0.043 (95% CI [-0.079,-0.006])), HIV-positive diagnosis compared to no diagnosis (-0.074 (95% CI [-0.143,-0.005])), and age (-0.001 per year (95% CI [-0.003,-0.0002])). Parameters associated with medications for OUD treatment were not statistically significant after controlling for extra-medical opioid use (0.0131 (95% CI [-0.0479,0.0769])), in line with prior studies. The secondary analysis revealed that withdrawal symptoms are a fundamental driver of HSUVs, with predictions of 0.817 (95% CI [0.768, 0.858]), 0.705 (95% CI [0.607, 0.786]), and 0.367 (95% CI [0.180, 0.575]) for moderate, severe, and worst level of symptoms, respectively.ConclusionWe observed HSUVs for OUD that were higher than those from previous studies that had been conducted without input from people living with the condition.

BACKGROUND AND OBJECTIVE: Half of patients with gastroesophageal reflux disease (GERD) experience persistent symptoms while on proton pump inhibitors (PPIs), thus driving efforts to develop novel adjunctive therapies for PPI-refractory GERD. An economic analysis was performed to establish at what cost and efficacy such potential medications are likely to become cost effective in clinical practice. METHODS: A Markov decision model was used to examine a hypothetical cohort of patients being evaluated for PPI-refractory GERD in the USA. The model compared 3 strategies: (1) usual care (i.e., upfront diagnostic testing with upper endoscopy ± ambulatory pH testing); (2) use of a PPI-adjunctive therapy after positive ambulatory pH testing; and (3) empiric use of a PPI-adjunctive therapy (i.e., diagnostic testing only after failing empiric treatment). The primary outcome was incremental cost per quality-adjusted life year (QALY) gained (third-party payer perspective) over a 10-year time horizon using a willingness to pay threshold of $100,000/QALY. RESULTS: In two-way sensitivity analyses varying the cost and effectiveness of the PPI-adjunctive therapy, most combinations revealed that use of the medication after positive pH testing was the most cost-effective approach. Empiric treatment was the preferred strategy only when the therapy was highly efficacious (≥ 87.5% response rate) and low cost (≤ $109/month). Use of PPI-adjunctive treatments were not cost effective when the cost exceeded $1150/month. CONCLUSION: Use of PPI-adjunctive therapies in those with persistent GERD symptoms may become cost effective when guided by ambulatory pH tests. These data can guide investigators, industry, and payers as they develop, validate, and price new treatments for PPI-refractory GERD.

BackgroundProject Orbis is a global initiative that aims to streamline regulatory review processes across international regulators in the USA, Canada, Australia, UK, Israel, Brazil, Singapore, and Switzerland to bring promising cancer drugs to patients earlier. We explored the clinical benefit, time to regulatory approval and health technology assessment recommendations, reimbursement outcomes, and monthly treatment prices of cancer drugs reviewed through this initiative.MethodsFor this retrospective, comparative analysis, we identified cancer drug approvals reviewed through Project Orbis in the USA, Canada, and the UK between May 1, 2019, and Nov 1, 2023. Approvals of cancer drugs reviewed Project Orbis were extracted from the Food and Drug Administration (FDA) Oncology Centre of Excellence and all other FDA approvals from the Drugs@FDA database. The co-primary outcomes were time of regulatory review, time from regulatory approval to health technology assessment recommendation (England, Scotland, and Canada), reimbursement outcomes, clinical benefit (defined as median gains in progression-free survival and overall survival) between cancer drug approvals reviewed by Project Orbis and other FDA approval processes, and monthly treatment prices. The Wilcoxon rank-sum and Fisher's Exact tests were used to examine statistical significance between approvals reviewed through Project Orbis and other FDA approvals during the same period.FindingsBetween May 1, 2019 and Nov 1, 2023, 81 (33%) of 244 cancer drugs approved by the FDA were reviewed through Project Orbis. The median overall survival gains were 4·1 months (IQR 3·3-5·1) compared with 2·7 months (2·1-3·9) for other FDA approvals. Similarly, progression-free survival gains were 2·6 months (IQR 1·7-4·9) for Project Orbis compared with 2·6 months (0·6-5·1) for other FDA approvals. Neither overall survival (p=0·11) nor progression-free survival (p=0·44) gains were significantly different between the two cohorts of approvals. Of the 14 UK Medicines and Healthcare products Regulatory Agency (MHRA) approvals reviewed by the Scottish Medicines Consortium (SMC), the agency gave positive recommendations for all 14 (100%). Of the 15 MHRA approvals reviewed by the National Institute for Health and Care Excellence (NICE), the agency gave positive recommendations for six (40%). Of the 49 approvals reviewed by the Canadian Agency for Drugs and Technologies in Health (CADTH), the agency conditionally recommended 44 (90%). The time between regulatory approval to NICE recommendation increased from a median of 137 days (IQR 102-172) in 2021 to 302 days (184-483) in 2023, SMC recommendation increased from 185 days (in 2021 for one drug only) to 368 days (IQR 313-476) in 2023, and CADTH decision increased from 97 days (in 2020 for one drug only) to 202 days (IQR 153-304) in 2023. The median monthly price of approvals reviewed through Project Orbis was US$20 000 per month (IQR 13 000-37 000).InterpretationClinical outcomes of Project Orbis were no different than other FDA approvals during the same time, and access, after a successful health technology assessment, was considerably delayed or absent, raising questions about whether Project Orbis participation translates into faster patient access to medicines with high clinical benefit and sustainable costs. Although future challenges might benefit from regulatory harmonisation, the advantages are currently unclear.FundingNone.

