WorldWideScience

Sample records for cost-effective national surveillance

  1. Cost effectiveness of surveillance for GI cancers.

    Science.gov (United States)

    Omidvari, Amir-Houshang; Meester, Reinier G S; Lansdorp-Vogelaar, Iris

    2016-12-01

    Gastrointestinal (GI) diseases are among the leading causes of death in the world. To reduce the burden of GI diseases, surveillance is recommended for some diseases, including for patients with inflammatory bowel diseases, Barrett's oesophagus, precancerous gastric lesions, colorectal adenoma, and pancreatic neoplasms. This review aims to provide an overview of the evidence on cost-effectiveness of surveillance of individuals with GI conditions predisposing them to cancer, specifically focussing on the aforementioned conditions. We searched the literature and reviewed 21 studies. Despite heterogeneity of studies in terms of settings, study populations, surveillance strategies and outcomes, most reviewed studies suggested at least some surveillance of patients with these GI conditions to be cost-effective. For some high-risk conditions frequent surveillance with 3-month intervals was warranted, while for other conditions, surveillance may only be cost-effective every 10 years. Further studies based on more robust effectiveness evidence are needed to inform and optimise surveillance programmes for GI cancers. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Cost-Effectiveness of Contralateral Prophylactic Mastectomy Versus Routine Surveillance in Patients With Unilateral Breast Cancer

    Science.gov (United States)

    Zendejas, Benjamin; Moriarty, James P.; O'Byrne, Jamie; Degnim, Amy C.; Farley, David R.; Boughey, Judy C.

    2011-01-01

    Purpose Contralateral prophylactic mastectomy (CPM) rates in women with unilateral breast cancer are increasing despite controversy regarding survival advantage. Current scrutiny of the medical costs led us to evaluate the cost-effectiveness of CPM versus routine surveillance as an alternative contralateral breast cancer (CBC) risk management strategy. Methods Using a Markov model, we simulated patients with breast cancer from mastectomy to death. Model parameters were gathered from published literature or national databases. Base-case analysis focused on patients with average-risk breast cancer, 45 years of age at treatment. Outcomes were valued in quality-adjusted life-years (QALYs). Patients' age, risk level of breast cancer, and quality of life (QOL) were varied to assess their impact on results. Results Mean costs of treatment for women age 45 years are comparable: $36,594 for the CPM and $35,182 for surveillance. CPM provides 21.22 mean QALYs compared with 20.93 for surveillance, resulting in an incremental cost-effectiveness ratio (ICER) of $4,869/QALY gained for CPM. To prevent one CBC, six CPMs would be needed. CPM is no longer cost-effective for patients older than 70 years (ICER $62,750/QALY). For BRCA-positive patients, CPM is clearly cost-effective, providing more QALYs while being less costly. In non-BRCA patients, cost-effectiveness of CPM is highly dependent on assumptions regarding QOL for CPM versus surveillance strategy. Conclusion CPM is cost-effective compared with surveillance for patients with breast cancer who are younger than 70 years. Results are sensitive to BRCA-positive status and assumptions of QOL differences between CPM and surveillance patients. This highlights the importance of tailoring treatment for individual patients. PMID:21690472

  3. Economics of infection control surveillance technology: cost-effective or just cost?

    Science.gov (United States)

    Furuno, Jon P; Schweizer, Marin L; McGregor, Jessina C; Perencevich, Eli N

    2008-04-01

    Previous studies have suggested that informatics tools, such as automated alert and decision support systems, may increase the efficiency and quality of infection control surveillance. However, little is known about the cost-effectiveness of these tools. We focus on 2 types of economic analyses that have utility in assessing infection control interventions (cost-effectiveness analysis and business-case analysis) and review the available literature on the economics of computerized infection control surveillance systems. Previous studies on the effectiveness of computerized infection control surveillance have been limited to assessments of whether these tools increase the sensitivity and specificity of surveillance over traditional methods. Furthermore, we identified only 2 studies that assessed the costs associated with computerized infection control surveillance. Thus, it remains unknown whether computerized infection control surveillance systems are cost-effective and whether use of these systems improves patient outcomes. The existing data are insufficient to allow for a summary conclusion on the cost-effectiveness of infection control surveillance technology. All future studies of computerized infection control surveillance systems should aim to collect outcomes and economic data to inform decision making and assist hospitals with completing business-cases analyses.

  4. A risk-profiling approach for surveillance of inflammatory bowel disease-colorectal carcinoma is more cost-effective: a comparative cost-effectiveness analysis between international guidelines.

    Science.gov (United States)

    Lutgens, Maurice; van Oijen, Martijn; Mooiweer, Erik; van der Valk, Mirthe; Vleggaar, Frank; Siersema, Peter; Oldenburg, Bas

    2014-11-01

    Colonoscopic surveillance for neoplasia is recommended for patients with inflammatory bowel disease (IBD)-related colitis. However, data on cost-effectiveness predate current international guidelines. To compare cost-effectiveness based on contemporary data between the surveillance strategies of the American Gastroenterological Association (AGA) and British Society of Gastroenterology (BSG). We constructed a Markov decision model to simulate the clinical course of IBD patients. We compared the 2 surveillance strategies for a base case of a 40-year-old colitis patient who was followed for 40 years. AGA surveillance distinguishes 2 groups: a high-risk group with annual surveillance and an average-risk group with biannual surveillance. BSG surveillance distinguishes 3 risk groups with yearly, 3-year, or 5-year surveillance. Patients could move from a no-dysplasia state with colonoscopic surveillance to 1 of 3 states for which proctocolectomy was indicated: (1) dysplasia/local cancer, (2) regional/metastasized cancer, or (3) refractory disease. After proctocolectomy, a patient moved to a no-colon state without surveillance. Direct costs of medical care, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. BSG surveillance dominated AGA surveillance with $9846 per QALY. Both strategies were equally effective with 24.16 QALYs, but BSG surveillance was associated with lower costs because of fewer colonoscopies performed. Costs related to IBD, surgery, or cancer did not affect cost-effectiveness. The model depends on the accuracy of derived data, and the assumptions that were made to reflect real-life situations. Study conclusions may only apply to the U.S. health care system. The updated risk-profiling approach for surveillance of IBD colorectal carcinoma by the BSG guideline appears to be more cost-effective. Copyright © 2014. Published by Elsevier Inc.

  5. Cost-effectiveness of endoscopic screening followed by surveillance for Barrett's esophagus: a review.

    Science.gov (United States)

    Barbiere, Josephine M; Lyratzopoulos, Georgios

    2009-12-01

    Screening interventions for Barrett's esophagus (BE) are appealing, but there is little supporting evidence. We reviewed health economics studies about BE endoscopic screening followed by, as required, endoscopic surveillance ("screening and surveillance" hereafter) to help inform the design and conduct of future research. Health economics studies about BE screening and surveillance were identified using electronic database searches and personal contact with authors of identified studies. No studies examined general population screening. Five US studies published between 2003 and 2007 examined the cost effectiveness of screening and surveillance (against no intervention) in patients with chronic gastroesophageal reflux disease (GERD). There was no randomized trial evidence to inform model construction. Assumptions about prevalence and transition probabilities between BE histologic subtypes and about surveillance and treatment protocols varied substantially between studies. Parameters such as potential BE diagnosis-related reduction in quality of life or increase in health care use, diagnostic accuracy, and infrastructural costs (for quality assurance) were considered either "optimistically" or not at all. Only 2 studies considered endoscopic treatments. No study considered the recently introduced radiofrequency ablation technique, or the potential for biomarker-based risk stratification of surveillance interval or duration. Current health economics evidence is likely to have provided optimistic cost-effectiveness estimates and is not sufficient to support introduction of endoscopic BE screening programs among GERD patients. The evidence does not adequately incorporate novel (endoscopic) treatments and the potential for (clinical, endoscopic, or biomarker-based) risk stratification of surveillance. Future research should aim to encompass both these factors.

