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Objectives: To assess the effect of Community Water Fluoridation (CWF) in the prevalence of dental caries and dental fluorosis in 12-year-old children living in Israel. Considering that CWF is important in the prevention of dental caries. Between 2002 and 2014, the water in communities of at least 5,000 individuals was fluoridated. In 2014, CWF in Israel stopped. Method and materials: Data on 12-year-old children from all areas in Israel from the national cross-sectional epidemiological survey conducted in 2011 to 2012 were stratified by city water fluoridation and by city and school socioeconomic status. Two dependent variables were defined: (1) DMFT index of caries experience in the permanent dentition; (2) dental fluorosis in central incisors using the Thylstrup-Fejerskov classification of fluorosis. Results: Data from 2,181 12-year-olds were analyzed. The average DMFT was 1.17 ± 1.72, and 49% were caries-free. Based on DMFT, the caries experience was significantly higher in nonfluoridated cities (1.38 vs 0.98 in fluoridated cities) and there were more caries-free children in fluoridated cities (56.4% vs 40.6% in nonfluoridated). DMFT was higher in cities with lower socioeconomic status than high socioeconomic status (1.29 vs 1.05, respectively, P < .001) and there were fewer caries-free children in low socioeconomic status cities (44.5% vs 53.0% in high socioeconomic status cities, P < .0001). Almost all the 10.3% of children with signs of fluorosis (scoring at least 1 in the Thylstrup-Fejerskov index), had questionable to mild fluorosis (9.3%). Conclusions: CWF is a cheap, simple method of dental health protection that reaches all socioeconomic levels, and cessation of water fluoridation reduced the health of Israel's children. Clinical significance: Water fluoridation provides substantial caries prevention, by reaching a substantial number of people. The relevance of this work is for policymakers to consider CWF as clinically proven method for reducing health inequalities. [ABSTRACT FROM AUTHOR]

Objectives: The prevalence and the economic burden of periodontal disease are high. To save or replace diseased teeth, an objective prognosis assessment using the long-term predictability of the various treatment options should be performed. As dental implants have become a treatment of choice for replacing missing teeth, the number of implant failures and complications has also increased. The objective of this review was to compare the cost-effectiveness of saving and maintaining the teeth vs replacing them with dental implants in patients with severe periodontal disease (with hopeless or questionable teeth). Method and materials: A database search was conducted using Medline (OVID), Embase, Web of Science, and CINAHL electronic sources until July 2023. Two reviewers reviewed the papers in accordance with the specific selection criteria after choosing the abstracts that met the initial selection criterion for full article retrieval. Results: Twelve articles were included, of which nine articles discussed the cost-effectiveness of preserving teeth in severe periodontal disease and three articles discussed the effectiveness of implants that replaced the periodontally compromised teeth. It was found that placing and maintaining implants was more costly than properly treating and maintaining periodontally compromised teeth. Supportive periodontal treatment contributed the most to the cost during the periodontal treatment. Conclusions: Implants are an effective choice to replace missing teeth; however, these are not permanent, present complications, and require strict maintenance. Thus, when deciding whether to maintain a periodontally compromised tooth or to replace it with a dental implant, in terms of cost-effectiveness, implant maintenance cost as well as the cost associated with treating implant complications should be considered. This cost seems to surpass the cost of treatment and maintenance of periodontally compromised teeth. [ABSTRACT FROM AUTHOR]

While green hydrogen production technologies like electrolysis have reached commercial scale, the primary challenge centers on efficient, and economically viable transportation of hydrogen. This study proposes an integrated geospatial techno-economic modeling approach to optimize hydrogen transportation through blending in existing pipelines. The simulations strategically locate green hydrogen production and blending points. The paper evaluates blending ratios, flow dynamics, and operating parameters to optimize hydrogen blending in natural gas pipelines. A techno-economic analysis quantifies costs and revenues across the supply chain, identifying the most economically viable hydrogen blending locations. The approach is validated through a case study in Wyoming, providing insights for industry stakeholders considering hydrogen-natural gas blending as a transition strategy. This integrated method offers a robust decision support tool for leveraging existing infrastructure to realize hydrogen's potential as a sustainable energy vector contributing to the broader goal of cleaner energy alternatives. [Display omitted] • Map energy infrastructure to optimize hydrogen production and injection points. • Simulate blending ratios, flow dynamics, and parameters for system optimization. • Perform a cost-benefit analysis to identify optimal hydrogen blending locations. • Validate the model with a Wyoming case study for industry stakeholder insights. [ABSTRACT FROM AUTHOR]

Purpose: Limited accessibility to hearing health care threatens healthy aging in place for older adults with hearing loss. A willingness-to-pay (WTP) approach was used to determine benefits and value of prescription advanced digital technology (ADT) hearing aids, over-the-counter (OTC) hearing devices, and rehabilitative services using benefit--cost analyses. Method: This study was a cross-sectional survey with chart review of hearing aid users at two independent audiology practices. Seventy hearing aid users (response rate: 15.6%) provided their WTP for ADT prescription hearing aids, OTC hearing devices, and hearing rehabilitative services. Benefit--cost ratios and net social benefit were calculated using deterministic and exploratory approaches. Point estimates for benefit--cost ratios and net social benefit were derived using bootstrap sampling with replacement (N = 5,000). Results: Median WTP for ADT prescription hearing aids and rehabilitative services were $2,000 and $250, respectively. WTP was lowest for OTC devices (Mdn = $0; maximum = $500). Benefit--cost ratios and net social benefit for ADT prescription hearing aids, OTC devices, and hearing rehabilitative services favored these interventions when out-of-pocket costs remained low. Benefit--cost analyses also produced results favoring prescription ADT hearing aid intervention with costs as high as $1,530 per device. Conclusions: WTP results indicated that all interventions under study have a measurable consumer-perceived benefit. Results of benefit--cost analyses favored the interventions but only when costs were lower than market prices. The benefit--cost analysis results for hearing care services underscore their value when provided as part of a comprehensive rehabilitative plan that may inform future health policy changes. [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]

Introduction: Home automation can deliver important outcomes for people with disabilities, including enhanced independence. Despite the millions of dollars spent on home automation in Australia and other developed nations, to date, there has been no economic evaluation of this type of assistive technology. Method: A social return on investment analysis of home automation study was undertaken. Primary data were collected using qualitative interviews with home automation consumers and other key stakeholders, including occupational therapists, a spinal rehabilitation physician, peer support advocate, and managers and technical personnel from home automation providers (n = 17). The analysis was supported by (1) secondary data from a scoping review on outcomes from home automation and (2) additional literature searches to identify suitable financial proxies and to make estimates of the proportion of home automation users expected to experience each outcome. A scenario approach was used with three home automation scenarios developed with increasing complexity and costs to calculate the social return on investment. Results: Eight outcomes from the use of home automation were identified, including reduced reliance on carers and family members, increased independence, and improved energy and comfort. The social return on investment ranged from $38.80 (low cost) to $15.10 (high cost) for every $1 invested across a 10‐year benefit period, with the financial proxy for reduced care attendant hours contributing the most to the social return ratio. Even the highest cost scenario was repaid in social value within the first year of the benefit period. Conclusion: This study suggests that home automation represents a sound investment and has a significant impact on the overall quality of life of people with disabilities. Focusing on the financial savings in care attendant hours alone should be compelling evidence for funders to recognise home automation's value and continue to fund this assistive technology. Consumer and Community Involvement: A consumer representative was a member of the project steering group, which supported the research team at all stages of the project. Plain Language Summary: When people get injured, their disability can stop them doing things around the home that they used to be able to do. Technology can help people with disabilities do things like open and close doors and turn off taps by pressing a button, so they do not have to wait for someone to help them. This technology can be expensive, but no one has looked at if it is worth the money. We spoke to some people with disabilities who used this type of technology, and they told us their lives were better now they used this technology. For example, they told us they were able to do things for themselves, they did not need carers as much, and they had better mental health. We spoke to businesses about the costs of different types of technology that can be used in the home. We then put a dollar value on the ways people with disabilities told us their lives were better. For example, for better mental health, we worked out how much it would cost to see a psychologist for 1 year. We found that the dollar value of the ways in which people with disabilities' lives were improved was at least 15 times more than the costs of the technology. This study therefore shows that this technology is worth the money and improves the lives of people with disabilities following serious injury. [ABSTRACT FROM AUTHOR]