This viewpoint discusses cost-effectiveness estimates for EtranaDez, a gene therapy for hemophilia B, using the Institute for Clinical and Economic Reviews (ICER) framework for single and short-term therapies (SSTs). EtranaDez offers long-term benefits from a single administration, in contrast to the high costs and frequent dosing required by current factor IX prophylaxis. However, the projected gains in health from EtranaDez are small relative to the cost implications of the therapy, and consequently, how the cost offsets associated with EtranaDez are counted has a substantial impact on assessing its cost-effectiveness. Strategies for assessing cost offsets used in the ICER SST framework include a 50/50 cost-sharing model between the health care system and the manufacturer and a cap of $150,000 annually on health care cost offsets. Results from the standard full cost-offset analysis as reported by ICER depicted EtranaDez as a dominant therapy with substantial cost savings compared with factor IX prophylaxis. However, while considering the ICER SST framework, particularly the $150,000 annual cap scenario, the cost-effectiveness was significantly reduced. The incremental cost-effectiveness ratio varied notably between these scenarios, challenging the conventional perception of value of gene therapy in health care. These cost-sharing scenarios highlight the potential of the ICER SST framework to help curtail inefficient health care spending. In cases in which the cost of existing treatment is exceedingly high, the application of such frameworks would improve efficiency in resource allocation, fostering a balance between incentives for innovation and economic sustainability in managed care systems.

BACKGROUND: Mental, neurological, and substance abuse (MNS) disorders describe a range of conditions that affect the brain and cause distress or functional impairment. In the Middle East and North Africa (MENA), MNS disorders make up 10.88 percent of the burden of disease as measured in disability-adjusted life years. The Kingdom of Saudi Arabia (KSA) is one of the main providers of mental health services and one of the largest contributors to mental health research in the region. Within the past decade, mental health resources and services has increased. METHODS: We employ a needs-based workforce estimate as a planning exercise to arrive at the total number of psychiatrists, nurses, and psychosocial care providers needed to meet the epidemiological need of mental health conditions of the population of KSA. Estimates for a potential mental health workforce gap were calculated using five steps: Step 1-Quantify target population for priority mental health conditions. Step 2-Identify number of expected cases per year. Step 3-Set target service coverage for each condition. Step 4-Estimate cost-effective health care service resource utilization for each condition. Step 5-Estimate service resources needed for each condition. RESULTS: The planning exercise indicates an epidemiologic need for a total of 17,100 full-time-equivalent (FTE) health care providers to treat priority MNS disorders. KSA appears to have a need-based shortage of 10,400 health workers to treat mental disorders. A total of 100 psychiatrists, 5700 nurses, and 4500 psychosocial care providers would be additionally needed (that is, above and beyond current levels) to address the priority mental health conditions. The shortfall is particularly severe for nurses and psychosocial workers who make up 98.9 percent of the shortfall. This shortage is substantial when compared to other high-income countries. Overall, the workforce needed to treat MNS conditions translates to 49.2 health workers per 100,000 population. CONCLUSION: Challenges to addressing the shortfall are Saudi specific which includes awareness of cultural customs and norms in the medical setting. These challenges are compounded by the lack of Saudi nationals in the mental health workforce. Saudi nationals make up 29.5 percent of the physician workforce and 38.8 percent of the nursing workforce. Policymakers and planners supplement this shortfall with non-Saudi providers, who must be mindful of Saudi-specific cultural considerations. Potential solutions to reducing the shortfall of mental health care workers includes nurse task shifting and training of general practitioners to screen for, and treat, a subset of MNS disorders.

BACKGROUND: Eculizumab and efgartigimod were approved to treat anti-acetylcholine receptor antibody-positive generalized myasthenia gravis (anti-AChR Ab-positive gMG). These relatively new biological treatments provide a more rapid onset of action and improved efficacy compared with conventional immunosuppressive treatments, but at a higher cost. OBJECTIVE: To assess the cost-effectiveness of eculizumab and, separately, efgartigimod, each added to conventional therapy vs conventional therapy alone, among patients with refractory anti-AChR Ab-positive gMG and those with anti-AChR Ab-positive gMG, respectively. METHODS: A Markov model with 4 health states was developed, evaluating costs and utility with a 4-week cycle length and lifetime time horizon from a health care system perspective and a modified societal perspective including productivity losses from patients and caregiver burden. Model inputs were informed by key clinical trials and relevant publications identified from targeted literature reviews, and drug costs were identified from Micromedex Red Book. Costs and outcomes were discounted at 3% per year. Incremental cost-effectiveness ratios (ICERs; cost per quality-adjusted life-year [QALY] gained) were calculated for each comparison. RESULTS: Among the corresponding populations, lifetime costs and QALYs, respectively, for eculizumab were $5,515,000 and 11.85, and for conventional therapy, $308,000 and 10.29, resulting in an ICER of $3,338,000/QALY gained. For efgartigimod, lifetime costs and QALYs, respectively, were $6,773,000 and 13.22, and for conventional therapy, $322,000 and 9.98, yielding an ICER of $1,987,000/QALY gained. After applying indirect costs in a modified societal perspective, the ICERs were reduced to $3,310,000/QALY gained for eculizumab and $1,959,000/QALY gained for efgartigimod. CONCLUSIONS: Eculizumab and efgartigimod are rapidly acting and effective treatments for myasthenia gravis. However, at their current price, both therapies greatly exceeded common cost-effectiveness thresholds, likely limiting patient access to these therapies.