  6. Stool DNA Analysis is Cost-Effective for Colorectal Cancer Surveillance in Patients With Ulcerative Colitis.

    Science.gov (United States)

    Kisiel, John B; Konijeti, Gauree G; Piscitello, Andrew J; Chandra, Tarun; Goss, Thomas F; Ahlquist, David A; Farraye, Francis A; Ananthakrishnan, Ashwin N

    2016-12-01

    Patients with chronic ulcerative colitis are at increased risk for colorectal neoplasia (CRN). Surveillance by white-light endoscopy (WLE) or chromoendoscopy may reduce risk of CRN, but these strategies are underused. Analysis of DNA from stool samples (sDNA) can detect CRN with high levels of sensitivity, but it is not clear if this approach is cost-effective. We simulated these strategies for CRN detection to determine which approach is most cost-effective. We adapted a previously published Markov model to simulate the clinical course of chronic ulcerative colitis, the incidence of cancer or dysplasia, and costs and benefits of care with 4 surveillance strategies: (1) analysis of sDNA and diagnostic chromoendoscopy for patients with positive results, (2) analysis of sDNA with diagnostic WLE for patients with positive results, (3) chromoendoscopy with targeted collection of biopsies, or (4) WLE with random collection of biopsies. Costs were based on 2014 Medicare reimbursement. The primary outcome was the incremental cost-effectiveness ratio (incremental cost/incremental difference in quality-adjusted life-years) compared with no surveillance and a willingness-to-pay threshold of $50,000. All strategies fell below the willingness-to-pay threshold at 2-year intervals. Incremental cost-effectiveness ratios were $16,362 per quality-adjusted life-year for sDNA analysis with diagnostic chromoendoscopy; $18,643 per quality-adjusted life-year for sDNA analysis with diagnostic WLE; $23,830 per quality-adjusted life-year for chromoendoscopy alone; and $27,907 per quality-adjusted life-year for WLE alone. In sensitivity analyses, sDNA analysis with diagnostic chromoendoscopy was more cost-effective than chromoendoscopy alone, up to a cost of $1135 per sDNA test. sDNA analysis remained cost-effective at all rates of compliance; when combined with diagnostic chromoendoscopy, this approach was preferred over chromoendoscopy alone, when the specificity of the sDNA test for CRN

  7. Cost-Effectiveness of Surveillance for Bloodstream Infections for Sepsis Management in Low-Resource Settings.

    Science.gov (United States)

    Penno, Erin C; Baird, Sarah J; Crump, John A

    2015-10-01

    Bacterial sepsis is a leading cause of mortality among febrile patients in low- and middle-income countries, but blood culture services are not widely available. Consequently, empiric antimicrobial management of suspected bloodstream infection is based on generic guidelines that are rarely informed by local data on etiology and patterns of antimicrobial resistance. To evaluate the cost-effectiveness of surveillance for bloodstream infections to inform empiric management of suspected sepsis in low-resource areas, we compared costs and outcomes of generic antimicrobial management with management informed by local data on etiology and patterns of antimicrobial resistance. We applied a decision tree model to a hypothetical population of febrile patients presenting at the district hospital level in Africa. We found that the evidence-based regimen saved 534 more lives per 100,000 patients at an additional cost of $25.35 per patient, resulting in an incremental cost-effectiveness ratio of $4,739. This ratio compares favorably to standard cost-effectiveness thresholds, but should ultimately be compared with other policy-relevant alternatives to determine whether routine surveillance for bloodstream infections is a cost-effective strategy in the African context.

  8. DVT surveillance program in the ICU: analysis of cost-effectiveness.

    Directory of Open Access Journals (Sweden)

    Ajai K Malhotra

    Full Text Available BACKGROUND: Venous Thrombo-embolism (VTE--Deep venous thrombosis (DVT and/or pulmonary embolism (PE--in traumatized patients causes significant morbidity and mortality. The current study evaluates the effectiveness of DVT surveillance in reducing PE, and performs a cost-effectiveness analysis. METHODS: All traumatized patients admitted to the adult ICU underwent twice weekly DVT surveillance by bilateral lower extremity venous Duplex examination (48-month surveillance period--SP. The rates of DVT and PE were recorded and compared to the rates observed in the 36-month pre-surveillance period (PSP. All patients in both periods received mechanical and pharmacologic prophylaxis unless contraindicated. Total costs--diagnostic, therapeutic and surveillance--for both periods were recorded and the incremental cost for each Quality Adjusted Life Year (QALY gained was calculated. RESULTS: 4234 patients were eligible (PSP--1422 and SP--2812. Rate of DVT in SP (2.8% was significantly higher than in PSP (1.3% - p<0.05, and rate of PE in SP (0.7% was significantly lower than that in PSP (1.5% - p<0.05. Logistic regression demonstrated that surveillance was an independent predictor of increased DVT detection (OR: 2.53 - CI: 1.462-4.378 and decreased PE incidence (OR: 0.487 - CI: 0.262-0.904. The incremental cost was $509,091/life saved in the base case, translating to $29,102/QALY gained. A sensitivity analysis over four of the parameters used in the model indicated that the incremental cost ranged from $18,661 to $48,821/QALY gained. CONCLUSIONS: Surveillance of traumatized ICU patients increases DVT detection and reduces PE incidence. Costs in terms of QALY gained compares favorably with other interventions accepted by society.

  9. Cost-effectiveness of surveillance programs for families at high and moderate risk of hereditary non-polyposis colorectal cancer

    DEFF Research Database (Denmark)

    Rose Olsen, Kim; Bojesen, Stig E; Gerdes, Anne-Marie M

    2007-01-01

    and moderate risk of HNPCC are offered surveillance from age 25 and age 45, respectively. The model includes costs for all families referred to genetic counseling, including genetic risk assessment, mutation analysis, and surveillance in relevant families with or without known mutation, plus the costs related...... the moderate risk group is evaluated genetically but not offered surveillance. Sensitivity analysis showed these findings to be robust, although cost-effectiveness can be improved in cases of more conservative referrals to genetic counseling. CONCLUSIONS: The result for high risk families confirms the findings...

  10. National Cardiac Device Surveillance Program Database

    Data.gov (United States)

    Department of Veterans Affairs — The National Cardiac Device Surveillance Program Database supports the Eastern Pacemaker Surveillance Center (EPSC) staff in its function of monitoring some 11,000...

  11. Cost-Effective Helicopter Options for Partner Nations

    Science.gov (United States)

    2015-01-01

    elevation feature MGTOW maximum gross takeoff weight MOB main operating base MoD Ministry of Defense MoI Ministry of Interior nm nautical miles NSRW...we provided a main operat- ing base ( MOB ) or forward operating base (FOB) from which operations would be conducted. In these instances, the...RAND RR141z1-2.2 MOB /FOB MOB /FOB X Y Z LZs Alternate LZs 23 nmPrimary LZ Bor der Bor der 120º 120º 10 Cost-Effective Helicopter Options for Partner

  12. Cost-Effectiveness Analysis of a Mobile Ear Screening and Surveillance Service versus an Outreach Screening, Surveillance and Surgical Service for Indigenous Children in Australia.

    Directory of Open Access Journals (Sweden)

    Kim-Huong Nguyen

    Full Text Available Indigenous Australians experience a high rate of ear disease and hearing loss, yet they have a lower rate of service access and utilisation compared to their non-Indigenous counterparts. Screening, surveillance and timely access to specialist ear, nose and throat (ENT services are key components in detecting and preventing the recurrence of ear diseases. To address the low access and utilisation rate by Indigenous Australians, a collaborative, community-based mobile telemedicine-enabled screening and surveillance (MTESS service was trialled in Cherbourg, the third largest Indigenous community in Queensland, Australia. This paper aims to evaluate the cost-effectiveness of the MTESS service using a lifetime Markov model that compares two options: (i the Deadly Ears Program alone (current practice involving an outreach ENT surgical service and screening program, and (ii the Deadly Ears Program supplemented with the MTESS service. Data were obtained from the Deadly Ears Program, a feasibility study of the MTESS service and the literature. Incremental cost-utility ratios were calculated from a societal perspective with both costs (in 2013-14 Australian dollars and quality-adjusted life years (QALYs discounted at 5% annually. The model showed that compared with the Deadly Ears Program, the probability of an acceptable cost-utility ratio at a willingness-to-pay threshold of $50,000/QALY was 98% for the MTESS service. This cost effectiveness arises from preventing hearing loss in the Indigenous population and the subsequent reduction in associated costs. Deterministic and probability sensitivity analyses indicated that the model was robust to parameter changes. We concluded that the MTESS service is a cost-effective strategy. It presents an opportunity to resolve major issues confronting Australia's health system such as the inequitable provision and access to quality healthcare for rural and remotes communities, and for Indigenous Australians

  13. Cost-effectiveness of adding decolonization to a surveillance strategy of screening and isolation for methicillin-resistant Staphylococcus aureus carriers.

    Science.gov (United States)

    Nelson, R E; Samore, M H; Smith, K J; Harbarth, S; Rubin, M A

    2010-12-01

    We compared the cost-effectiveness of a methicillin-resistant Staphylococcus aureus (MRSA) programme of active surveillance plus decolonization with the current Veterans Health Administration (VHA) strategy of active surveillance alone, as well as a common strategy of no surveillance. A decision-analytical model was developed for an inpatient stay time horizon, using the VHA's perspective. Model inputs were taken from published literature where available, and supplemented with expert opinion when necessary. Effectiveness outcomes were hospital-acquired MRSA infections and deaths avoided. One-way and two-way sensitivity analyses and Monte Carlo simulations were performed. In the base-case analysis, the strategy of active surveillance plus decolonization dominated (i.e. lower cost and greater effectiveness) both the comparison strategies of active surveillance and no surveillance. In addition, the active surveillance strategy dominated the strategy of no surveillance. One-way and two-way sensitivity analyses demonstrated that at low levels of direct benefit of decolonization (1-4%), the strategy of active surveillance plus decolonization would no longer be dominant. In the probabilistic sensitivity analysis, active surveillance plus decolonization dominated both the other two strategies, and the active surveillance strategy dominated no surveillance in all of 1000 Monte Carlo simulations. These results provide a strong economic argument for adding an MRSA decolonization protocol to the current VHA active surveillance strategy.