Person-centered coaching provided by clinical nurse specialists (CNSs) is an effective, acceptable, and feasible evidence-based intervention. Psychosocial distress experienced by older adults and their families during transitions of care can contribute to adverse events. CNS coaching demonstrated increased self-reported preparedness for healthcare transitions and knowledge-of-care options. CNS coaching promoted engagement and self-efficacy. Nurse administrators can incorporate this intervention in a variety of care settings to improve outcomes related to transitions of care. [ABSTRACT FROM AUTHOR]

Our paper explores in a large Romanian sample (2168 adolescents) the relational costs and benefits of the number of friends at school. Using the MEDCURVE procedure to test the non-linear mediation effects, our results show that psychological safety, bullying and negative relations mediate the association between the number of friends and depression and anxiety, while social acceptance and bullying mediate the association between the number of friends and academic self-efficacy. In general, our results show that the relational benefits of friendship tend to diminish as the number of friends increase, in general over 9 friends (depending on the relational state) and parents, teachers and school counselors should help adolescents manage their number of friends in order to prevent the relational costs associated with engaging in too many (superficial) friendships. [ABSTRACT FROM AUTHOR]

Summary: Sequential romosozumab-to-alendronate or sequential teriparatide-to-alendronate can be a cost-effective treatment option for postmenopausal women at very high risk of fracture. Purpose: To estimate the 10-year probability of a major osteoporotic fracture (MOF) at which sequential treatment with romosozumab or teriparatide followed by alendronate, compared with alendronate alone, becomes cost-effective in a UK setting. Methods: A microsimulation model with a Markov structure was used to simulate fractures, costs, and quality-adjusted life years (QALYs), in women receiving sequential treatment with either romosozumab or teriparatide followed by alendronate, compared with alendronate alone. Patients aged 50 to 90 years with a recent MOF, hip or spine fracture were followed from the start of a 5-year treatment until the age of 100 years or death. The analysis had a healthcare perspective. Efficacy of romosozumab, teriparatide and alendronate was derived from phase III randomised controlled trials. Resource use and unit costs were derived from the literature. Cost-effectiveness intervention threshold (CEIT), defined as the 10-year probability of a major osteoporotic fracture at which treatment becomes cost-effective, was compared with clinically appropriate intervention thresholds for bone-forming treatment in women with very high fracture risk as recommended by the UK National Osteoporosis Guideline Group (NOGG). Results: The base case analysis showed that sequential romosozumab-to-alendronate treatment was cost-effective from a 10-year MOF probability of 18–35% and above depending on age and site of sentinel fracture at a willingness to pay (WTP) of £30,000. For teriparatide-to-alendronate, treatment was cost-effective at a 10-year MOF probability of 27–57%. The results were sensitive to pricing of the drugs but relatively insensitive to treatment duration, romosozumab persistence assumptions, and site of sentinel fracture. The CEITs for romosozumab-to-alendronate treatment were lower than the clinical thresholds from the age of 70 years meaning that treatment could be considered both cost-effective and aligned with the NOGG treatment guidelines. By contrast, for teriparatide-to-alendronate the CEITs were higher than the clinical thresholds irrespective of age. However, cost-effective scenarios were found in the presence of strong clinical risk factors in addition to a recent sentinel fracture. Conclusion: The results of this study indicate that sequential romosozumab-to-alendronate or teriparatide-to-alendronate treatment can be a cost-effective treatment option for postmenopausal women at very high risk of fracture. [ABSTRACT FROM AUTHOR]

The article discusses the importance of identifying somatic RET mutations in patients with medullary thyroid cancer (MTC) to guide treatment decisions. It highlights the need for this analysis in patients with advanced MTC, as it can impact the choice of therapy. The study suggests that performing RET somatic mutation analysis at the time of diagnosis or during the initial postoperative evaluation is crucial for patients with structural disease, while it may not be necessary for patients showing an excellent response or biochemical incomplete response without risk factors for structural recurrence. The article also discusses the challenges and methods of detecting RET mutations in MTC patients, emphasizing the importance of tailored analysis based on individual patient characteristics. [Extracted from the article]

Objectives: This study compares the demographics, diagnoses, re-admission rates, sick leaves, and prescribed medications of patients accessing digital general practitioner (GP) visits with those of patients opting for traditional face-to-face appointments in a primary health care setting. Design: The study adopted a retrospective analysis of patient record data collected in 2019, comparing visits to a digital primary health center with traditional health center visits. Setting: Primary health care. Participants: The data encompassed patients who utilized the digital clinic and those who visited public health centers for primary health care services. Main Outcome Measures: The study assessed demographics, health diagnoses, prescribed medications, sick leave recommendations, re-admission rates, and differences in costs between digital clinic and face-to-face visits. Secondary outcomes included a comparative analysis of medication categories, resolution rates for health problems, and potential impacts on health care utilization. Results: Digital clinic users were typically younger, more educated, and predominantly female compared with health centre users. Digital visits were well-suited for uncomplicated infections, while health centre appointments were associated with a higher prevalence of chronic conditions. Medication patterns differed between the two modalities, with digital clinic users receiving generic over-the-counter drugs and antibiotics, whereas health centre visits commonly involved cardiac and antihypertensive medications. Sick leave recommendations were slightly higher in the digital clinic, but the difference was not significant. Approximately 70% of health problems addressed in the digital clinic were successfully resolved, and the cost of digital visits was about 50,3% of face-to-face appointments. Conclusion: Digital health care services offer a cost-efficient alternative for specific health problems, appealing to younger, educated individuals, when compared to the users of public health center, and may enable improvement of cost-effectiveness combined with acceptable demand management and patient segmentation practices. The results highlight the potential benefits of digital clinics, particularly for uncomplicated cases, while also emphasizing the importance of suitable referral mechanisms for in-person consultations. [ABSTRACT FROM AUTHOR]

In communities of Sub-Saharan Africa, where local elites participate in the selection of households for cash transfers, there is a tendency to deviate from laid down rules for various reasons. Using qualitative data from selected districts where Ghana's Livelihood Empowerment Against Poverty (LEAP) programme is implemented, this study investigates the reasons why district and community elites deviate from prescribed selection processes of the LEAP programme. Drawing on the concept of competitive clientelism, the findings suggest that elites are deeply guided by political patronage to fulfil one primary goal, protecting their role in office. Such ambition is facilitated by the discretionary power accorded to elites by the local government system and socio-cultural values deeply rooted in Ghanaian society. In conclusion, the study draws out key lessons from the analysis and suggests a design of beneficiary selection frameworks that acknowledges the nature of domestic politics, institutions of power and powerful actors at the subnational level. The article also highlights the implications of the findings for the broad politics of social protection literature. [ABSTRACT FROM AUTHOR]

Background: Almost 2 million people in the UK live with sight loss, and this number is predicted to double by 2050. There is increasing recognition of the need to provide counselling services to people living with sight loss. Aim: The aim of this research was to assess whether there is an unmet need for counselling services for people living with sight loss in North Wales and to estimate the social value and budget impact of the potential roll‐out of counselling services to this population. Method: Between December 2020 and May 2021, a telephone survey was completed by 192 people living with sight loss in North Wales, UK. The survey instrument was a 19‐item questionnaire, which included the Short Warwick–Edinburgh Mental Well‐being Scale (SWEMWBS). Using data from the SWEMWBS and published statistics, a social return on investment (SROI) and budget impact analysis were conducted. Results: Most respondents (84%, n = 161) had never been offered counselling in relation to sight loss. Thirty‐nine per cent (n = 74) stated that they would use a new counselling service if it were available. Fifty‐one per cent (n = 97) indicated that counselling could be especially beneficial for people who have recently been registered or diagnosed with sight loss (the timely window). Of those who completed the SWEMWBS, approximately 25% reported low mental well‐being or probable depression. Social return on investment analysis estimated that providing counselling services for people with sight loss in North Wales could generate a social value of £3.42 for every £1 invested. Conclusion: Timely counselling may improve an individual's ability to cope with sight loss and improve their quality of life over time. [ABSTRACT FROM AUTHOR]

This paper examines the Food and Drug Administration's regulation of drug safety. In one of the most sophisticated cost-benefit analyses to date, (Cost-benefit analysis of the FDA: The case of the prescription drug user fee acts, The Journal of Public Economics, 92, 1306–1325.) argue that between 1998 and 2005 the FDA's drug submission process under the Prescription Drug User Fee Act (PDUFA) increased social surplus by $14–31 billion. However, this conclusion is based upon inappropriate data that underestimate the welfare costs of drugs that were withdrawn from the market due to their harmful side effects. Once appropriate epidemiological data are used to calculate the welfare costs of a single drug, Vioxx, which was withdrawn from the market after it was found to cause heart attacks, PDUFA I-II are found to have caused a net reduction in social welfare of between $1-201 billion. This indicates that statistically infrequent regulatory mistakes may have large social welfare implications that can counteract the benefits of years of accurate regulatory decisions. Thanks to Sarah Bernhardt, Romit Bhattacharya, Stephen DeCanio, Marco Giani, Colin Jennings, John Meadowcroft, and Tariq Thachil for helpful comments and suggestions. Special thanks to the helpful comments offered by two anonymous referees. [ABSTRACT FROM AUTHOR]