OBJECTIVE: Nursing home residents may be particularly vulnerable to coronavirus disease 2019 (COVID-19). Therefore, a question is when and how often nursing homes should test staff for COVID-19 and how this may change as severe acute respiratory coronavirus virus 2 (SARS-CoV-2) evolves. DESIGN: We developed an agent-based model representing a typical nursing home, COVID-19 spread, and its health and economic outcomes to determine the clinical and economic value of various screening and isolation strategies and how it may change under various circumstances. RESULTS: Under winter 2023-2024 SARS-CoV-2 omicron variant conditions, symptom-based antigen testing averted 4.5 COVID-19 cases compared to no testing, saving $191 in direct medical costs. Testing implementation costs far outweighed these savings, resulting in net costs of $990 from the Centers for Medicare & Medicaid Services perspective, $1,545 from the third-party payer perspective, and $57,155 from the societal perspective. Testing did not return sufficient positive health effects to make it cost-effective [$50,000 per quality-adjusted life-year (QALY) threshold], but it exceeded this threshold in ≥59% of simulation trials. Testing remained cost-ineffective when routinely testing staff and varying face mask compliance, vaccine efficacy, and booster coverage. However, all antigen testing strategies became cost-effective (≤$31,906 per QALY) or cost saving (saving ≤$18,372) when the severe outcome risk was ≥3 times higher than that of current omicron variants. CONCLUSIONS: SARS-CoV-2 testing costs outweighed benefits under winter 2023-2024 conditions; however, testing became cost-effective with increasingly severe clinical outcomes. Cost-effectiveness can change as the epidemic evolves because it depends on clinical severity and other intervention use. Thus, nursing home administrators and policy makers should monitor and evaluate viral virulence and other interventions over time.

OBJECTIVE: Implantable loop recorders (ILRs) are increasingly used for long-term rhythm monitoring after ischaemic and cryptogenic stroke, with the goal of detecting atrial fibrillation (AF) and subsequent initiation of oral anticoagulation to reduce risk of adverse clinical outcomes. There is a need to determine the effectiveness of different rhythm monitoring strategies in this context. METHODS: We conducted a retrospective cohort analysis of individuals with commercial and Medicare Advantage insurance in Optum Labs Data Warehouse who had incident ischaemic or cryptogenic stroke and no prior cardiovascular implantable electronic device from 1 January 2016 to 30 June 2021. Patients were stratified by rhythm monitoring strategy: ILR, long-term continuous external cardiac monitor (>48 hours to 30 days) or Holter monitor (≤48 hours). The primary outcome was risk-adjusted all-cause mortality at 12 months. Secondary outcomes included new diagnosis of AF and oral anticoagulation, bleeding, and costs. RESULTS: Among 48 901 patients with ischaemic or cryptogenic stroke, 9235 received an ILR, 29 103 long-term continuous external monitor and 10 563 Holter monitor only. Mean age was 69.9 (SD 11.9) years and 53.5% were female. During the 12-month follow-up period, patients who received ILRs compared with those who received long-term continuous external monitors had a higher odds of new diagnosis of AF and oral anticoagulant initiation (adjusted OR 2.27, 95% CI 2.09 to 2.48). Compared with patients who received long-term continuous external monitors, those who received ILRs had similar 12-month mortality (HR 1.00; 95% CI 0.89 to 1.12), with approximately $13 000 higher costs at baseline (including monitor cost) and $2500 higher costs during 12-month follow-up. CONCLUSIONS: In this large real-world study of patients with ischaemic or cryptogenic stroke, ILR placement resulted in more diagnosis of AF and initiation of oral anticoagulation, but no difference in mortality compared with long-term continuous external monitors.

UNLABELLED: Continuous tobacco use in patients with cancer is linked to substantial healthcare costs due to increased risks and complications, whereas quitting smoking leads to improved treatment outcomes and cost reductions. Addressing the need for empirical evidence on the economic impact of smoking cessation, this study examined the association between smoking cessation and healthcare cost utilization among a sample of 930 patients with cancer treated at The University of Texas MD Anderson Cancer Centers Tobacco Research and Treatment Program (TRTP). Applying conditional quantile regression and propensity scores to address confounding, our findings revealed that abstinence achieved through the TRTP significantly reduced the median cost during a 3-month period post-quitting by $1,095 [β = -$1,095, P = 0.007, 95% confidence interval (CI), = (-$1,886 to -$304)]. Sensitivity analysis corroborated these conclusions, showing a pronounced cost reduction when outlier data were excluded. The long-term accrued cost savings from smoking cessation could potentially offset the cost of participation in the TRTP program, underscoring its cost effectiveness. An important implication of this study is that by reducing smoking rates, healthcare systems can more efficiently allocate resources, enhance patient health outcomes, and lessen the overall cancer burden. PREVENTION RELEVANCE: This study emphasizes the dual impact of smoking cessation programs in patients with cancer: quitting smoking and reducing healthcare costs. It highlights the importance of integrating cessation programs into cancer prevention strategies, ensuring both individual health benefits and broader, system-wide economic efficiencies. See related Spotlight, p. 197.