  14. Cost-effectiveness analysis of beta-blockers vs endoscopic surveillance in patients with cirrhosis and small varices

    Science.gov (United States)

    Di Pascoli, Lorenza; Buja, Alessandra; Bolognesi, Massimo; Montagnese, Sara; Gatta, Angelo; Gregori, Dario; Merkel, Carlo

    2014-01-01

    AIM: To evaluate the most cost-effectiveness strategy for preventing variceal growth and bleeding in patients with cirrhosis and small esophageal varices. METHODS: A stochastic analysis based on decision trees was performed to compare the cost-effectiveness of beta-blockers therapy starting from a diagnosis of small varices (Strategy 1) with that of endoscopic surveillance followed by beta-blockers treatment when large varices are demonstrated (Strategy 2), for preventing variceal growth, bleeding and death in patients with cirrhosis and small esophageal varices. The basic nodes of the tree were gastrointestinal endoscopy, inpatient admission and treatment for bleeding, as required. All estimates were performed using a Monte Carlo microsimulation technique, consisting in simulating observations from known probability distributions depicted in the model. Eight-hundred-thousand simulations were performed to obtain the final estimates. All estimates were then subjected to Monte Carlo Probabilistic sensitivity analysis, to assess the impact of the variability of such estimates on the outcome distributions. RESULTS: The event rate (considered as progression of varices or bleeding or death) in Strategy 1 [24.09% (95%CI: 14.89%-33.29%)] was significantly lower than in Strategy 2 [60.00% (95%CI: 48.91%-71.08%)]. The mean cost (up to the first event) associated with Strategy 1 [823 £ (95%CI: 106 £-2036 £)] was not significantly different from that of Strategy 2 [799 £ (95%CI: 0 £-3498 £)]. The cost-effectiveness ratio with respect to this endpoint was equal to 50.26 £ (95%CI: -504.37 £-604.89 £) per event avoided over the four-year follow-up. When bleeding episodes/deaths in subjects whose varices had grown were included, the mean cost associated with Strategy 1 was 1028 £ (95%CI: 122 £-2581 £), while 1699 £ (95%CI: 171 £-4674 £) in Strategy 2. CONCLUSION: Beta-blocker therapy turn out to be more effective and less expensive than endoscopic surveillance for

  15. Evaluating the cost effectiveness of national program for control of blindness in Jorhat district, India

    Science.gov (United States)

    Laskar, Nasrin B.

    2015-01-01

    Background: We evaluated the cost of different components of the national program for control of blindness (NPCB) and assess the cost effectiveness of this program. Materials and Methods: An observational study was conducted in Jorhat District of Assam, India from July 2009 to June 2010 for assessing the cost effectiveness of the NPCB. Four broad categories of cost inputs, that is, capital costs, recurrent costs, prime/variable costs, and fixed costs were considered. The cost incurred by the provider was taken as the actual cost of delivery of different component of services to the patients, which was calculated from the costs of labor, material, and capital costs using the time utilization pattern recommended by WHO. Result: The District Blindness Control Society, Jorhat had spent 58.93% of total expense on fixed heads of which 65.86% had been spent for cataract surgery. The medical care cost was found to be Indian rupee (INR) 425 for intracapsular cataract extraction (ICCE), INR 675 for extracapsular cataract extraction + intraocular lens (ECCE + IOL) and INR 225 for refractive error correction. The patient-wise provider cost was estimated to be INR 519 for ICCE, INR 769 for ECCE + IOL implantation and INR 319 for spectacle correction of refractive error. Conclusion: National program for control of blindness is a cost effective means of controlling and treating blindness. PMID:26283841

  16. Multivariate causal attribution and cost-effectiveness of a national mass media campaign in the Philippines.

    Science.gov (United States)

    Kincaid, D Lawrence; Do, Mai Phuong

    2006-01-01

    Cost-effectiveness analysis is based on a simple formula. A dollar estimate of the total cost to conduct a program is divided by the number of people estimated to have been affected by it in terms of some intended outcome. The direct, total costs of most communication campaigns are usually available. Estimating the amount of effect that can be attributed to the communication alone, however is problematical in full-coverage, mass media campaigns where the randomized control group design is not feasible. Single-equation, multiple regression analysis controls for confounding variables but does not adequately address the issue of causal attribution. In this article, multivariate causal attribution (MCA) methods are applied to data from a sample survey of 1,516 married women in the Philippines to obtain a valid measure of the number of new adopters of modern contraceptives that can be causally attributed to a national mass media campaign and to calculate its cost-effectiveness. The MCA analysis uses structural equation modeling to test the causal pathways and to test for endogeneity, biprobit analysis to test for direct effects of the campaign and endogeneity, and propensity score matching to create a statistically equivalent, matched control group that approximates the results that would have been obtained from a randomized control group design. The MCA results support the conclusion that the observed, 6.4 percentage point increase in modern contraceptive use can be attributed to the national mass media campaign and to its indirect effects on attitudes toward contraceptives. This net increase represented 348,695 new adopters in the population of married women at a cost of U.S. $1.57 per new adopter.

  17. Use of cost-effectiveness analysis to determine inventory size for a national cord blood bank.

    Science.gov (United States)

    Howard, David H; Meltzer, David; Kollman, Craig; Maiers, Martin; Logan, Brent; Gragert, Loren; Setterholm, Michelle; Horowitz, Mary M

    2008-01-01

    Transplantation with stem cells from stored umbilical cord blood units is an alternative to living unrelated bone marrow transplantation. The larger the inventory of stored cord units, the greater the likelihood that transplant candidates will match to a unit, but storing units is costly. The authors present the results of a study, commissioned by the Institute of Medicine, as part of a report on the establishment of a national cord blood bank, examining the optimal inventory level. They emphasize the unique challenges of undertaking cost-effectiveness analysis in this field and the contribution of the analysis to policy. The authors estimate the likelihood that transplant candidates will match to a living unrelated marrow donor or a cord blood unit as a function of cord blood inventory and then calculate the life-years gained for each transplant type by match level using historical data. They develop a model of the cord blood inventory level to estimate total costs as a function of the number of stored units. The cost per life-year gained associated with increasing inventory from 50,000 to 100,000 units is $44,000 to $86,000 and from 100,000 to 150,000 units is $64,000 to $153,000, depending on the assumption about the degree to which survival rates for cord transplants vary by match quality. Expanding the cord blood inventory above current levels is cost-effective by conventional standards. The analysis helped shape the Institute of Medicine's report, but it is difficult to determine the extent to which the analysis influenced subsequent congressional legislation.

  18. CPSC’s National Electronic Injury Surveillance System (NEISS)

    Data.gov (United States)

    US Consumer Product Safety Commission — CPSC’s National Electronic Injury Surveillance System (NEISS) is a national probability sample of hospitals in the U.S. and its territories. Patient information is...

  19. The Air Force Needs to Improve Cost-Effectiveness and Availability of the Joint Surveillance Target Attack Radar System (Redacted)

    Science.gov (United States)

    2016-11-01

    Introduction Objective We determined whether the Air Force made cost-effective purchases on the performance-based logistics ( PBL ) contract to support...logistics ( PBL ) contract to support JSTARS. Specifically, the JSTARS contracting officer did not establish adequate oversight procedures to validate the...must develop and implement PBL strategies that improve total system availability while minimizing cost and the size of spare parts inventory

  20. The Brazilian Unified National Health System: Proposal of a Cost-effectiveness Evaluation Model

    Directory of Open Access Journals (Sweden)

    Lilian Ribeiro de Oliveira

    2016-04-01

    Full Text Available The Brazilian Unified National Health System (Sistema Único de Saúde [SUS] is in a prominent position compared to the existing social policies. One of the new tools used by SUS is known as Performance Index of the Unified Health System (Índice de Desempenho do Sistema Único de Saúde [IDSUS], which is intended to measure the performance of each municipality. Therefore, the aim of this study was to propose a model of cost-effectiveness to compare IDSUS performance against total revenues achieved in Homogeneous Group 2, consisting of 94 municipalities and analysed using data from IDSUS and the System Information of the Public Budget for Health Care (Sistema de Informação do Orçamento Público em Saúde [SIOPS] for the year 2011. After structuring this data, we carried out descriptive statistical and cluster analysis in order to group similar municipalities in accordance with established variables: IDSUS performance, population and total revenue in health per capita. Even with the division of municipalities into homogeneous groups and after using variables such as population and revenue to regroup them, the results showed there are municipalities with heterogeneous characteristics. Another finding is in the use and intersection of two distinct databases (IDSUS and SIOPS, which allowed for visualizing the impact of health care revenue on the municipalities performance.