Introduction Heterogenous clinical manifestations, overlapping phenotypes, and complex genetic backgrounds are common in patients with endocrine tumors. There are no comprehensive recommendations for genetic testing and counseling of these patients compared to other hereditary cancer syndromes. The application of multigene panel testing is common in clinical genetic laboratories, but their performance for patients with endocrine tumors has not been assessed. Methods As a national reference center, we prospectively tested the diagnostic utility and cost-efficiency of a multigene panel covering 113 genes representing genetic susceptibility for solid tumors; 1279 patients (including 96 cases with endocrine tumors) were evaluated between October 2021 and December 2022 who were suspected to have hereditary tumor syndromes. Results The analytical performance of the hereditary cancer panel was suitable for diagnostic testing. Clinical diagnosis was confirmed in 24% (23/96); incidental findings in genes not associated with the patient's phenotype were identified in 5% (5/96). A further 7% of pathogenic/likely pathogenic variants were detected in genes with potential genetic susceptibility roles but currently no clear clinical consequence. Cost-benefit analysis showed that the application of a more comprehensive gene panel in a diagnostic laboratory yielded a shorter turnaround time and provided additional genetic results with the same cost and workload. Discussion Using comprehensive multigene panel results in faster turnaround time and cost-efficiently identifies genetic alterations in hereditary endocrine tumor syndromes. Incidentally identified variants in patients with poor prognoses may serve as a potential therapeutic target in tumors where therapeutic possibilities are limited. [ABSTRACT FROM AUTHOR]

Background: Internationally, adolescent alcohol consumption has been a major community concern for decades. Globally, there is a growing array of interventions aimed at preventing youth alcohol-related problems. Notably, the Communities that Care (CTC) process in the USA has proven to be a cost-effective intervention, leading to a reduction in adolescent alcohol-related problems. In Australia, the CTC trial has shown positive outcomes such as reduced adolescent alcohol and drug use, antisocial behaviors, and the availability of alcohol in the community. To encourage wider adoption, it is essential to ascertain the cost-effectiveness of the Australian CTC trial and its potential impact on addressing youth alcohol problems. Method: We conducted a limited societal perspective benefit-cost analysis focused on reducing adolescent (aged 10–14) alcohol use in the initial four CTC communities in Australia, spanning 2001 to 2015. To ensure accuracy, estimated benefits were adjusted for joint effects to prevent the double counting of the benefits over time. Results: The Australian CTC trial, as an adolescent alcohol prevention strategy, demonstrates robust economic credentials, delivering a return of AUD 2.6 for each dollar invested. The cost savings resulting from the reduction in alcohol consumption were estimated at AUD 123 per youth per 15 years and AUD 8 per person per year. The average cost of the CTC trial amounted to AUD 48 per youth over 15 years and AUD 3 per youth per year. The largest contribution to primary benefits were reductions in crime and violence with 93% of the total benefits. Conclusions: This study makes a valuable contribution to the international economic evidence related to youth alcohol prevention initiatives. The results affirm the strong cost-effectiveness potential of the initial CTC trial implementation in Australia. Moreover, conducting further cost-benefit modelling for additional outcomes and beyond the intervention's timeframe is likely to enhance the economic viability of the CTC trial. [ABSTRACT FROM AUTHOR]

Introduction: Antimicrobial resistance is a challenge to be faced by all livestock sectors; within beef farming, antibiotic use patterns vary by country and management practices. Argentina is a country with high beef production & consumption but limited information surrounding antibiotic use. The aims of this project was to understand how antibiotics are being used across the beef industry in Argentina and exploring drivers of usage. Methods: Quantitative and qualitative data was collected by: A survey of breeding and feedlot farms including antibiotic use (from purchase data); a detailed analysis of two feedlot farms' therapeutic antibiotic use records; a survey of vets' views on certain antibiotic practices; and a focus group of farmers and vets focusing on wider influences affecting decision making. Antibiotic use data was calculated using mg/population corrected unit (PCU) (ESVAC) and thematic analysis was used to identify drivers of antibiotic use among participants. Results: The median use across 17 farms that supplied purchase data was 76.52 mg/kg PCU (ESVAC; IQR = 36.81 mg/kg PCU [ESVAC]). The detailed farm records showed that the largest reason for treatment was group treatments (72.92% of treatments) followed by treatment for respiratory disease (12.75% of treatments). Macrolides accounted for 76.37% of treatments. Nearly half of farms used routine prophylactic treatment for arriving animals (n = 7/18). The use of quarantine and 'sick pens' were seen as important by surveyed vets with antibiotic prophylaxis and in-feed antibiotics seen as contributors to antibiotic resistance. The focus group highlighted the influence of the economic and political landscape on husbandry practices and the responsibility the farming sector had towards antibiotic stewardship. Discussion: Overall, Argentine beef feedlots resemble North American beef feedlots in terms of antibiotic practices but with considerably lower usage, with in-feed monensin representing a large proportion of total ABU. The adaptation period presents a challenge to animal health; antibiotics are administered a prophylaxis, metaphylactic and individual treatments depending on farm management practices. Further research into internationally comparable measures of ABU and detailed cost-benefit analysis of practical, on-farm interventions are needed to aid improved antimicrobial stewardship in livestock systems globally. [ABSTRACT FROM AUTHOR]

Introduction: Owing to the lack of local cost and clinical effectiveness data in sub-Saharan Africa, economic evaluations of the rotavirus vaccine are still limited in the region. In this study, we utilize different data sources, including aggregated routine health information system data to examine the net benefits of the rotavirus vaccine in Uganda. We also present ways in which health facility data can be used to assess subnational vaccination coverage as well as the effect of the vaccine on diarrhoea hospitalization. Methods: We used monthly health facility data collected between 2015 and 2021 to study the relationship between rollout of rotavirus vaccine and diarrhoea hospitalization. We gathered information from empirical studies on the cost of diarrhoea (household and health facility) and vaccine administration to estimate the costs averted due to the rotavirus vaccine. As household costs, we considered out-of-pocket payments associated with the episodes of diarrhoea and the productivity loss associated with time spent on treatment and with mortality using a human capital approach. Finally, we employed an interrupted time series analysis to examine the effect of rotavirus vaccine on diarrhoea hospitalization. Costs are presented in 2018 US dollars. Results: As of 2021, nationwide coverage of the first and second doses of the rotavirus vaccine (RV) in Uganda was estimated at 89% and 65% respectively, with variations observed across the regions. The study revealed a decrease in diarrhoea hospitalization by 1% for each 1% increase in RV coverage. Moreover, the study showed that diarrhoea hospitalization reduced by 2% for each additional month post- vaccine rollout. Excluding productivity losses due to mortality, the analyses of costs averted due to the RV reveal that between 2018 and 2021, Uganda saved approximately $57 million ($7 per capita) in expenses associated with diarrhoea. The return on investment (ROI) due to RV was calculated to be $1.48 per dollar invested. When including mortality costs, the net benefit reached up to $3 billion in economic cost ($385 per capita), and an ROI of $78 overall. Furthermore, the study demonstrated that RV provided substantial health benefits, particularly for socially disadvantaged groups. Excluding mortality costs, the ROI for the two most disadvantaged groups ranged from $1.71 to $2.03 per dollar spent, while for the remaining groups, it ranged from $1.10 to $1.14. Conclusion: This manuscript stresses the importance of RV in alleviating the burden of diarrhoeal diseases and associated costs in Uganda. The study not only emphasizes the tangible benefits derived from the vaccine but also highlights the role of routine aggregated healthcare information systems in systematically monitoring the effectiveness and coverage of interventions. [ABSTRACT FROM AUTHOR]