BACKGROUND: Audit and Feedback (A&F) interventions based on quality indicators have been shown to lead to significant improvements in compliance with evidence-based care including de-adoption of low-value practices (LVPs). Our primary aim was to evaluate the cost-effectiveness of adding a hypothetical A&F module targeting LVPs for trauma admissions to an existing quality assurance intervention targeting high-value care and risk-adjusted outcomes. A secondary aim was to assess how certain A&F characteristics might influence its cost-effectiveness. METHODS: We conducted a cost-effectiveness analysis using a probabilistic static decision analytic model in the Québec trauma care continuum. We considered the Québec Ministry of Health perspective. Our economic evaluation compared a hypothetical scenario in which the A&F module targeting LVPs is implemented in a Canadian provincial trauma quality assurance program to a status quo scenario in which the A&F module is not implemented. In scenarios analyses we assessed the impact of A&F characteristics on its cost-effectiveness. Results are presented in terms of incremental costs per LVP avoided. RESULTS: Results suggest that the implementation of A&F module (Cost = $1,480,850; Number of LVPs = 6,005) is associated with higher costs and higher effectiveness compared to status quo (Cost = $1,124,661; Number of LVPs = 8,228). The A&F module would cost $160 per LVP avoided compared to status quo. The A&F module becomes more cost-effective with the addition of facilitation visits; more frequent evaluation; and when only high-volume trauma centers are considered. CONCLUSION: A&F module targeting LVPs is associated with higher costs and higher effectiveness than status quo and has the potential to be cost-effective if the decision-makers willingness-to-pay is at least $160 per LVP avoided. This likely represents an underestimate of true ICER due to underestimated costs or missed opportunity costs. Results suggest that virtual facilitation visits, frequent evaluation, and implementing the module in high-volume centers can improve cost-effectiveness.

HighlightsWe illustrate the steps involved in carrying out cost-effectiveness analysis using net benefit regressions with possibly censored demo data by providing step-by-step guidance and code applied to a data set.We demonstrate the importance of these new methods by illustrating how naïve methods for handling censoring can lead to biased cost-effectiveness results.

Cost-benefit analysis (CBA) is a toolkit based in applied economic analysis to provide net impact values in dollar terms for direct and indirect benefits minus costs associated with a policy or intervention. CBA can include valuations of lives saved and of lives preserved via fatality and injury avoidance. The application of conceptually correct CBA to agricultural health and safety to date is limited. This article reviews how economic “shadow prices” can be used to estimate costs and benefits of interventions adjusted for farmwork populations relative to a “do nothing” status quo. The article provides a generalizable framework for future analyses of specific interventions, as well as background on tangible valuation methodologies that could contribute to impact analyses and funding requests highlighting the importance of farm health and safety. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionsResilience training shows moderate effect in combatting burnout, yet little is known about its cost-effectiveness. This study analyzes the cost-effectiveness of offering resilience training to medical students with elevated stress from a Dutch university medical center (payer) perspective compared to mental health support as usual.We constructed a state-transition cohort (Markov) model to estimate quality-adjusted lifeyears and associated costs of offering resilience training to a cohort of 410 first-year medical students over a 6-year timeframe. Utility values were obtained through baseline data from the DEcrease STress through RESilience training for Students (DESTRESS) study. Data on transition probabilities and the effect of resilience training were based on the best available literature. We resampled all data to generate 10,000 simulations of incremental costs and effects in a probabilistic analysis.On average students gained 0.15 QALYs (95%CI 0.09, 0.20) at a cost-saving of €1076 (95%CI 412, 2008), making resilience training the dominant strategy. These savings resulted from an assumed reduction in study delay due to a reduction in symptoms of stress and burnout. For every euro the university invests in resilience training, we estimatea return of investment of €2.79.This study provides evidence that offering resilience training to medical students is cost-effective and cost-saving. [ABSTRACT FROM AUTHOR]

Accidents are frequent in the construction industry, where managerial negligence and inadequate safety supervision are significant factors that contribute to these safety incidents. However, existing research tended to concentrate on the outcomes resulting from inadequate safety supervision but neglected the decision-making process behind insufficient supervision, which fails to fundamentally address the issue of accidents caused by insufficient supervision. To address these gaps, this study examines the key cost–benefit factors influencing safety supervision decisions among employers, contractors, supervisors, and construction workers in the Chinese construction industry. Using semistructured interviews with 49 participants and questionnaire surveys with 203 respondents, the effects of various factors on safety supervision were identified. An evolutionary game model was then employed for simulation based on the identified key factors to provide recommendations. The findings reveal 58 pivotal cost–benefit factors that influence safety-related decisions, encompassing four explicit benefits, eight implicit benefits, 35 explicit costs, and 11 implicit costs. The results indicate that implicit costs and benefits are significant factors driving safety supervision. Explicit costs are primarily driven by company or project standards, whereas implicit costs are influenced by company or employee attitudes and perceptions. Additionally, recommendations were proposed: increasing awareness of the implicit benefits of safety supervision, reducing noncritical expenditures, improving hazard awareness, and strengthening government and employer supervision. This research contributes to enriching the cost–benefit framework in construction safety supervision, shedding light on the root causes of insufficient safety supervision through a cost–benefit analysis, and implementing measures to promote safety supervision and onsite safety performance. [ABSTRACT FROM AUTHOR]