  1. A national hypertension treatment program in Germany and its estimated impact on costs, life expectancy, and cost-effectiveness.

    Science.gov (United States)

    Gandjour, Afschin; Stock, Stephanie

    2007-10-01

    Almost 15 million Germans may suffer from untreated hypertension. The purpose of this paper is to estimate the cost-effectiveness of a national hypertension treatment program compared to no program. A Markov decision model from the perspective of the statutory health insurance (SHI) was built. All data were taken from secondary sources. The target population consists of hypertensive male and female patients at high or low risk for cardiovascular events at different age groups (40-49, 50-59, and 60-69 years). The analysis shows fairly moderate cost-effectiveness ratios even for low-risk groups (less than 12,000 euros per life year gained). In women at high risk antihypertensive treatment even leads to savings. This suggests that a national hypertension treatment program provides good value for money. Given the considerable costs of the program itself, any savings from avoiding long-term consequences of hypertension are likely to be offset, however.

  2. Incorporating Cost-Effectiveness Data in a Fair Process for Priority Setting Efforts; Comment on “Use of Cost-Effectiveness Data in Priority Setting Decisions: Experiences from the National Guidelines for Heart Diseases in Sweden”

    Directory of Open Access Journals (Sweden)

    Sitaporn Youngkong

    2015-07-01

    Full Text Available Cost-effectiveness data is useful for use in priority setting decisions in order to improve the efficiency of resources used. This paper thereby responds to Eckard et al. which addressed the use of cost-effectiveness data in the actual prioritization decisions in the Swedish national clinical guidelines for heart diseases. Based on a set of experiences on the use of economic evaluation in priority setting processes, this paper emphasizes the potential approach to incorporating cost-effectiveness data in the prioritization process to enhance transparency of the decisions, and highlights the importance of designing a fair decision-making process that can enforce the sustained implementation of cost-effectiveness data.

  3. US national breastfeeding monitoring and surveillance: current status and recommendations.

    Science.gov (United States)

    Chapman, Donna J; Pérez-Escamilla, Rafael

    2009-05-01

    Eleven federally funded datasets assessing breastfeeding behaviors in the United States (Early Childhood Longitudinal Survey, Infant Feeding Practices Survey II, National Health and Nutrition Examination Survey, National Immunization Survey, National Survey of Children's Health, National Survey of Early Childhood Health, National Survey of Family Growth, Pediatric Nutrition Surveillance System, Pregnancy Nutrition Surveillance System, Pregnancy Risk Assessment Monitoring Survey, and WIC Participant and Program Characteristics) were reviewed to evaluate breastfeeding variables (initiation, duration and exclusivity) and determine whether relevant breastfeeding determinants were collected to evaluate breastfeeding practices from a health disparities perspective. The datasets used inconsistent breastfeeding definitions, limited ethnic descriptors, and varied regarding availability of relevant determinants. Multiple datasets collect breastfeeding data, but a coordinated US breastfeeding monitoring and surveillance system does not exist. Suggestions to improve this system include: standardizing breastfeeding definitions, expanding ethnic/racial descriptors, collecting additional relevant variables, and reducing recall periods.

  4. Cost effectiveness of a government supported policy strategy to decrease sodium intake: global analysis across 183 nations.

    Science.gov (United States)

    Webb, Michael; Fahimi, Saman; Singh, Gitanjali M; Khatibzadeh, Shahab; Micha, Renata; Powles, John; Mozaffarian, Dariush

    2017-01-10

     To quantify the cost effectiveness of a government policy combining targeted industry agreements and public education to reduce sodium intake in 183 countries worldwide.  Global modeling study.  183 countries.  Full adult population in each country.  A "soft regulation" national policy that combines targeted industry agreements, government monitoring, and public education to reduce population sodium intake, modeled on the recent successful UK program. To account for heterogeneity in efficacy across countries, a range of scenarios were evaluated, including 10%, 30%, 0.5 g/day, and 1.5 g/day sodium reductions achieved over 10 years. We characterized global sodium intakes, blood pressure levels, effects of sodium on blood pressure and of blood pressure on cardiovascular disease, and cardiovascular disease rates in 2010, each by age and sex, in 183 countries. Country specific costs of a sodium reduction policy were estimated using the World Health Organization Noncommunicable Disease Costing Tool. Country specific impacts on mortality and disability adjusted life years (DALYs) were modeled using comparative risk assessment. We only evaluated program costs, without incorporating potential healthcare savings from prevented events, to provide conservative estimates of cost effectiveness MAIN OUTCOME MEASURE:  Cost effectiveness ratio, evaluated as purchasing power parity adjusted international dollars (equivalent to the country specific purchasing power of US$) per DALY saved over 10 years.  Worldwide, a 10% reduction in sodium consumption over 10 years within each country was projected to avert approximately 5.8 million DALYs/year related to cardiovascular diseases, at a population weighted mean cost of I$1.13 per capita over the 10 year intervention. The population weighted mean cost effectiveness ratio was approximately I$204/DALY. Across nine world regions, estimated cost effectiveness of sodium reduction was best in South Asia (I$116/DALY); across the world

  5. Cost effectiveness of a government supported policy strategy to decrease sodium intake: global analysis across 183 nations

    Science.gov (United States)

    Webb, Michael; Fahimi, Saman; Singh, Gitanjali M; Khatibzadeh, Shahab; Micha, Renata; Powles, John

    2017-01-01

    Objective To quantify the cost effectiveness of a government policy combining targeted industry agreements and public education to reduce sodium intake in 183 countries worldwide. Design Global modeling study. Setting 183 countries. Population Full adult population in each country. Intervention A “soft regulation” national policy that combines targeted industry agreements, government monitoring, and public education to reduce population sodium intake, modeled on the recent successful UK program. To account for heterogeneity in efficacy across countries, a range of scenarios were evaluated, including 10%, 30%, 0.5 g/day, and 1.5 g/day sodium reductions achieved over 10 years. We characterized global sodium intakes, blood pressure levels, effects of sodium on blood pressure and of blood pressure on cardiovascular disease, and cardiovascular disease rates in 2010, each by age and sex, in 183 countries. Country specific costs of a sodium reduction policy were estimated using the World Health Organization Noncommunicable Disease Costing Tool. Country specific impacts on mortality and disability adjusted life years (DALYs) were modeled using comparative risk assessment. We only evaluated program costs, without incorporating potential healthcare savings from prevented events, to provide conservative estimates of cost effectiveness Main outcome measure Cost effectiveness ratio, evaluated as purchasing power parity adjusted international dollars (equivalent to the country specific purchasing power of US$) per DALY saved over 10 years. Results Worldwide, a 10% reduction in sodium consumption over 10 years within each country was projected to avert approximately 5.8 million DALYs/year related to cardiovascular diseases, at a population weighted mean cost of I$1.13 per capita over the 10 year intervention. The population weighted mean cost effectiveness ratio was approximately I$204/DALY. Across nine world regions, estimated cost effectiveness of sodium reduction

  6. 1995 Annual epidemiologic surveillance report for Brookhaven National Laboratory

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-12-31

    The US Department of Energy`s (DOE) conduct of epidemiologic surveillance provides an early warning system for health problems among workers. This program monitors illnesses and health conditions that result in an absence of five or more consecutive workdays, occupational injuries and illnesses, and disabilities and deaths among current workers. This report summarizes epidemiologic surveillance data collected from Brookhaven National Laboratory (BNL) from January 1, 1995 through December 31, 1995. The data were collected by a coordinator at BNL and submitted to the Epidemiologic Surveillance Data Center, located at Oak Ridge Institute for Science and Education, where quality control procedures and data analyses were carried out.

  7. Beyond cost-effectiveness, analysis. Value-based pricing and result-oriented financing as a pathway to sustainability for the national health system in Spain

    National Research Council Canada - National Science Library

    Alvaro Hidalgo-Vega

    2017-01-01

    Beyond cost-effectiveness, analysis. Value-based pricing and result-oriented financing as a pathway to sustainability for the national health system in SpainThe editorial addresses the current use of economic evaluation...