Introduction: Stress-induced volatile organic compounds (VOCs) that induce plant immunity bear potential for biocontrol. Here, we explore the potential of nonanal to enhance the seed yield of common bean (Phaseolus vulgaris) under open field conditions that are realistic for smallholder farmers. Methods and results: Using plastic cups with a nonanal-containing lanolin paste as low-cost dispensers, we observed that exposure of Flor de Junio Marcela (FJM) plants over 48h to airborne nonanal was followed by a 3-fold higher expression of pathogenesis-related (PR) genes PR1 and PR4. Both genes further increased their expression in response to subsequent challenge with the fungal pathogen Colletotrichum lindemuthianum. Therefore, we conclude that nonanal causes resistance gene priming. This effect was associated with ca. 2.5-fold lower infection rates and a 2-fold higher seed yield. Offspring of nonanal-exposed FJM plants exhibited a 10% higher emergence rate and a priming of PR1- and PR4-expression, which was associated with decreased infection by C. lindemuthianum and, ultimately, a ca. 3-fold increase in seed yield by anthracnose-infected offspring of nonanal-exposed plants. Seeds of nonanal-exposed and of challenged plants contained significantly more phenolic compounds (increase by ca 40%) and increased antioxidant and radical scavenging activity. Comparative studies including five widely used bean cultivars revealed 2-fold to 3-fold higher seed yield for nonanal-exposed plants. Finally, a cost-benefit analysis indicated a potential economic net profit of nonanal exposure for some, but not all cultivars. Outlook: We consider nonanal as a promising candidate for an affordable tool that allows low-income smallholder farmers to increase the yield of an important staple-crop without using pesticides [ABSTRACT FROM AUTHOR]

Simple Summary: Chimeric transcripts frequently function as oncogenic drivers and represent potential targets for tumor-specific therapies. Routine methods for detecting these transcripts include (i) approaches that can detect a limited number of pre-defined targets, such as immunohistochemistry, fluorescence in situ hybridization, and reverse transcription–quantitative polymerase chain reaction, and (ii) approaches that can simultaneously detect multiple fusions, such as NanoString assays and NGS targeted panels. Whole transcriptome sequencing enables the analysis of a wide range of cancer biomarkers, including dysregulated genes, molecular pathways, and both known and novel cancer driver fusion transcripts. However, this method is not commonly employed for fusion discovery due to inadequate coverage at the fusion breakpoint. To address this limitation, we have developed a novel bioinformatics approach that enables the highly accurate prediction of clinically significant ALK fusions from RNA sequencing data. This extends the functionality of whole transcriptome NGS and improves its cost-effectiveness. Background: In clinical practice, various methods are used to identify ALK gene rearrangements in tumor samples, ranging from "classic" techniques, such as IHC, FISH, and RT-qPCR, to more advanced highly multiplexed approaches, such as NanoString technology and NGS panels. Each of these methods has its own advantages and disadvantages, but they share the drawback of detecting only a restricted (although sometimes quite extensive) set of preselected biomarkers. At the same time, whole transcriptome sequencing (WTS, RNAseq) can, in principle, be used to detect gene fusions while simultaneously analyzing an incomparably wide range of tumor characteristics. However, WTS is not widely used in practice due to purely analytical limitations and the high complexity of bioinformatic analysis, which requires considerable expertise. In particular, methods to detect gene fusions in RNAseq data rely on the identification of chimeric reads. However, the typically low number of true fusion reads in RNAseq limits its sensitivity. In a previous study, we observed asymmetry in the RNAseq exon coverage of the 3′ partners of some fusion transcripts. In this study, we conducted a comprehensive evaluation of the accuracy of ALK fusion detection through an analysis of differences in the coverage of its tyrosine kinase exons. Methods: A total of 906 human cancer biosamples were subjected to analysis using experimental RNAseq data, with the objective of determining the extent of asymmetry in ALK coverage. A total of 50 samples were analyzed, comprising 13 samples with predicted ALK fusions and 37 samples without predicted ALK fusions. These samples were assessed by targeted sequencing with two NGS panels that were specifically designed to detect fusion transcripts (the TruSight RNA Fusion Panel and the OncoFu Elite panel). Results: ALK fusions were confirmed in 11 out of the 13 predicted cases, with an overall accuracy of 96% (sensitivity 100%, specificity 94.9%). Two discordant cases exhibited low ALK coverage depth, which could be addressed algorithmically to enhance the accuracy of the results. It was also important to consider read strand specificity due to the presence of antisense transcripts involving parts of ALK. In a limited patient sample undergoing ALK-targeted therapy, the algorithm successfully predicted treatment efficacy. Conclusions: RNAseq exon coverage analysis can effectively detect ALK rearrangements. [ABSTRACT FROM AUTHOR]

Purpose: Surgical site infections (SSIs) following spine surgery are associated with morbidity and resource utilization. Applying prophylactic closed-incisional negative pressure wound therapy (ciNPWT) during posterior instrumented fusion has mixed results in reducing rates of wound complications and SSI. We evaluated the clinical efficacy and potential cost-savings associated with ciNPWT in high-risk patients receiving posterior instrumented spinal fusion. Methods: We retrospectively reviewed patients receiving posterior instrumented spinal fusion for any surgical indication between July 1, 2017 and December 31, 2019, and compared rates of wound dehiscence, SSI, and reoperation for wound complications between standard surgical dressings and ciNPWT. Surgical dressing selection was based on the senior author's assessment of infection risk factors. Results: A total of 229 patients (n = 85 standard surgical dressings, n = 144 ciNPWT) were included. The ciNPWT group had significantly more risk factors for wound-related complications, including older age (61.8 vs. 58.5 years, p = 0.042), diabetes mellitus (36.8% vs. 23.5%, p = 0.037), more instrumented levels (5.6 vs. 3.9, p < 0.0001), estimated blood loss (1298 vs. 998 mL, p = 0.036), and deformity was the predominant operative indication (29.9% vs. 17.7%, p = 0.040). Prophylactic ciNPWT was associated with significantly lower rates of wound dehiscence (21.5% vs. 34.1%, p = 0.036) and SSI (8.3% vs. 21.2%, p = 0.005). Number needed to treat with ciNPWT to prevent one SSI was 8 patients. The cost of preventing one SSI was $4,560. Cost-benefit analysis demonstrated a potential mean savings of $21,662 per operative SSI prevented and $270,775 per 100 patients undergoing posterior instrumented fusion with ciNPWT. Conclusions: Prophylactic ciNPWT use is a cost-effective means of reducing rates of wound dehiscence and SSI following posterior instrumented fusion. Previous presentations: An abstract from this work was presented as an oral presentation at the 2023 CNS Annual Meeting in Washington, DC. [ABSTRACT FROM AUTHOR]

Cost benefit analysis (CBA) is used in many fields to ensure efficient allocation of scarce resources but is rarely applied in conservation. By using a common metric to evaluate projects in complex social‐ecological systems, CBA can help to maximize the impact of conservation funding. It can also help to interrogate issues of distributional equity, plan for effective community‐based conservation, and inform future research and strategic priorities. We demonstrate this using the example of the Nyerere Selous‐Udzungwa Wildlife Corridor in Tanzania, a wildlife corridor aiming to restore connectivity between two protected areas to enhance African elephant (Loxodonta africana) conservation outcomes and mitigate human–elephant conflict. We combine novel data on elephant crop depredation with crop price and productivity data, elephant valuation methods, and ecosystem service values to analyze corridor costs and benefits from contrasting global and local community perspectives. From the global perspective, we find benefits to outweigh costs by at least 4.6:1. From the communities' perspective, we find that while substantial benefits should secure buy‐in to the project, continued subsidy will be required to cover the costs. Our findings support generalized recommendations for application of CBA across diverse systems and conservation priorities. [ABSTRACT FROM AUTHOR]

This study investigates the influence of old directors on corporate social responsibility (CSR) using roughly 25,000 firm-year observations from 2001 to 2015 in the United States. We employ the widely used selection, optimization, and compensation (SOC) model from psychology to explain the CSR decisions of old directors. Our results indicate that firms with a higher percentage of old directors tend to have lower engagement in CSR activities. To address endogeneity, we adopt the difference-in-differences method and use the event of sudden deaths and unexpected retirements of old directors and find that our results remain robust. Our analysis also reveals that the negative impact of old directors on CSR is more significant in firms where directors receive fewer reputational spillover benefits from CSR initiatives and/or firms exhibiting poor corporate governance. In addition, this adverse impact of old directors comes from two effects: a reduction in efforts to enhance CSR strengths and an increase in inaction to address CSR concerns. Overall, these findings suggest that the CSR decision-making process of old directors involves assessing the costs and benefits of CSR engagements, consistent with our hypothesis derived from the SOC model. [ABSTRACT FROM AUTHOR]