Featured Application: The proposed measures for the modification and supplementation of the CBA methodology in the Slovak Republic in the field of GHG emission assessments after their implementation can objectify the CBA results for this sector and can bring more realistic results for the process of assessing the implementation of transport construction in road transport. This comparative analysis identified disproportions in the CBA methodologies of selected countries in the scope of GHG emissions and their economic value in assessing transport projects in Slovakia and selected Central European countries. This study identifies the disparities in CBA methodologies in the Slovak Republic in the field of greenhouse gases. It proposes specific measures for improving the methodology itself, the use of best practices from CBA methodologies in selected countries, and discusses the possible implementation of the latest standards in the field of greenhouse gases and their economic value. These steps can objectify the calculated economic value of climate change for policymakers and decision-makers on transport infrastructure investments. The proposed measures for the modification and supplementation of the CBA methodology in the Slovak Republic in the field of GHG emission assessments after their implementation can objectify the CBA results for this sector and can bring more realistic results for the process of assessing the implementation of transport construction in road transport. The paper contains a case study for the calculation of GHG emissions from road transport, their economic value, and their disproportion in case of changes in the CBA methodology in the Slovak Republic for the assessment of road transport projects. [ABSTRACT FROM AUTHOR]

AbstractValid and reliable measures of the harms to victims of crime are critical inputs to policy choices. Recent advances in cost-benefit methodology allow these measures to be directly estimated in causal models, but these models require individual- or event-level data. This article presents a new conceptual framework, known as HAVEN (Harms After Victimization: Experiences and Needs), for individual victim harm measurement. Guided by the conceptual framework, these models solve three critical problems in victim harm measurement: they motivate data linkage across medical and legal systems (and other) data; they integrate the log-normal distribution of harms into the framework and thereby include catastrophic costs as valid measures rather than exclude as outliers; and they prioritize integrated systems data (i.e. medical-legal) rather than single system measures of victimization harm. The conceptual framework also creates a dynamic framework to expand individual- and event-level harm measurement in future studies. [ABSTRACT FROM AUTHOR]

The energy industry is constantly changing and evolving. One of the visible solutions is the pursuit of low-emission solutions. One such solution is investment in renewable energy sources (RESs), including hydropower, which in 2023 will constitute a dominant share in the production of electricity from RESs (47.02%) in the world. One of the alternative solutions is the use of hydropower in wastewater treatment plants, whose global potential is estimated at about 4350 TWh. An important issue in the operation of these facilities is their profitability. This article presents an economic analysis of a hydropower plant in the wastewater treatment plant in Toruń (northern Poland) in order to assess its profitability in the context of profits, costs, and payback period. The analyses showed the profitability of 9 out of 12 characterized variants, with the payback period estimated for real variants at 10.75–23.74 years and for theoretical variants at 5.06–5.32 years. The most significant factor in reducing the payback period was the level of electricity production between years, while different types of settlements and changes in electricity sales prices played a lesser role. Taking into account all profitable variants, after 25 years of operation, the net income will amount to PLN 1.07 million for the actual variants and PLN 3.18 million for the theoretical variants. The work can contribute to understanding the specifics of the operation of such facilities, which is consistent with, among others, the goals of sustainable development, climate and energy policies, or the circular economy. [ABSTRACT FROM AUTHOR]

Ethical utilitarianism is a consequence-oriented ethical theory that pursues the maximization of happiness and fully considers the long-term impact of behavior. In the ethical review of human organ donation and transplantation, this theory is mainly applied in three aspects, ethical review supervision, process and content. However, in practice, it faces challenges such as the difficulty and subjectivity of utility calculation, the balance between individual rights and social welfare, the long-term impact of decision-making, and international cooperation under a global perspective. Therefore, governance strategies such as improving ethical review policy rules, refining the ethical review system by drawing on international experience, and strengthening public education and publicity are proposed. Despite many challenges, ethical utilitarianism still provides an important theoretical framework for the ethical review of human organ donation and transplantation. Therefore, this article reviews the application of ethical utilitarianism in the ethical review of human organ donation and transplantation and its challenges, aiming to provide a reference for related research on the ethical review of human organ donation and transplantation. [ABSTRACT FROM AUTHOR]

Societal Impact Statement: Intercropping techniques like the Three Sisters, where maize, beans, and squash are grown in an intermixed arrangement, have sustained communities in the Americas for thousands of years and continue to be practiced around the world. In collaboration with the Catawba Indian Nation, we assessed the yield and labor demands required when farming with Three Sisters versus monoculture arrangements. Our results illustrate how farmers could use different planting strategies depending on their priorities (e.g., maximizing yield) and available resources (e.g., conserving land, seeds, or labor). Studies like these can help inform food sovereignty programs and support cultural initiatives in Native communities. Summary: Many Native American communities have historically grown maize, beans, and squash in polyculture as the Three Sisters because of the reciprocal ecological benefits the species provide each other and the surrounding environment. For instance, archaeological remains indicate that the Catawba Indian Nation had grown the Three Sisters for hundreds of years before experiencing the expansion of the colonial market economy, a smallpox epidemic, and the drastic loss of land.To support the Catawba Indian Nation's food sovereignty and traditional ecological knowledge initiatives, we assess the yield and labor demands of growing their traditional variety of maize, beans, and squash plants in the Three Sisters planting design versus in monoculture conditions.While total maize yield was equivalent in monoculture and the Three Sisters, plants grew larger, had higher survival, and produced greater yield per plant and per unit area of land in the Three Sisters. [Correction added on 21 November 2024, after first online publication: The preceding sentence has been corrected.] Squash yield was highest in monoculture. Trellising bean plants in monoculture required the most labor, and altogether, yield per hour of labor was higher in monoculture than in the Three Sisters.Ultimately, the most appropriate farming strategy for the Catawba Indian Nation to use will depend on their priorities (e.g., maximizing the production of one species versus all species). We discuss the challenges managers of small farms face when considering traditional versus modern agricultural methods and describe how a respectful partnership between the Catawba Nation and Davidson College expanded and enhanced the outcomes of this study. [ABSTRACT FROM AUTHOR]