  8. National- and state-level impact and cost-effectiveness of nonavalent HPV vaccination in the United States.

    Science.gov (United States)

    Durham, David P; Ndeffo-Mbah, Martial L; Skrip, Laura A; Jones, Forrest K; Bauch, Chris T; Galvani, Alison P

    2016-05-03

    Every year in the United States more than 12,000 women are diagnosed with cervical cancer, a disease principally caused by human papillomavirus (HPV). Bivalent and quadrivalent HPV vaccines protect against 66% of HPV-associated cervical cancers, and a new nonavalent vaccine protects against an additional 15% of cervical cancers. However, vaccination policy varies across states, and migration between states interdependently dilutes state-specific vaccination policies. To quantify the economic and epidemiological impacts of switching to the nonavalent vaccine both for individual states and for the nation as a whole, we developed a model of HPV transmission and cervical cancer incidence that incorporates state-specific demographic dynamics, sexual behavior, and migratory patterns. At the national level, the nonavalent vaccine was shown to be cost-effective compared with the bivalent and quadrivalent vaccines at any coverage despite the greater per-dose cost of the new vaccine. Furthermore, the nonavalent vaccine remains cost-effective with up to an additional 40% coverage of the adolescent population, representing 80% of girls and 62% of boys. We find that expansion of coverage would have the greatest health impact in states with the lowest coverage because of the decreasing marginal returns of herd immunity. Our results show that if policies promoting nonavalent vaccine implementation and expansion of coverage are coordinated across multiple states, all states benefit both in health and in economic terms.

  9. Beyond cost-effectiveness, analysis. Value-based pricing and result-oriented financing as a pathway to sustainability for the national health system in Spain

    Directory of Open Access Journals (Sweden)

    Alvaro Hidalgo-Vega

    2017-01-01

    Full Text Available Beyond cost-effectiveness, analysis. Value-based pricing and result-oriented financing as a pathway to sustainability for the national health system in SpainThe editorial addresses the current use of economic evaluation in the assessment and potential funding and reimbursement of health technologies. Cost-effectiveness ratio and the acceptability thresholds are analyzed, pointing out the limitations that the current approach has for capturing the value of new technologies. A potential shift from National Health Systems to value-based prices is discussed, with a focus on health economics outcomes where multi-criteria analyses can be a complementary tool to traditional cost-effectiveness approaches.

  10. Using National Data to Estimate Average Cost Effectiveness of EFNEP Outcomes by State/Territory

    Science.gov (United States)

    Baral, Ranju; Davis, George C.; Blake, Stephanie; You, Wen; Serrano, Elena

    2013-01-01

    This report demonstrates how existing national data can be used to first calculate upper limits on the average cost per participant and per outcome per state/territory for the Expanded Food and Nutrition Education Program (EFNEP). These upper limits can then be used by state EFNEP administrators to obtain more precise estimates for their states,…

  11. National Cost-effectiveness of ASHRAE Standard 90.1-2010 Compared to ASHRAE Standard 90.1-2007

    Energy Technology Data Exchange (ETDEWEB)

    Thornton, Brian; Halverson, Mark A.; Myer, Michael; Loper, Susan A.; Richman, Eric E.; Elliott, Douglas B.; Mendon, Vrushali V.; Rosenberg, Michael I.

    2013-11-30

    Pacific Northwest National Laboratory (PNNL) completed this project for the U.S. Department of Energy’s (DOE’s) Building Energy Codes Program (BECP). DOE’s BECP supports upgrading building energy codes and standards, and the states’ adoption, implementation, and enforcement of upgraded codes and standards. Building energy codes and standards set minimum requirements for energy-efficient design and construction for new and renovated buildings, and impact energy use and greenhouse gas emissions for the life of buildings. Continuous improvement of building energy efficiency is achieved by periodically upgrading energy codes and standards. Ensuring that changes in the code that may alter costs (for building components, initial purchase and installation, replacement, maintenance and energy) are cost-effective encourages their acceptance and implementation. ANSI/ASHRAE/IESNA Standard 90.1 is the energy standard for commercial and multi-family residential buildings over three floors.

  12. National Health Interview Survey (NHIS) - National Cardiovascular Disease Surveillance Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — 2001 to 2014. The National Health Interview Survey (NHIS) has monitored the health of the nation since 1957. NHIS data on a broad range of health topics are...

  13. National Health Interview Survey (NHIS) - National Cardiovascular Disease Surveillance Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — 2001 forward. The National Health Interview Survey (NHIS) has monitored the health of the nation since 1957. NHIS data on a broad range of health topics are...

  14. A cost-effectiveness analysis of three components of a syndromic surveillance system for the early warning of epidemics in rural China

    OpenAIRE

    Ding, Yan; Sauerborn, Rainer; Xu, Biao; Shaofa, Nie; Yan, Weirong; Diwan, Vinod K.; Dong, Hengjin

    2015-01-01

    Background Syndromic surveillance systems (SSSs) collect non-specific syndromes in early stages of disease outbreaks. This makes an SSS a promising tool for the early detection of epidemics. An Integrated Surveillance System in rural China (ISSC project), which added an SSS to the existing Chinese surveillance system for the early warning of epidemics, was implemented from April 2012 to March 2014 in Jiangxi and Hubei Provinces. This study aims to measure the costs and effectiveness of the th...

  15. Making the business case for enhanced depression care: the National Institute of Mental Health-harvard Work Outcomes Research and Cost-effectiveness Study.

    Science.gov (United States)

    Wang, Philip S; Simon, Gregory E; Kessler, Ronald C

    2008-04-01

    Explore the business case for enhanced depression care and establish a return on investment rationale for increased organizational involvement by employer-purchasers. Literature review, focused on the National Institute of Mental Health-sponsored Work Outcomes Research and Cost-effectiveness Study. This randomized controlled trial compared telephone outreach, care management, and optional psychotherapy to usual care among depressed workers in large national corporations. By 12 months, the intervention significantly improved depression outcomes, work retention, and hours worked among the employed. Results of the Work Outcomes Research and Cost-effectiveness Study trial and other studies suggest that enhanced depression care programs represent a human capital investment opportunity for employers.

  16. National Vital Statistics System (NVSS) - National Cardiovascular Disease Surveillance Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — 2001 to 2013. NVSS is a secure, web-based data management system that collects and disseminates the Nation's official vital statistics. Data for this dataset has...

  17. Surveillance for surgical site infection (SSI) after neurosurgery: influence of the US or Brest (France) National Nosocomial Infection Surveillance risk index on SSI rates.

    Science.gov (United States)

    Lietard, Claire; Thébaud, Véronique; Besson, Gérard; Lejeune, Benoist

    2008-11-01

    A total of 5,628 neurosurgical patients were observed in France to assess the occurrence of surgical site infection (SSI). Their risk of SSI was defined by calculating both the US National Nosocomial Infection Surveillance and the Brest National Nosocomial Infection Surveillance risk indexes. This study compares SSI rates stratified according to either the US or Brest (France) National Nosocomial Infection Surveillance risk index. The SSI rates were correlated with National Nosocomial Infection Surveillance data involving only local operation durations.

  18. Cost-Effective Pavement Performance Management of Indiana's Enhanced National Highway System through Strategic Modification of the Pavement Rehabilitation Treatment Trigger Values

    OpenAIRE

    Noureldin, Menna; Fricker, Jon D.; Sinha, Kumares C.

    2015-01-01

    Cost-Effective Pavement Performance Management of Indiana's Enhanced National Highway System through Strategic Modification of the Pavement Rehabilitation Treatment Trigger Values Presented during Session 3: Policy and Funding, moderated by Magdy Mikhail, at the 9th International Conference on Managing Pavement Assets (ICMPA9) in Alexandria, VA. Includes conference paper and PowerPoint slides.

  19. Beyond cost-effectiveness, analysis. Value-based pricing and result-oriented financing as a pathway to sustainability for the national health system in Spain

    Directory of Open Access Journals (Sweden)

    Alvaro Hidalgo-Vega

    2017-01-01

    Full Text Available The editorial addresses the current use of economic evaluation in the assessment and potential funding and reimbursement of health technologies. Cost-effectiveness ratio and the acceptability thresholds are analyzed, pointing out the limitations that the current approach has for capturing the value of new technologies. A potential shift from National Health Systems to value-based prices is discussed, with a focus on health economics outcomes where multi-criteria analyses can be a complementary tool to traditional cost-effectiveness approaches.

  20. Beyond counting cases: Public health impacts of national Paediatric Surveillance Units

    NARCIS (Netherlands)

    Grenier, D.; Elliott, E.J.; Zurynski, Y.; Rodrigues Pereira, R.; Preece, M.; Lynn, R.; Kries, R. von; Zimmermann, H.; Dickson, N.P.; Virella, D.