Background: Indigenous people in high-income countries have worse eye health outcomes when compared to non-Indigenous people, contributing to ongoing socioeconomic disadvantage. Although services have been designed to address these disparities, it is unclear if they have undergone comprehensive economic evaluation. Our scoping review aimed to identify the number, type, quality, and main findings of such evaluations. Methods: MEDLINE, Embase, Web of Science, Cochrane Library Database, the National Health Service Economic Evaluation Database, EconLit, and relevant grey literature were systematically searched as per our pre-registered protocol. All economic evaluations of real or model services designed to meet the eye care needs of Indigenous populations in high-income countries were included. Two reviewers independently screened studies, extracted data, and assessed quality using the Quality of Health Economic Studies instrument. Results: We identified 20 studies evaluating services for Indigenous populations in Australia (n = 9), Canada (n = 7), and the United States of America (n = 4). Common services included diabetic retinopathy (DR) screening through fundus photographs acquired in local primary health care clinics (n = 7) or by mobile teams (n = 6), and general eye care through teleophthalmology (n = 2), outreach ophthalmology (n = 2) or an Indigenous health care clinic optometrist (n = 1). These services were economically favourable in 85% of comparisons with conventional alternatives, mainly through reduced costs of travel, in-person consults, and vision loss. Only four studies assessed the benefits of increased patient uptake. Only five included patient evaluations, but none integrated these into their quantitative analysis. Methodological issues included no stated economic perspective (n = 10), no sensitivity analysis (n = 12), no discounting (n = 9), inappropriate measurement of costs (n = 13) or outcomes (n = 5), and unjustified assumptions (n = 15). Conclusion: Several Indigenous eye care services are cost-effective, particularly remote DR screening. Other services are promising but require evaluation, with attention to avoid common methodological pitfalls. Well-designed evaluations can guide the allocation of scarce resources to services with demonstrated effectiveness and sustainability. Trial registration: Our scoping review protocol was pre-registered (Open Science Framework DOI: https://doi.org/10.17605/OSF.IO/YQKWN). [ABSTRACT FROM AUTHOR]

Background: Between 2006 and 2016 the prevalence of overweight and obesity among children and adolescents aged 5–19 years in Peru increased from 22.7 to 27.0%. This investment case quantifies the economic impacts of childhood and adolescent overweight and obesity in Peru. It identifies and quantifies the potential impact of a set of new or expanded interventions that can strengthen current national efforts to prevent and reduce child and adolescent overweight and obesity. Methods: A deterministic Markov cohort model with a societal cost perspective estimated reductions in mortality and morbidity from implementing interventions to prevent and reduce child and adolescent overweight and obesity and the impact in savings in healthcare costs and gains in wages and productivity. Interventions identified through a review of published literature includes a school-based social marketing campaign, exclusive breastfeeding promotion and support, a healthy food and drink policy for school premises, and a 20% subsidy on fruits and vegetables for people living below the national poverty line. The return on investment (ROI) was calculated along with the estimated cost savings associated with the interventions. Analysis was conducted to test ROI sensitivity to changes in the key parameters and assumptions. Results: Between 2025 and 2092, the expected combined direct and indirect healthcare costs attributable to child and adolescent overweight and obesity in Peru are 210.6 billion USD. The direct healthcare costs are 1.8 billion USD, and the indirect costs are 208.8 billion USD. Expected savings for all interventions combined is 13.9 billion USD with a per-person savings of 12,089.8 USD. The expected ROI of the four interventions combined is 39.3 USD (30-years), 64.6 USD (50-years), and 164.1 USD (66-years) per one USD invested. Conclusions: The overweight and obesity epidemic among children and adolescents in Peru requires wide-ranging and expanded implementation of policies to achieve long-term reductions in prevalence. This study's findings show that the four priority interventions have high ROIs and can be used to guide policy to address the complex interplay of factors that contribute to the obesogenic environment. [ABSTRACT FROM AUTHOR]

Prisoners face inequalities relating to health and social care and educational needs. Peer support (prisoners providing support to other prisoners) is used in addition to professional support to address needs. It is not clear how effective or cost-effective peer-support services are, how they are implemented or experienced, or how best to evaluate such schemes. This review aimed to evaluate the following: 1. Outcomes and economic outcomes that have been studied for prison peer support, and data sources used. 2. Effectiveness and cost of prison peer support. 3. Implementation and experiences with prison peer support. A rapid systematic scoping review (registered on International Prospective Register of Systematic Reviews: CRD42022351592) that focussed on peer support within adult prisons. The search included six databases, grey literature databases, handsearching journals, and reviewing reference lists (June 2022). Studies were screened, and data were extracted. Narrative synthesis was used to analyse findings. Seventy papers were included (qualitative: 30, quantitative: 21, and mixed-methods: 19). No studies measured cost/cost-effectiveness. A range of methods were used to measure effectiveness (e.g., surveys, routinely collected data), implementation, and experience (e.g. interviews, surveys, observation). There was evidence of some positive effects (e.g., disease detection, mental health). Factors influencing peer support in prisons included individual, service, and organisational factors. Benefits (for prisons/prisoners/staff) and challenges (e.g., burden, exploitation) were identified. Prison peer support services are internationally used to address public health. Future research could robustly evaluate effectiveness and cost effectiveness. Attention should be given to potential risks and barriers affecting implementation. [ABSTRACT FROM AUTHOR]

Objective: The present study investigated the association between social media engagement and factors related to well-being (e.g., depression, anxiety, sleep, loneliness, self-esteem). Participants: A sample of 1120 college student-athletes (338 males, 777 females, 5 identified as non-binary) from nine universities participated in this study. Method: Data were collected through self-report measures and screen shots of participants' screen time in the previous week. Results: Overall screen time taken from devices was not associated with self-reported well-being, whereas use of social media during daily activities was related to worse well-being across domains (e.g., lower self-esteem, higher fear of missing out, stress, anxiety, depression). In addition, student-athlete perceptions that social media interfere with their lives were related to worse well-being. Conclusions: The implications of these findings, including the possibility of using protective behavioral strategies (PBS) to reduce negative impacts of social media in college students, are discussed. [ABSTRACT FROM AUTHOR]

Simple Summary: Currently, pathologists use ultrastaging to detect whether cancer has spread to the lymph nodes. This process is time-consuming and expensive. Our pilot study explored the use of a deep learning algorithm to help detect cancer spread to lymph nodes of early-stage cervical cancer patients. Using this technology could make the detection process faster, more efficient, and less costly. We evaluated an algorithm that was originally designed to identify cancer spread to lymph nodes in breast and colon cancer in cervical cancer patients. The study included 21 women with different types of early-stage cervical cancer. The algorithm was used to analyze 47 lymph node samples and successfully identified all cases where cancer had spread, showing 100% accuracy. Although the algorithm was initially developed for other cancers, it proved highly effective in this new population. More prospective research in a larger group of patients is needed to confirm its cost-effectiveness. Background/objectives: Pathological ultrastaging, an essential part of sentinel lymph node (SLN) mapping, involves serial sectioning and immunohistochemical (IHC) staining in order to reliably detect clinically relevant metastases. However, ultrastaging is labor-intensive, time-consuming, and costly. Deep learning algorithms offer a potential solution by assisting pathologists in efficiently assessing serial sections for metastases, reducing workload and costs while enhancing accuracy. This proof-of-principle study evaluated the effectiveness of a deep learning algorithm for SLN metastasis detection in early-stage cervical cancer. Methods: We retrospectively analyzed whole slide images (WSIs) of hematoxylin and eosin (H&E)-stained SLNs from early-stage cervical cancer patients diagnosed with an SLN metastasis with either H&E or IHC. A CE-IVD certified commercially available deep learning algorithm, initially developed for detection of breast and colon cancer lymph node metastases, was employed off-label to assess its sensitivity in cervical cancer. Results: This study included 21 patients with early-stage cervical cancer, comprising 15 with squamous cell carcinoma, five with adenocarcinoma, and one with clear cell carcinoma. Among these patients, 10 had macrometastases and 11 had micrometastases in at least one SLN. The algorithm was applied to evaluate H&E WSIs of 47 SLN specimens, including 22 that were negative for metastasis, 13 with macrometastases, and 12 with micrometastases in the H&E slides. The algorithm detected all H&E macro- and micrometastases with 100% sensitivity. Conclusions: This proof-of-principle study demonstrated high sensitivity of a deep learning algorithm for detection of clinically relevant SLN metastasis in early-stage cervical cancer, despite being originally developed for adenocarcinomas of the breast and colon. Our findings highlight the potential of leveraging an existing algorithm for use in cervical cancer, warranting further prospective validation in a larger population. [ABSTRACT FROM AUTHOR]