Background: In the current post-pandemic context, the main characteristics of workplaces have changed radically. Among the most prominent aspects of the post-pandemic workplace are hybrid arrangements, wide-spread remote work as the main work arrangement and increasing automation and robotization. These changes pose major concerns in terms of workplace wellness and occupational health and safety, primarily due to emerging or insufficiently analyzed risks in the workplace. Objective: Especially in the post-pandemic world, where emerging risks in the workplace add to the pre-existing organizational challenges, the key to preventive and proactive organizational behavior is integration of ergonomics in current work environments, irrespective of the type of work arrangement (remote, in office, manufacturing plants, etc.). Starting from this idea, the authors aimed to create an intervention model and to support the decision-making process to ensure successful implementation of ergonomic interventions. Methods: The article presents a new perspective on workplace risk management and enhancement of workplace wellbeing based on a framework that encompasses workplace risk assessment, proposal of ergonomic interventions, and the managerial and financial evaluation of the proposed interventions. Results: A key contribution to the literature in the field is represented by case studies on two companies, where cost-benefit analysis (CBA) was performed to assess validity of the proposed framework. Conclusions: The paper is a valuable contribution to the literature in the field of ergonomic interventions due to the innovative approach proposed by the authors. Innovation through combination is the key to a framework that addresses the real need of practitioners aiming to improve working conditions and ensure work-life balance across industries. [ABSTRACT FROM AUTHOR]

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Water Sensitive Urban Design (WSUD) has emerged as a vital framework for integrating sustainable water management into urban planning, tackling the increasing challenges posed by urbanization and climate change. WSUD aims to align water systems with natural ecosystems by minimizing runoff, improving water quality, and promoting biodiversity while also offering recreational and aesthetic benefits for urban residents. While the environmental advantages of WSUD are well-established, its social and economic aspects warrant more in-depth exploration. This review analyses the social and economic impacts of WSUD, focusing on its effects on community well-being, property values, infrastructure costs, and public engagement. It also discusses the significance of citizen perceptions, socio-economic equity, and financing mechanisms in the adoption of WSUD. The findings highlight the necessity for interdisciplinary approaches and policy reforms that incorporate social and economic considerations into WSUD planning to ensure long-term success and sustainability. This analysis aims to enhance understanding of how WSUD can contribute to resilient, equitable, and sustainable urban communities. [ABSTRACT FROM AUTHOR]

The heading "Wireless Networks in Hospitals: Ensuring Seamless Communication in Critical Situations" examines hospital wireless network enhancement. When patient well-being is at stake, this strategy encourages honest conversation. Service quality, resource efficiency, and network security are crucial. These mathematical models increase hospital wireless network stability based on Internet of Thing (IoT). Service management effectiveness influences who gets vital medical information quickly. Information and crucial messages are delivered faster. A mathematical technique considers the relevance and transmission time of each data payload to estimate its priority factor (P(i)). Network performance determines QoS settings. Priority data is transmitted first to ensure quick delivery to the intended recipients. This technology is essential for updating hospital WiFi networks, especially in critical situations where it can transmit accurate and timely information and save lives. WiFi reliability is essential for building operations. Compare failure frequency and MTBF to assess each network point's reliability. An exponential reliability function determines network dependability. The mean time between failures is used. This method maintains network functionality despite its complexity. Determine which pieces are crucial and how they influences network health. This simplifies network backups and maintenance. Load balancing distributes network tasks among entry points. This strategy helps the network function smoothly and minimize congestion during peak demand. The weighted round-robin timing algorithm determines how busy each access point is to send fresh network traffic to the proper areas. By equally distributing load and prioritizing underutilized access points, this method maintains network stability and keeps critical lines available. These three approaches form a full healthcare WiFi network strengthening plan. Mission-critical data is prioritized, the network is more robust, and resources may be allocated quickly. Our solution often outperforms the existing standard in network stability, communication, and cost. [ABSTRACT FROM AUTHOR]

A challenge for cost-benefit analysis is that it ignores ethical values such as justice, fairness, and equity. One standard response is to regard CBA results as just one factor in a more complex decision-process where ethical and democratic factors are also considered. This paper considers an alternative response: extending CBA so that it takes into account not only self-interested input but also moral preferences such as a ‘taste’ for fairness. Drawing on existing research and the example of resource allocation, the paper develops and analyzes objections to extended CBA. Evaluation of these objections, the paper shows, depends on how the original challenge is interpreted and how the problem of ‘ignoring’ ethical values is understood. While some interpretations lead to an impasse between defenders and critics of extended CBA, the paper proposes a novel interpretation – focused on political representationality – and showcases the limits of CBA as a coherent response. [ABSTRACT FROM AUTHOR]