    2007-01-01

    Paediatric Surveillance Units (PSUs) have been established in 14 countries and facilitate national, prospective, active surveillance for a range of conditions, with monthly reporting by child health specialists. The International Network of Paediatric Surveillance Units (INoPSU) was established in 1

  1. Surveillance

    DEFF Research Database (Denmark)

    Albrechtslund, Anders; Coeckelbergh, Mark; Matzner, Tobias;

    Studying surveillance involves raising questions about the very nature of concepts such as information, technology, identity, space and power. Besides the maybe all too obvious ethical issues often discussed with regard to surveillance, there are several other angles and approaches that we should...... like to encourage. Therefore, our panel will focus on the philosophical, yet non-ethical issues of surveillance in order to stimulate an intense debate with the audience on the ethical implications of our enquiries. We also hope to provide a broader and deeper understanding of surveillance....

  2. Whole-Genome Sequencing for National Surveillance of Shigella flexneri

    Directory of Open Access Journals (Sweden)

    Marie A. Chattaway

    2017-09-01

    Full Text Available National surveillance of Shigella flexneri ensures the rapid detection of outbreaks to facilitate public health investigation and intervention strategies. In this study, we used whole-genome sequencing (WGS to type S. flexneri in order to detect linked cases and support epidemiological investigations. We prospectively analyzed 330 isolates of S. flexneri received at the Gastrointestinal Bacteria Reference Unit at Public Health England between August 2015 and January 2016. Traditional phenotypic and WGS sub-typing methods were compared. PCR was carried out on isolates exhibiting phenotypic/genotypic discrepancies with respect to serotype. Phylogenetic relationships between isolates were analyzed by WGS using single nucleotide polymorphism (SNP typing to facilitate cluster detection. For 306/330 (93% isolates there was concordance between serotype derived from the genome and phenotypic serology. Discrepant results between the phenotypic and genotypic tests were attributed to novel O-antigen synthesis/modification gene combinations or indels identified in O-antigen synthesis/modification genes rendering them dysfunctional. SNP typing identified 36 clusters of two isolates or more. WGS provided microbiological evidence of epidemiologically linked clusters and detected novel O-antigen synthesis/modification gene combinations associated with two outbreaks. WGS provided reliable and robust data for monitoring trends in the incidence of different serotypes over time. SNP typing can be used to facilitate outbreak investigations in real-time thereby informing surveillance strategies and providing the opportunities for implementing timely public health interventions.

  3. Injury surveillance at the 1985 National Boy Scout Jamboree.

    Science.gov (United States)

    Wetterhall, S F; Waxweiler, R J

    1988-01-01

    Few studies have examined the rate of injuries for those attending summer camps and other recreational facilities. We developed a surveillance system for the 1985 National Boy Scout Jamboree to determine the incidence, nature, and cause of injuries among participants. To characterize the more severe injuries among scouts, we monitored referral visits to an onsite Army hospital. During the 9 day event there was a total of 179 injuries requiring referral visits among the 24,885 scouts, for an overall incidence of 8.5 injuries per 10,000 person-days. Twenty-eight injuries (16%) involved fractures. Ten injuries required hospitalization, for an overall rate of 0.5 per 10,000 person-days. Thirty-six (20%) of the injuries occurred during six organized athletic activities. Of these six, two new Jamboree activities, the bucking bronco and bicycle motocross racing, had the highest event-specific rates, 14.4 and 11.4 injuries per 10,000 participants, respectively. These two events also accounted for one-third of all fractures. In contrast, there were no firearm-related injuries among the 32,616 participants in riflery events. This simple and inexpensive surveillance system provided a mechanism for monitoring activity modifications, as well as useful information for the selection and planning of organized activities at future Jamborees and similar recreational events.

  4. Epidemiologic surveillance. Annual report for Sandia National Laboratories 1994

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1994-12-31

    Epidemiologic surveillance at DOE facilities consists of regular and systematic collection, analysis, and interpretation of data on absences due to illness and injury in the work force. Its purpose is to provide an early warning system for health problems occurring among employees at participating sites. In this annual report, 1994 morbidity data for the Sandia National Laboratories are summarized. These analyses focus on absences of 5 or more consecutive workdays occurring among workers aged 15-76 years. They are arranged in five sets of tables that present: (1) the distribution of the labor force by occupational category and pay status; (2) the absences per person, diagnoses per absence, and diagnosis rates for the whole work force; (3) diagnosis rates by type of disease or injury; (4) diagnosis rates by occupational category; and (5) relative risks for specific types of disease or injury by occupational category.

  5. Epidemiologic surveillance. Annual report for Idaho National Engineering Laboratory 1994

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1994-12-31

    Epidemiologic surveillance at DOE facilities consists of regular and systematic collection, analysis, and interpretation of data on absences due to illness and injury in the work force. Its purpose is to provide an early warning system for health problems occurring among employees at participating sites. In this annual report, the 1994 morbidity data for the Idaho National Engineering Laboratory are summarized. These analyses focus on absences of 5 or more consecutive workdays occurring among workers aged 17-85 years. They are arranged in five sets of tables that present: (1) the distribution of the labor force by occupational category and pay status; (2) the absences per person, diagnoses per absence, and diagnosis rates for the whole work force; (3) diagnosis rates by type of disease or injury; (4) diagnosis rates by occupational category; and (5) relative risks for specific types of disease or injury by occupational category.

  6. Is adding HCV screening to the antenatal national screening program in Amsterdam, the Netherlands, cost-effective?

    NARCIS (Netherlands)

    Urbanus, Anouk T.; van Keep, Marjolijn; Matser, Amy A.; Rozenbaum, Mark H.; Weegink, Christine J.; van den Hoek, Anneke; Prins, Maria; Postma, Maarten J.

    2013-01-01

    INTRODUCTION: Hepatitis C virus (HCV) infection can lead to severe liver disease. Pregnant women are already routinely screened for several infectious diseases, but not yet for HCV infection. Here we examine whether adding HCV screening to routine screening is cost-effective. METHODS: To estimate

  7. Is adding HCV screening to the antenatal national screening program in Amsterdam, the Netherlands, cost-effective?

    NARCIS (Netherlands)

    Urbanus, Anouk T.; van Keep, Marjolijn; Matser, Amy A.; Rozenbaum, Mark H.; Weegink, Christine J.; van den Hoek, Anneke; Prins, Maria; Postma, Maarten J.

    2013-01-01

    INTRODUCTION: Hepatitis C virus (HCV) infection can lead to severe liver disease. Pregnant women are already routinely screened for several infectious diseases, but not yet for HCV infection. Here we examine whether adding HCV screening to routine screening is cost-effective. METHODS: To estimate th

  8. Impact and Cost-Effectiveness Analysis of the National School-Based Sexuality Education Programme in Estonia

    Science.gov (United States)

    Kivela, Jari; Haldre, Kai; Part, Kai; Ketting, Evert; Baltussen, Rob

    2014-01-01

    Policy-makers making decisions on the implementation of school-based sexuality education (SE) programmes face two important questions: (1) what are the costs of implementing and scaling up SE programmes, and (2) what are the impacts? This paper responds to these questions by retrospectively assessing costs, impact and cost-effectiveness of the…

  9. A Cost-Effectiveness Tool to Guide the Prioritization of Interventions for Rheumatic Fever and Rheumatic Heart Disease Control in African Nations

    Science.gov (United States)

    Lubinga, Solomon J.; Mayosi, Bongani; Babigumira, Joseph B.

    2016-01-01

    Background Rheumatic heart disease (RHD) prevalence and mortality rates remain especially high in many parts of Africa. While effective prevention and treatment exist, coverage rates of the various interventions are low. Little is known about the comparative cost-effectiveness of different RHD interventions in limited resource settings. We developed an economic evaluation tool to assist ministries of health in allocating resources and planning RHD control programs. Methodology/Principal Findings We constructed a Markov model of the natural history of acute rheumatic fever (ARF) and RHD, taking transition probabilities and intervention effectiveness data from previously published studies and expert opinion. Our model estimates the incremental cost-effectiveness of scaling up coverage of primary prevention (PP), secondary prevention (SP) and heart valve surgery (VS) interventions for RHD. We take a healthcare system perspective on costs and measure outcomes as disability-adjusted life-years (DALYs), discounting both at 3%. Univariate and probabilistic sensitivity analyses are also built into the modeling tool. We illustrate the use of this model in a hypothetical low-income African country, drawing on available disease burden and cost data. We found that, in our hypothetical country, PP would be cost saving and SP would be very cost-effective. International referral for VS (e.g., to a country like India that has existing surgical capacity) would be cost-effective, but building in-country VS services would not be cost-effective at typical low-income country thresholds. Conclusions/Significance Our cost-effectiveness analysis tool is designed to inform priorities for ARF/RHD control programs in Africa at the national or subnational level. In contrast to previous literature, our preliminary findings suggest PP could be the most efficient and cheapest approach in poor countries. We provide our model for public use in the form of a Supplementary File. Our research has

  10. National Status and Trends, Benthic Surveillance Project Sites, 1984-1992, National Centers for Coastal Ocean Science

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data set reports information regarding the nominal sampling locations for the National Status and Trends Benthic Surveillance Project sites. One record is...