Given their frontline role in Australia and Aotearoa New Zealand (ANZ) healthcare, trainee medical officers (TMOs) will play a crucial role in the development and use of artificial intelligence (AI) for clinical care, ongoing medical education and research. As 'digital natives', particularly those with technical expertise in AI, TMOs should also be leaders in informing the safe uptake and governance of AI within ANZ healthcare as they have a practical understanding of its associated risks and benefits. However, this is only possible if a culture of broad collaboration is instilled while the use of AI in ANZ is still in its initial phase. [ABSTRACT FROM AUTHOR]

Background: Dynamic transmission models are often used to provide epidemiological guidance for pandemic policy decisions. However, how economic evaluation is typically incorporated into this technique to generate cost-effectiveness estimates of pandemic policy responses has not previously been reviewed. Methods: We systematically searched the Embase, PubMed and Scopus databases for dynamic epidemiological modelling studies that incorporated economic evaluation of public health and social measures (PHSMs), with no date restrictions, on 7 July 2024. Results: Of the 2,719 screened studies, 51 met the inclusion criteria. Most studies (n = 42, 82%) modelled SARS-CoV-2. A range of PHSMs were examined, including school closures, testing/screening, social distancing and mask use. Half of the studies utilised an extension of a Susceptible-Exposed-Infectious-Recovered (SEIR) compartmental model. The most common type of economic evaluation was cost-effectiveness analysis (n = 24, 47%), followed by cost-utility analysis (n = 17, 33%) and cost–benefit analysis (n = 17, 33%). Conclusions: Economic evaluation is infrequently incorporated into dynamic epidemiological modelling studies of PHSMs. The scope of this research should be expanded, given the substantial cost implications of pandemic PHSM policy responses. [ABSTRACT FROM AUTHOR]

Many youths with attention‐deficit/hyperactivity disorder (ADHD) experience significant long‐term impairment and may develop concurrent mental and somatic health difficulties as adults. This is associated with burden and costs for the individual and society which could be prevented through continued support in youth. Yet, only few young people transition to adult mental health services for ongoing care in different countries worldwide. We provide an overview on current transition practices, highlighting the gaps in knowledge and the barriers to effective service transitioning, while considering the large geographical variation in available guidelines and service provision. For ease of use, this review is organized in a question‐and‐answer format covering different aspects of the transition process and considering both service users' and clinicians' perspectives. Consensus is needed to identify those that require continued care, the optimal timing to arrange transition, and the most suitable services. Finally, we discuss cost‐effectiveness of transition practices, consider examples of best practice, and propose recommendations on how to improve transitional care, including the importance of service users' input into transition planning. [ABSTRACT FROM AUTHOR]

Poor oral health has been associated with various systemic diseases (e.g., endocarditis, pneumonia, cardiovascular disease, and diabetes) and decreased quality of life. When enacted in 1965, Medicare excluded coverage for comprehensive dental services. As of 2023, Medicare has allowed coverage of limited dental services inextricably linked to specific medical conditions. Many Medicare Advantage plans (Medicare Part C) offer dental coverage. Yet in 2019, approximately 24 million Medicare beneficiaries (47% of all Medicare enrollees), lacked dental coverage. Seventy-one percent of traditional Medicare enrollees (those not enrolled in a Medicare Advantage Plan) reported that high cost was the primary reason that they did not obtain dental care. The importance of oral health for the older adults has been the main reason that a national interprofessional consortium, which includes several national nursing organizations, has been advocating for legislation to expand Medicare to include dental coverage. The consortium's efforts have been thwarted by fierce opposition from the American Dental Association and many Republican legislators. Given the vital role that nurses and advanced practice nurses play in caring for the nation's older adults and disabled, nursing's voice needs to be strengthened as leaders in advocating for inclusion of dental benefits in traditional Medicare. [ABSTRACT FROM AUTHOR]

The information‐seeking behaviour of adults focuses on optimizing the gathering and utilizing information to minimize search costs. In contrast, children tend to engage in information search during decision‐making with less consideration for costs. This difference in behaviour is believed to be linked to the development of executive functions. Therefore, the present study aimed to investigate the relationship between executive function and cost‐related information‐gathering behaviour. We assessed 56 children aged 4–6 years, involving three tasks: an information‐gathering task, an inhibitory control and a working memory task. In the information‐gathering task, children participated in both non‐cost and cost conditions, where they were given the opportunity to freely gather information or incur a cost to acquire information. The findings revealed that children with higher inhibitory control tended to gather less information when a cost was involved. This highlights the important role of inhibitory control in shaping information‐seeking behaviour in early childhood. [ABSTRACT FROM AUTHOR]

The authors call on researchers, public health professionals, medical providers, and policymakers to address the access of foster care youth to preexposure prophylaxis (PrEP) from a number of appropriate dimensions. Topics include independent yet interconnected dimensions of access suggested by R. Penchansky and J. W. Thomas, dimensions of preexposure prophylaxis access, and prioritizing HIV prevention strategies for foster youths.

Purpose: This pilot study evaluated the cost–benefit of research-based Treatment Foster Care Oregon (TFCO) as an alternative treatment setting to residential care for children in the Illinois child welfare system. Methods: Using secondary analysis of child welfare administrative data, this study observed, for 2 years, 52 children enrolled in TFCO and 67 children who were eligible for TFCO but remained in or entered residential care. Results: Over the 2-year period, the average daily cost of care for children in TFCO was $249, compared to $320 for children in residential care, resulting in cost-savings of $51,058 per child and an overall net benefit of $94,294 per child. Conclusions: The promising cost–benefit evidence of TFCO as implemented in a state child welfare system has implications on social work services and placement decision-making, and system capacity in scaling up short-term therapeutic foster homes for children who might otherwise languish in residential care. [ABSTRACT FROM AUTHOR]

Objectives: This manuscript presents a comprehensive framework for the assessment of the value of real-world evidence (RWE) in healthcare decision-making. While RWE has been proposed to overcome some limitations of traditional, one-off studies, no systematic framework exists to measure if RWE actually lowers the burden. This framework aims to fill that gap by providing conceptual approaches for evaluating the time and cost efficiencies of RWE, thus guiding strategic investments in RWE infrastructure. Methods: The framework consists of four components: (114th Congress. 21st Century Cures Act.; 2015. https://www.congress.gov/114/plaws/publ255/PLAW-114publ255.pdf.) identification of stakeholders using and producing RWE, (National Health Council. Glossary of Patient Engagement Terms. Published 2019. Accessed May 18. 2021. https://nationalhealthcouncil.org/glossary-of-patient-engagement-terms/.) understanding value propositions on how RWE can benefit stakeholders, (Center for Drug Evaluation and Research. CDER Patient-Focused Drug Development. U.S. Food & Drug Administration.) defining key performance indicators (KPIs), and (U.S. Department of Health and Human Services - Food and Drug Administration: Center for Devices and Radiological Health and Center for Biologics Evaluation and Research. Use of Real-World Evidence to Support Regulatory Decision-Making for Medical Devices - Guidance for Industry and Food and Drug Administration Staff. 2017. http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guida.) establishing metrics and case studies to assess value. KPIs are categorized as 'better, faster, or cheaper" as an indicator of value: better focusing on high-quality actionable evidence; 'faster,' denoting time-saving in evidence generation, and 'cheaper,' emphasizing cost-efficiency decision compared to methodologies that do not involve data routinely collected in clinical practice. Metrics and relevant case studies are tailored based on stakeholder value propositions and selected KPIs that can be used to assess what value has been created by using RWE compared to traditional evidence-generation approaches and comparing different RWE sources. Results: Operationalized through metrics and case studies drawn from the literature, the value of RWE is documented as improving treatment effect heterogeneity evaluation, expanding medical product labels, and expediting post-market compliance. RWE is also shown to reduce the cost and time required to produce evidence compared to traditional one-off approaches. An original example of a metric that measures the time saved by RWE methods to detect a signal of a product failure was presented based on analysis of the National Cardiovascular Disease Registry. Conclusions: The framework presented in this manuscript offers a comprehensive approach for evaluating the value of RWE, applicable to all stakeholders engaged in leveraging RWE for healthcare decision-making. Through the proposed metrics and illustrated case studies, valuable insights are provided into the heightened efficiency, cost-effectiveness, and improved decision-making within clinical and regulatory domains facilitated by RWE. While this framework is primarily focused on medical devices, it could potentially inform the determination of RWE value in other medical products. By discerning the variations in cost, time, and data utility among various evidence-generation methods, stakeholders are empowered to invest strategically in RWE infrastructure and shape future research endeavors. [ABSTRACT FROM AUTHOR]