The Qinghai–Tibetan Plateau (QTP) has the largest area of natural grassland in China, and continuous grassland degradation poses a serious threat to regional ecological security and sustainable resource management. It is essential to comprehensively evaluate the cost–benefit differences and drivers of grassland degradation across various zones to enhance sustainable management practices. This study presents a zonal management framework for the ecological restoration of degraded grasslands based on cost–benefit analysis, specifically applied to Qinghai in the Northeastern QTP. The results indicate: (1) Although the overall NDVI of grasslands shows an upward trend, some areas still exhibit significant degradation. (2) Cost–benefit analysis can divide degraded grasslands into four types of Ecological Management Zones (EMZs): high-cost–high-benefit zone, high-cost–low-benefit zone, low-cost–low-benefit zone, and low-cost–high-benefit zone. (3) The driving factors of grassland degradation show significant differences in different EMZs. Based on these research findings, differentiated spatial planning and management strategies for grassland ecological restoration were developed for each EMZ. This study not only provides a scientific methodology for grassland ecological restoration but also offers important insights for the sustainable management of grassland resources in the QTP and other ecologically sensitive areas. [ABSTRACT FROM AUTHOR]

This study presents a novel sustainability plan tailored for Istanbul Airport, leveraging advanced decision-making methodologies to address the urgent need for sustainable practices in aviation. By integrating the entropy weighting and 2-tuple linguistic T-spherical fuzzy multi-criteria decision-making (MCDM) models, the study offers a comprehensive approach to evaluating and prioritizing sustainability criteria based on expert input from 12 professionals. The novelty of this research lies in its unique combination of advanced MCDM techniques with cutting-edge technologies, including IoT-enabled monitoring systems, digital twin models, blockchain-based sustainability reporting, and carbon capture initiatives, tailored specifically for large-scale airport operations. The study develops a phased implementation roadmap comprising three stages: (1) a short-term focus on energy efficiency and renewable energy infrastructure, achieving significant cost reductions within a 3–7.5-year payback period; (2) medium-term initiatives integrating IoT and digital twins to enhance operational efficiency; and (3) long-term measures incorporating carbon capture and blockchain for transparency and compliance. Key implementation steps include upgrading energy systems, deploying IoT sensors, creating digital replicas of airport infrastructure, and establishing regulatory and stakeholder collaboration frameworks. This research contributes a replicable framework for airports worldwide, bridging theoretical models with actionable solutions. [ABSTRACT FROM AUTHOR]

Microplastics pollution is becoming a major environmental concern for air, soil, and water. The European Union (EU) Zero Pollution Action Plan targets to reduce microplastics release to the environment by 30% by 2030. Tyre wear is estimated to be the most important contributor to unintentionally released microplastics to the environment. For this reason, the new Euro 7 vehicle emission standard introduced placeholders for limiting tyre abrasion. In this study, we calculate the environmental pollution from tyres using as a basis a recent review on tyre wear emission factors. We also estimate the impact of reducing the average emission factors following the Euro 7 implementation dates. Additionally, we present the cost savings to the EU by such a reduction over a time horizon until 2050. Even though the final cost saving estimations come with some uncertainty due to lack of accurate and up-to-date emission factors, especially for heavy-duty vehicles, the introduction of tyre wear limits has a significant positive impact under all scenarios examined. [ABSTRACT FROM AUTHOR]

This study demonstrates the benefits of comprehensive school building (SB) energy efficiency (EE) improvements through building envelope renovations, lighting upgrades, and changes to cleaner heat sources. The parametric study in the building energy simulation software was used to check the application of various interventions on the energy consumption of existing SBs while reducing CO2 emissions with the most profitable return on investment (ROI). The energy savings from window replacements did not correspond with expectations. However, other measures such as the wall, roof insulation, and lighting modernization improved EE by up to 152 kWh/m2 and 41 kg/m2 CO2/m2 annually. The study also points to a significant trade-off between district heating (which reduces CO2 but has a slower ROI) and other heating solutions. The results suggest that climate-specific insulation thickness and glazing type needs are required, and optimal insulation strategies are shown to improve EE by 48–56% and CO2 reductions of 45–56%. Lighting replacement and biogas boiler use were both impactful. The findings support the importance of sustainable practices, which should stimulate educational awareness and environmental responsibility. This research presents actionable insights for EE and sustainable development from within educational facilities. [ABSTRACT FROM AUTHOR]

In recent years, clam mariculture output in China has steadily increased. However, environmental pollution and high aquaculture intensity have led to frequent diseases and unstable economic benefits. This study analyzes field research data from clam farming in Zhejiang Province, Tianjin City, and Shandong Province, focusing on farming costs, revenue, break-even points, and net profit sensitivity. The findings reveal that (1) variable costs consistently exceeded fixed costs, particularly in seedling costs, labor, and water rental; (2) net profit and margins ranked highest in Zhejiang, followed by Tianjin and Shandong; (3) Zhejiang exhibited the lowest break-even operation rate and the largest price discrepancies; (4) sensitivity to selling prices was high across all regions, with Zhejiang showing the lowest sensitivity to variable costs. To enhance economic benefits and promote sustainable development, government authorities and industry stakeholders should focus on cultivating high-quality seeds, implementing scientific management, developing green aquaculture, and emphasizing brand development. [ABSTRACT FROM AUTHOR]