  11. National Status and Trends, Benthic Surveillance Project Chemistry Data, 1984-1992, National Centers for Coastal Ocean Science

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The National Status and Trends (NSandT) Benthic Surveillance Project Chemistry data file reports the trace concentrations of a suite of chemical contaminants in...

  12. National Status and Trends, Benthic Surveillance Project Chemistry Data, 1984-1992, National Centers for Coastal Ocean Science

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The National Status and Trends (NS&T) Benthic Surveillance Project Chemistry data file reports the trace concentrations of a suite of chemical contaminants in...

  13. National Status and Trends, Benthic Surveillance Project Sites, 1984-1992, National Centers for Coastal Ocean Science

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data set reports information regarding the nominal sampling locations for the National Status and Trends Benthic Surveillance Project sites. One record is...

  14. Cost-Effectiveness and Cost Thresholds of Generic and Brand Drugs in a National Chronic Hepatitis B Treatment Program in China.

    Science.gov (United States)

    Toy, Mehlika; Hutton, David W; So, Samuel K

    2015-01-01

    Chronic liver disease and liver cancer associated with chronic hepatitis B (CHB) are leading causes of death among adults in China. Although newborn hepatitis B immunization has successfully reduced the prevalence of CHB in children, about 100 million Chinese adults remain chronically infected. If left unmanaged, 15-25% will die from liver cancer or liver cirrhosis. Antiviral treatment is not necessary for all patients with CHB, but when it is indicated, good response to treatment would prevent disease progression and reduce disease mortality and morbidity, and costly complications. The aim of this study is to analyze the cost-effectiveness of generic and brand antiviral drugs for CHB treatment in China, and assessing various thresholds at which a highly potent, low resistance antiviral drug would be cost-saving and/or cost-effective to introduce in a national treatment program. We developed a Markov simulation model of disease progression using effectiveness and cost data from the medical literature. We measured life-time costs, quality adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), and clinical outcomes. The no treatment strategy incurred the highest health care costs ($12,932-$25,293) per patient, and the worst health outcomes, compared to the antiviral treatment strategies. Monotherapy with either entecavir or tenofovir yielded the most QALYs (14.10-19.02) for both HBeAg-positive and negative patients, with or without cirrhosis. Threshold analysis showed entercavir or tenofovir treatment would be cost saving if the drug price is $32-75 (195-460 RMB) per month, highly cost-effective at $62-110 (379-670 RMB) per month and cost-effective at $63-120 (384-734 RMB) per month. This study can support policy decisions regarding the implementation of a national health program for chronic hepatitis B treatment in China at the population level.

  15. Cost-Effectiveness and Cost Thresholds of Generic and Brand Drugs in a National Chronic Hepatitis B Treatment Program in China.

    Directory of Open Access Journals (Sweden)

    Mehlika Toy

    Full Text Available Chronic liver disease and liver cancer associated with chronic hepatitis B (CHB are leading causes of death among adults in China. Although newborn hepatitis B immunization has successfully reduced the prevalence of CHB in children, about 100 million Chinese adults remain chronically infected. If left unmanaged, 15-25% will die from liver cancer or liver cirrhosis. Antiviral treatment is not necessary for all patients with CHB, but when it is indicated, good response to treatment would prevent disease progression and reduce disease mortality and morbidity, and costly complications. The aim of this study is to analyze the cost-effectiveness of generic and brand antiviral drugs for CHB treatment in China, and assessing various thresholds at which a highly potent, low resistance antiviral drug would be cost-saving and/or cost-effective to introduce in a national treatment program. We developed a Markov simulation model of disease progression using effectiveness and cost data from the medical literature. We measured life-time costs, quality adjusted life years (QALYs, incremental cost-effectiveness ratios (ICERs, and clinical outcomes. The no treatment strategy incurred the highest health care costs ($12,932-$25,293 per patient, and the worst health outcomes, compared to the antiviral treatment strategies. Monotherapy with either entecavir or tenofovir yielded the most QALYs (14.10-19.02 for both HBeAg-positive and negative patients, with or without cirrhosis. Threshold analysis showed entercavir or tenofovir treatment would be cost saving if the drug price is $32-75 (195-460 RMB per month, highly cost-effective at $62-110 (379-670 RMB per month and cost-effective at $63-120 (384-734 RMB per month. This study can support policy decisions regarding the implementation of a national health program for chronic hepatitis B treatment in China at the population level.

  16. Cost-Effectiveness and Cost Thresholds of Generic and Brand Drugs in a National Chronic Hepatitis B Treatment Program in China

    Science.gov (United States)

    Toy, Mehlika; Hutton, David W.; So, Samuel K.

    2015-01-01

    Chronic liver disease and liver cancer associated with chronic hepatitis B (CHB) are leading causes of death among adults in China. Although newborn hepatitis B immunization has successfully reduced the prevalence of CHB in children, about 100 million Chinese adults remain chronically infected. If left unmanaged, 15–25% will die from liver cancer or liver cirrhosis. Antiviral treatment is not necessary for all patients with CHB, but when it is indicated, good response to treatment would prevent disease progression and reduce disease mortality and morbidity, and costly complications. The aim of this study is to analyze the cost-effectiveness of generic and brand antiviral drugs for CHB treatment in China, and assessing various thresholds at which a highly potent, low resistance antiviral drug would be cost-saving and/or cost-effective to introduce in a national treatment program. We developed a Markov simulation model of disease progression using effectiveness and cost data from the medical literature. We measured life-time costs, quality adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), and clinical outcomes. The no treatment strategy incurred the highest health care costs ($12,932-$25,293) per patient, and the worst health outcomes, compared to the antiviral treatment strategies. Monotherapy with either entecavir or tenofovir yielded the most QALYs (14.10–19.02) for both HBeAg-positive and negative patients, with or without cirrhosis. Threshold analysis showed entercavir or tenofovir treatment would be cost saving if the drug price is $32–75 (195–460 RMB) per month, highly cost-effective at $62–110 (379–670 RMB) per month and cost-effective at $63–120 (384–734 RMB) per month. This study can support policy decisions regarding the implementation of a national health program for chronic hepatitis B treatment in China at the population level. PMID:26536626

  17. Cost-Effectiveness of a National Initiative to Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated Staphylococcus aureus Bacteraemia

    Science.gov (United States)

    Graves, Nicholas; Page, Katie; Martin, Elizabeth; Brain, David; Hall, Lisa; Campbell, Megan; Fulop, Naomi; Jimmeison, Nerina; White, Katherine; Paterson, David; Barnett, Adrian G.

    2016-01-01

    Background The objective is to estimate the incremental cost-effectiveness of the Australian National Hand Hygiene Inititiave implemented between 2009 and 2012 using healthcare associated Staphylococcus aureus bacteraemia as the outcome. Baseline comparators are the eight existing state and territory hand hygiene programmes. The setting is the Australian public healthcare system and 1,294,656 admissions from the 50 largest Australian hospitals are included. Methods The design is a cost-effectiveness modelling study using a before and after quasi-experimental design. The primary outcome is cost per life year saved from reduced cases of healthcare associated Staphylococcus aureus bacteraemia, with cost estimated by the annual on-going maintenance costs less the costs saved from fewer infections. Data were harvested from existing sources or were collected prospectively and the time horizon for the model was 12 months, 2011–2012. Findings No useable pre-implementation Staphylococcus aureus bacteraemia data were made available from the 11 study hospitals in Victoria or the single hospital in Northern Territory leaving 38 hospitals among six states and territories available for cost-effectiveness analyses. Total annual costs increased by $2,851,475 for a return of 96 years of life giving an incremental cost-effectiveness ratio (ICER) of $29,700 per life year gained. Probabilistic sensitivity analysis revealed a 100% chance the initiative was cost effective in the Australian Capital Territory and Queensland, with ICERs of $1,030 and $8,988 respectively. There was an 81% chance it was cost effective in New South Wales with an ICER of $33,353, a 26% chance for South Australia with an ICER of $64,729 and a 1% chance for Tasmania and Western Australia. The 12 hospitals in Victoria and the Northern Territory incur annual on-going maintenance costs of $1.51M; no information was available to describe cost savings or health benefits. Conclusions The Australian National Hand

  18. Cost-Effectiveness of a National Initiative to Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated Staphylococcus aureus Bacteraemia.