With the impact and cost of continued river degradation and climate changeinduced extreme rainfall and floods, there is growing urgency to achieve and maintain good river health to meet global sustainable development goals. Upscaling and working with nature-based solutions at regional, catchment and fluvial corridor scales is critical. One way to achieve this is to work within a recovery-enhanced approach to river rehabilitation, incorporating processes of geomorphic and vegetative recovery to build fluvial corridors in areas where they have become fragmented. Geomorphologically-informed cost-benefit analysis has not previously been applied in a riverine or riparian context, at the catchment or regional scale needed. We applied Marxan in a novel manner to undertake the first cost-benefit analysis for geomorphologically-informed rehabilitation of river systems. We estimated that to rehabilitate 75,500 km of streams in coastal catchments of NSW will cost $8.2 billion, comparing favourably to recent single flood event insurance losses, and projected future losses. We developed Marxan scenarios based on three broad approaches to river management: ad hoc and reactive, working with recovery and corridors, across current and future time periods. We found there are considerable current and flow-on future financial and non-financial benefits, and lower initial total and per-hectare rehabilitation costs, by fully adopting working with recovery or corridors approaches and moving away from the ad hoc and reactive approaches which dominate current practice. Implementing targeted rehabilitation based on a rolling sequence over time of corridors scenarios provides optimal holistic solutions to improve geomorphic condition and enhance recovery potential at landscape-scale. Our study demonstrates the use of Marxan as an accessible tool to address prioritisation complexity, and to run and cost landscape-scale rehabilitation scenarios over time. Our study also demonstrates the positive offsite feedbacks that occur through multiplier effects, as recovery occurs, and corridors are built. Geomorphologically-informed decision making becomes more robust, transparent, cost-effective, consistent across catchments, and adaptive to local situations and evolving river management priorities. [ABSTRACT FROM AUTHOR]

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Objectives To estimate the number and burden of medication errors associated with prescription information transfer within the National Health Service (NHS) in England and the impact of implementing an interoperable prescription information system (a single digital prescribing record shared across NHS settings) in reducing these errors. Methods We constructed a probabilistic mathematical model. We estimated the number of transition medication errors that would be undetected by standard medicines reconciliation, based on published literature, and scaled this up based on the annual number of hospital admissions. We used published literature to estimate the proportion of errors that lead to harm and applied this to the number of errors to estimate the associated burden (healthcare resource use and deaths). Finally, we used reported effect sizes for electronic prescription information sharing interventions to estimate the impact of implementing an interoperable prescription information system on number of errors and resulting harm. Results Annually, around 1.8 million (95% credibility interval (CrI) 1.3 to 2.6 million) medication errors were estimated to occur at hospital transitions in England, affecting approximately 380 000 (95% CrI 260 397 to 539 876) patient episodes. Harm from these errors affects around 31 500 (95% CrI 22 407 to 42 906) patients, with 36 500 (95% CrI 25 093 to 52 019) additional bed days of inpatient care (costing around £17.8 million (95% CrI £12.4 to £24.9 million)) and >40 (95% CrI 9 to 146) deaths. Assuming the implementation of an interoperable prescription information system could reduce errors by 10% and 50%, there could be 180 000-913 000 fewer errors, 3000-15 800 fewer people who experience harm and 4-22 lives saved annually. Conclusions An interoperable prescription information system could provide major benefits for patient safety. Likely additional benefits include healthcare professional time saved, improved patient experience and care quality, quicker discharge and enhanced cross-organisational medicines optimisation. Our findings provide vital safety and economic evidence for the case to adopt interoperable prescription information systems. [ABSTRACT FROM AUTHOR]

Newborn screening (NBS) has been one of the big innovations in public health. It has grown over the decades, especially with the introduction of tandem mass spectrometry. However, it is likely to expand significantly in the coming decades with the introduction of genomic testing. Traditionally, in NBS, there has been a pattern of repeat testing for confirmation and follow-up diagnostic testing. This follow-up is critical as NBS is a screening program. This pathway is appropriate for low-cost tests, but if public health authorities are going to invest in high-cost screening such as whole-genome sequencing, they are likely to baulk at repeating these expensive tests in a diagnostic setting. Our study investigates whether screening-grade data from NBS can be transitioned into diagnostic-grade data using a panel of single-nucleotide variants (SNVs) on a diagnostic specimen. These SNVs could be used to link the diagnostic specimen with all of the provenance requirements associated with routine pathology and the NBS genomic data. This strategy has large cost benefits and opens up the rapid use of NBS genomic data should a child present in an acute care setting and a genetic diagnosis is suspected. This approach will greatly speed up the confirmation of positive NBS results and reduce family anxiety due to delayed diagnostic testing. [ABSTRACT FROM AUTHOR]

This work presents a comprehensive Social Life Cycle Assessment (S-LCA) and Social Cost-Benefit Analysis (S-CBA) conducted as part of a research project, studying biofuel production for the maritime and aviation sectors, from various types of non-food waste biomasses. The inclusion of social considerations complements and expands on the environmental and economic ones. The importance of social group criteria was determined through expert questionnaires, leading to the identification of social impacts groups and social criteria from stakeholders across participating countries. The results successfully identified and quantified social impacts, and align with those reported in similar cases in relevant literature. Social Cost-Benefits, monetarizing social factors, demonstrated several social benefits, including reduction in Greenhouse Gas Emissions. However, it also highlighted social costs, such as Economic Costs associated with the initial investment. The study revealed critical social hotspots within the impact categories, making significant strides in understanding the social impacts of biofuel production, providing valuable insights for decision-makers, and contributing to the broader goal of sustainable and socially responsible biofuel production. [ABSTRACT FROM AUTHOR]

The global banana industry faces a significant threat from Fusarium oxysporum f. sp. cubense Tropical Race 4 (TR4). While prior research has concentrated on TR4's dissemination, reproductive conditions, and resistant banana varieties, this study employs a socioeconomic and cost-benefit analysis to explore the vulnerability of banana producers to TR4 in Colombia. It assesses the financial viability of current monitoring strategies and estimates potential losses in the event of TR4 spreading within the study area. Interviews were conducted with producers and key stakeholders in Colombia's top two banana-producing departments, Antioquia and Magdalena. The findings reveal that farming systems are highly vulnerable to TR4, particularly due to the prevalent use of corms. Producers employ preventive measures such as cement paths, fences, disinfecting stations, and footbaths to counteract TR4's spread. A cost-benefit analysis indicates that the benefits of these prevention methods significantly outweigh the associated costs, with a net present value of implementing prevention strategies per hectare of $95,389 USD and $112,527 USD in Magdalena and Antioquia and a benefit-cost ratio of 3.1 and 4.2, respectively. Considering the substantial impact TR4 could have in Colombia if it becomes more widespread, we recommend widespread adoption of preventive measures, including the construction and utilization of cement paths and disinfectant methods on all banana farms. Additionally, to enhance awareness and early detection, we propose leveraging technology, such as mobile applications (apps) and chat groups, to empower farmers in identifying and preventing the spread of TR4. [ABSTRACT FROM AUTHOR]

Background: Australia's clinical trials sector is highly productive with continued sector investment needed to enhance research impact. Generating economic evidence alongside trials has the potential to facilitate the implementation of trial results into practice. Ascertaining the use of health economic evaluations alongside clinical trials can assist in determining whether clinical trials fully realize and operationalize their potential to change policy and practice. The aims of this study were to ascertain the uptake of health economic evaluations alongside Australian-led clinical trials and explore associations between uptake and trial characteristics. Methods: This observational study comprised a descriptive analysis of clinical trials registries, a cross-sectional survey of Australian Clinical Trials Alliance (ACTA) networks, and a subgroup analysis of completed acute care trials. Descriptive analyses of trial registrations were conducted, with logistic regressions used to identify predictors of proposing and subsequently publishing a health economic evaluation alongside acute care trials. Results: Few randomized Australian-led clinical trials (11% of 9251) and ACTA network trials (43% of 227) proposed a health economic evaluation. In the subgroup analysis, 22% of the 324 acute care trials and 53% of the 38 ACTA network acute care trials proposed a health economic evaluation. Acute care trials funded by government bodies were significantly more likely to propose and publish a health economic evaluation than those funded by hospitals, universities, and other funders, after adjusting for phase, registration year, primary sponsor type, and comparator. Conclusions: Current uptake of health economic evaluations alongside Australian-led clinical trials is low, with uptake higher among the subset of ACTA network trials. This is despite economic evidence playing an increasingly prominent role in health system management, as well as rising health expenditure, limited budgets, and competing demands. There is significant opportunity to embed health economic evaluations alongside clinical trials, particularly phase 3 trials, to increase research outputs and optimize research translation. Investing in clinical trial networks that support funding for a health economist or a health economic evaluation may be an effective strategy to increase the uptake of health economic evaluations alongside trials. [ABSTRACT FROM AUTHOR]