To assess whether the adult Expanded Food and Nutrition Education Program (EFNEP) is a cost-effective intervention that generates sustained improvement in biomarkers of chronic disease risk. A longitudinal quasi-experimental design with 2 parallel arms (untreated comparison vs EFNEP) and 4 waves of data collection (pretest, posttest, 6 months, and 12 months after completion). Eligible adult EFNEP community settings in Colorado, Florida, Maryland, and Washington. Free-living adults (n = 500) aged 18–50 years, with income ≤ 185% of the Federal Poverty Line. Adult EFNEP delivered using an evidence-based curriculum, Eating Smart • Being Active. Chronic disease biomarkers (body mass index, blood pressure, and HbA1c), food and physical activity behaviors, dietary intake, health status, and demographics will be measured using objective biometric indicators, the Adult EFNEP Questionnaire, a 24-hour dietary recall, a health questionnaire, and demographic forms. Linear mixed models will be used to assess whether adult EFNEP has a significant (P < 0.01) impact on 3 chronic disease biomarkers. The program's estimated impact on chronic disease biomarkers will be incorporated into a cost-benefit analysis framework to assess the economic value generated by adult EFNEP through chronic disease risk reduction. [ABSTRACT FROM AUTHOR]

Public health emergencies sometimes require the restriction of civil liberties through social distancing: lockdowns, quarantines, the closure of public spaces and institutions, and so on. Social distancing measures can decrease mortality and morbidity, but they also cause social and economic harm. Policymakers have to make trade-offs between "lives and livelihoods," while introducing only minimally necessary restrictions on civil liberties. Traditionally, cost-benefit analysis has played a central role in formulating these trade-offs. Recently, however, some philosophers have argued that the trade-offs should instead be made on the basis of contractualist moral theory. In this essay, I argue against the use of contractualism for this purpose. [ABSTRACT FROM AUTHOR]

In clinical trials involving experimental subjects who are also patients, what is supposed to become of the imperative to focus on the patient's best interest? A second set of policy questions concerns patients who want to die. Are there limits to the imperative to let patients choose for themselves? Is commodification a threat to autonomy? When, if ever, do costs and benefits become decisively important? Can we know what to count as a cost-effective preparation for the next pandemic? When we put procedures in place to protect against abuse, is there any way to prevent such measures from becoming bureaucratic obstacles to accomplishing anything at all? [ABSTRACT FROM AUTHOR]

Nature-based Solutions (NbSs) play a pivotal role in mitigating the impact of microclimates on human well-being. The effectiveness of NbSs is contingent upon the synergy between natural capital, defined by the ecological structure and functions of the ecosystem, and human-derived capital, encompassing the economic investments required for implementation. This study introduces a decision-making framework designed to evaluate the impact of NbSs and advocate for optimal solutions for human health at the local scale, amalgamating ecological and economic assessments. Physiological Equivalent Temperature (PET) was chosen as a key urban parameter to assess the efficacy of NbSs in mitigating urban microclimates and enhancing human health. The PET analysis was conducted using ENVI-met 5.0.3 software across diverse urban scenarios in Gallipoli city, Italy. Integrated with a cost–benefit analysis of NbSs considering various investment scenarios, the study aimed to identify the most effective solution. Results indicated positive effects of NbSs in open spaces and around building blocks where the PET levels remained below 30 °C. Conversely, scenarios without NbSs exhibited PETs exceeding 40 °C, with peaks of 50 °C, posing potential risks to human health. Considering the social and economic benefits associated with PET mitigation, the cost–benefit analysis suggests that implementing NbSs using a mix of young and mature plants in the initial phase is advantageous compared to using only young plants. Thus, in establishing NbSs, it is crucial to consider not only the quantity of vegetation but also the strategic timing of implementation. In conclusion, our work offers an innovative framework that combines ecological and economic perspectives, providing valuable insights for decision-makers in urban planning and promoting the practical application of NbSs for enhanced human well-being. [ABSTRACT FROM AUTHOR]

In water-scarce regions, policymakers resort to reclaimed water (RW) and desalinated seawater (DSW) to supply economic agents when conventional resources are not available. This paper develops a proposal for a simple methodology to apply a cost–benefit analysis (CBA) approach to RW and DSW as a support to the evaluation of water policy goals. To test the method, it applies a CBA to RW and DSW in Axarquia (southern Spain), a water-scarce region suffering a long and extreme drought that is impacting urban supply and the agricultural sector. The benefit-to-cost ratio (BCR) of 17.02 estimated for reclaimed water highlights its high return on investment, suggesting that it offers substantial economic and environmental benefits. This high BCR indicates that reclaimed water as a resource for irrigation is highly cost-effective, particularly if it is combined with nutrient management. By contrast, the estimated BCR of 4.05 for desalinated water, although positive, is considerably lower, suggesting that desalinated water is a feasible but less cost-effective solution due to its high energy requirements and associated costs. This methodology may be extended to other hydrological systems, such as aquifer basins, to promote the generation of more comprehensive insights. [ABSTRACT FROM AUTHOR]