Background: The cost of cancer drugs presents a significant challenge to accessibility of treatment worldwide. Projections indicate that by 2040, two-thirds of cancer cases will occur in low- and middle- income countries. Paradoxically, despite this impending burden, LMICs command less than 5% share of global resources for treating cancer. Morocco, like many LMICs, faces significant obstacles in providing innovative cancer treatments to its population. Aim: Firstly, we aimed to conduct an original research investigating the availability and affordability of innovative cancer drugs in Morocco. Secondly, we sought to review the broader market dynamics, pricing, and reimbursement policies in the country. Methods: For the first objective, we identified a preliminary list of medicines approved for oncological indications in the Moroccan market based on resources from ANAM (National Agency for Health Insurance), pharmacy regulators, and online resources that compile information on approved medicines. For the second objective, we exhaustively reviewed the regulatory documents, legal texts and grey literature reports. All the informations were examined by pharma delegates and local experts. Results: As of January 2024, Morocco has 39 innovative anticancer medicines with market authorization. 30% of these drugs were approved after 2020. The majority of approved drugs were for breast, lung, colorectal, and prostate cancer. The period between FDA approval and entry into the Moroccan market ranges from 2 to 7 years, with a median of 3 years for breast cancer drugs and 7 years for more expensive drugs like Olaparib and Osimertinib. 22 out of the 39 drugs are not reimbursed, with an average reimbursement time of 4 years. Compared to prices in France, the most notable pricing disparities concern immunotherapy agents, priced 600 to 900 euros lower in France, while drugs like Pazopanib and Erlotinib cost 50% less in Morocco. Conclusion: Our study reveals significant disparities in the availability and affordability of innovative cancer drugs in Morocco. Regulatory hurdles, importation challenges, and pricing strategies contribute to this inequitable landscape. Addressing systemic barriers, fostering collaborations between stakeholders, and adopting a value-based pricing approach are imperative steps toward ensuring equitable access to high-quality interventions for patients, regardless of their geographical location. [ABSTRACT FROM AUTHOR]

This study provides updated estimates of the cost-of-illness for three common and costly health outcomes: myocardial infarction, asthma and stroke. We use a regression approach based on a large data set which provides a representative sample of individual health-related expenditures in the United States. Our core estimates are that the estimated cost of a first myocardial infarction is $238,000, the cost of new onset asthma is $170,000, and the cost of a first stroke is $175,000. We also demonstrate the importance of including wage income and caregiving costs and document differences in short- and long-term costs for some health outcomes. Looking forward, these cost-of-illness estimates can be used to inform environmental benefit-cost analysis such as those performed by the United States Environmental Protection Agency (EPA). [ABSTRACT FROM AUTHOR]

Background: Blended learning, a pedagogical approach combining traditional classroom instruction with online components, has gained prominence in nursing education. While offering numerous benefits, student satisfaction with blended learning remains a critical concern. This study contributes to the existing literature by providing a comprehensive evaluation of the determinants influencing nursing students' satisfaction with this innovative educational modality. By examining a wide range of factors, including sociodemographic characteristics, academic factors, and environmental influences, this research offers valuable insights for educators to optimize blended learning experiences in nursing education. Methods: A descriptive cross-sectional research design was conducted. This study investigates the factors influencing nursing students' satisfaction with blended learning at Alexandria University, Egypt, where blended learning programs have been integrated into the curriculum primarily through the Microsoft Teams platform. A convenient sample of 1266 nursing students from both bachelor and technical educational institutions participated in the study from September 2023 to the end of December 2023. Data were collected using an online survey containing two measurement tools: the Blended Learning Satisfaction Scale and the Environmental Facilitators and Barriers to Student Persistence in Online Courses scale. Statistical analyses, including descriptive statistics and backward multiple linear regression, were conducted to identify factors that are associated with the satisfaction of nursing students' with blended learning. Results: Findings indicate that factors such as age, gender, income, employment status, access to suitable internet sources, academic year, computer literacy, preferred learning method, and perceptions of environmental facilitators significantly influence satisfaction scores (all p < 0.001). The overall regression model, with an adjusted R² of 0.31, signifies that 31% of the variance in satisfaction scores is explained collectively by the previously mentioned variables (F = 21.21, p < 0.001). Conclusion: Students' sociodemographic variables, preference for blended learning, and perception of environmental facilitators such as encouragement to enroll in the course significantly influence nursing students' satisfaction levels with blended learning. However, limitations in the current study such as self-report bias, convenient sampling, and cross-sectional design limit the generalizability and causal inferences of these findings. [ABSTRACT FROM AUTHOR]

Background: This study will evaluate the Basic Income for Care Leavers in Wales pilot (BIP), which is the most generous basic income scheme in the world. A cohort of care-experienced young people who become aged 18 during a 12-month enrolment period (July 2022-June 2023) are receiving £1,600 (before tax) per month for two years, and the Welsh Government intends this to have a range of benefits. This evaluation will examine the impact of BIP, the implementation of the pilot and how it is experienced, and its value for money. Methods: The study is a theory-based quasi-experimental evaluation, and the design and methods are informed by ongoing co-production with care-experienced young people. We will estimate the impact of BIP on participants using self-reported survey data and routinely collected administrative data. This will include outcomes across a range of domains, including psychological wellbeing, physical and mental health, financial impact, education, training and volunteering. Comparisons between temporal (Welsh) and geographical (English, using administrative data) controls will be done using coarsened exact matching and difference in differences analysis. The process evaluation will examine how BIP is implemented and experienced, primarily through monitoring data (quantitative) and interview, observational, and focus group data (qualitative). The economic evaluation will take a public sector and a societal perspective to identify, measure and value the costs and outcomes of BIP, and to synthesise the evidence to inform a social cost-benefit analysis at 24 months post-intervention. Discussion: BIP is unusual in that it targets a wide range of outcomes and is available to an entire national cohort of participants. The evaluation also has several practical constraints. Therefore, the study will use a range of methods and triangulate between different analyses to assess how successful it is. Findings will inform policy in relation to care leavers, social security and basic income studies worldwide. [ABSTRACT FROM AUTHOR]

Background: While previous studies have examined various platforms that enable providers to connect, Virtual Hallway (VH) stands out with its unique features. The value add is that this online platform connects primary care providers and specialists for synchronous phone-based conversations and aims to reduce referrals and enhance the quality of referrals. VH allows providers to easily log in, select the required specialty, book call times, receive reminders, and have calls documented, ensuring a high connection rate. In May 2022, the provincial health authority in Nova Scotia, a Canadian province, and VH initiated a feasibility study facilitated through the Health Innovation Hub in Nova Scotia. The goal was to enable primary care providers to connect with specialists, thereby reducing wait times and unnecessary referrals, and facilitating timely access to relevant clinical direction for patients. The current evaluation assessed utilization, value for money in economic analysis, and consultation experiences. Methods: The study used post, cross-sectional, and cost-benefit study designs. We collected data through various methods, including administratively recorded utilization, theory-driven surveys, and cost data. Utilization was measured by the number of completed consults and the number of healthcare professionals using the VH platform. We analyzed the data using a combination of descriptive statistics and a cost-benefit analysis, which also involved conducting probabilistic sensitivity analysis. Results: The study found that approximately 84% of the VH consultations avoided needing in-person specialist referrals. The return on investment was 1.8 (95% CI: 0.8 to 3.0), indicating that the monetary value of the measurable benefits associated with VH exceeded the value of the resources invested. The provider experience survey revealed high satisfaction levels with VH across user groups, with 92% of specialists and 96% of primary care providers reporting being satisfied or highly satisfied with their experience. These positive indicators of provider experience were further supported by the fact that 97% of respondents agreed or strongly agreed that they intended to continue to use VH in their practice, and 97% of respondents agreed or strongly agreed that they would recommend VH to a colleague. Conclusions: The study suggests that VH was well-received by users, with high levels of satisfaction reported and a reduced need for in-person referrals. It also represented value for money. Further research could explore how the availability of virtual health services can lead to reduced utilization of healthcare resources among different groups of patients. [ABSTRACT FROM AUTHOR]