    Directory of Open Access Journals (Sweden)

    Nicholas Graves

    Full Text Available The objective is to estimate the incremental cost-effectiveness of the Australian National Hand Hygiene Inititiave implemented between 2009 and 2012 using healthcare associated Staphylococcus aureus bacteraemia as the outcome. Baseline comparators are the eight existing state and territory hand hygiene programmes. The setting is the Australian public healthcare system and 1,294,656 admissions from the 50 largest Australian hospitals are included.The design is a cost-effectiveness modelling study using a before and after quasi-experimental design. The primary outcome is cost per life year saved from reduced cases of healthcare associated Staphylococcus aureus bacteraemia, with cost estimated by the annual on-going maintenance costs less the costs saved from fewer infections. Data were harvested from existing sources or were collected prospectively and the time horizon for the model was 12 months, 2011-2012.No useable pre-implementation Staphylococcus aureus bacteraemia data were made available from the 11 study hospitals in Victoria or the single hospital in Northern Territory leaving 38 hospitals among six states and territories available for cost-effectiveness analyses. Total annual costs increased by $2,851,475 for a return of 96 years of life giving an incremental cost-effectiveness ratio (ICER of $29,700 per life year gained. Probabilistic sensitivity analysis revealed a 100% chance the initiative was cost effective in the Australian Capital Territory and Queensland, with ICERs of $1,030 and $8,988 respectively. There was an 81% chance it was cost effective in New South Wales with an ICER of $33,353, a 26% chance for South Australia with an ICER of $64,729 and a 1% chance for Tasmania and Western Australia. The 12 hospitals in Victoria and the Northern Territory incur annual on-going maintenance costs of $1.51M; no information was available to describe cost savings or health benefits.The Australian National Hand Hygiene Initiative was cost-effective

  19. A GIS-driven integrated real-time surveillance pilot system for national West Nile virus dead bird surveillance in Canada

    Directory of Open Access Journals (Sweden)

    Aramini Jeff

    2006-04-01

    Full Text Available Abstract Background An extensive West Nile virus surveillance program of dead birds, mosquitoes, horses, and human infection has been launched as a result of West Nile virus first being reported in Canada in 2001. Some desktop and web GIS have been applied to West Nile virus dead bird surveillance. There have been urgent needs for a comprehensive GIS services and real-time surveillance. Results A pilot system was developed to integrate real-time surveillance, real-time GIS, and Open GIS technology in order to enhance West Nile virus dead bird surveillance in Canada. Driven and linked by the newly developed real-time web GIS technology, this integrated real-time surveillance system includes conventional real-time web-based surveillance components, integrated real-time GIS components, and integrated Open GIS components. The pilot system identified the major GIS functions and capacities that may be important to public health surveillance. The six web GIS clients provide a wide range of GIS tools for public health surveillance. The pilot system has been serving Canadian national West Nile virus dead bird surveillance since 2005 and is adaptable to serve other disease surveillance. Conclusion This pilot system has streamlined, enriched and enhanced national West Nile virus dead bird surveillance in Canada, improved productivity, and reduced operation cost. Its real-time GIS technology, static map technology, WMS integration, and its integration with non-GIS real-time surveillance system made this pilot system unique in surveillance and public health GIS.

  20. 77 FR 66620 - Request for Nominations for Candidates To Serve on the National Public Health Surveillance and...

    Science.gov (United States)

    2012-11-06

    ... Serve on the National Public Health Surveillance and Biosurveillance Advisory Committee (NPHSBAC) The... National Public Health Surveillance and Biosurveillance Advisory Committee (NPHSBAC). This committee... the human health component of biosurveillance. The Committee will ensure that the Federal...

  1. Early warning epidemic surveillance in the Pacific island nations: an evaluation of the Pacific syndromic surveillance system.

    Science.gov (United States)

    Craig, Adam T; Kama, Mike; Samo, Marcus; Vaai, Saine; Matanaicake, Jane; Joshua, Cynthia; Kolbe, Anthony; Durrheim, David N; Paterson, Beverley J; Biaukula, Viema; Nilles, Eric J

    2016-07-01

    The Pacific Syndromic Surveillance System (PSSS), launched in 2010, provides a simple mechanism by which 121 sentinel surveillance sites in 21 Pacific island countries and areas perform routine indicator- and event-based surveillance for the early detection of infectious disease outbreaks. This evaluation aims to assess whether the PSSS is meeting its objectives, what progress has been made since a formative evaluation of the system was conducted in 2011, and provides recommendations to enhance the PSSS's performance in the future. Twenty-one informant interviews were conducted with national operators of the system and regional public health agencies that use information generated by it. Historic PSSS data were analysed to assess timeliness and completeness of reporting. The system is simple, acceptable and useful for public health decision-makers. The PSSS has greatly enhanced Pacific island countries' ability to undertake early warning surveillance and has contributed to efforts to meet national surveillance-related International Health Regulation (2005) capacity development obligations. Despite this, issues with timeliness and completeness of reporting, data quality and system stability persist. A balance between maintaining the system's simplicity and technical advances will need to be found to ensure its long-term sustainability, given the low-resource context for which it is designed. © 2016 John Wiley & Sons Ltd.

  2. 2003 Idaho National Engineering and Environmental Laboratory Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Security, Office of Illness and Injury Prevention Programs

    2007-05-23

    Annual Illness and Injury Surveillance Program report for 2003 for Idaho National Lab. The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of epidemiologic surveillance activities that provide an early warning system for health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence of workdays, occupational injuries and illnesses, and disabilities and deaths among current workers.

  3. Is the HIV sentinel surveillance system adequate in China? Findings from an evaluation of the national HIV sentinel surveillance system

    Science.gov (United States)

    Lin, Wen; Chen, Sanny; Seguy, Nicole; Chen, Zhongdan; Sabin, Keith; Calleja, Jesus García

    2012-01-01

    Background An external evaluation was conducted to assess the performance of the national HIV sentinel surveillance system (HSS), identify operational challenges at national and local levels and provide recommendations for improvement. Methods The United States Centers for Disease Control and Prevention’s (CDC) Updated Guidelines for Evaluating Public Health Surveillance Systems were followed to assess the key attributes of HSS. Comprehensive assessment activities were conducted, including: using a detailed checklist to review surveillance guidelines, protocols and relevant documents; conducting self-administered, anonymous surveys with 286 local China CDC staff; and carrying out field observations in 32 sentinel sites in four provinces. Results China has built an extensive HSS with 1888 sentinel sites to monitor HIV epidemic trends by population groups over time. The strengths of HSS lie in its flexibility, simplicity, usefulness and increase in coverage in locations and populations. With its rapid expansion in 2010, HSS faces challenges in maintaining acceptability, timeliness, data quality, representativeness and sustainability. Recommendations Implementation of the national guidelines should be standardized by strengthening training, monitoring and supervision of all staff involved, including community-based organizations. National surveillance guidelines need to be revised to strengthen data quality and representativeness, particularly to include specific instructions on HIV testing result provision, collection of identifying information, sample size and sampling methods particularly for men who have sex with men (MSM), collection of refusal information, and data interpretation. Sustainability of China’s HSS could be strengthened by applying locally tailored surveillance strategies, strengthening coordination and cooperation among government agencies and ensuring financial and human resources. PMID:23908946

  4. Lymphatic filariasis in Nigeria; micro-stratification overlap mapping (MOM as a prerequisite for cost-effective resource utilization in control and surveillance.

    Directory of Open Access Journals (Sweden)

    Patricia N Okorie

    Full Text Available BACKGROUND: Nigeria has a significant burden of lymphatic filariasis (LF caused by the parasite Wuchereria bancrofti. A major concern to the expansion of the LF elimination programme is the risk of serious adverse events (SAEs associated with the use of ivermectin in areas co-endemic with Loa filariasis. To better understand this, as well as other factors that may impact on LF elimination, we used Micro-stratification Overlap Mapping (MOM to highlight the distribution and potential impact of multiple disease interventions that geographically coincide in LF endemic areas and which will impact on LF and vice versa. METHODOLOGY/PRINCIPAL FINDINGS: LF data from the literature and Federal Ministry of Health (FMoH were collated into a database. LF prevalence distributions; predicted prevalence of loiasis; ongoing onchocerciasis community-directed treatment with ivermectin (CDTi; and long-lasting insecticidal mosquito net (LLIN distributions for malaria were incorporated into overlay maps using geographical information system (GIS software. LF was prevalent across most regions of the country. The mean prevalence determined by circulating filarial antigen (CFA was 14.0% (n = 134 locations, and by microfilaria (Mf was 8.2% (n = 162 locations. Overall, LF endemic areas geographically coincided with CDTi priority areas, however, LLIN coverage was generally low (<50% in areas where LF prevalence was high or co-endemic with L. loa. CONCLUSIONS/SIGNIFICANCE: The extensive database and series of maps produced in this study provide an important overview for the LF Programme and will assist to maximize existing interventions, ensuring cost effective use of resources as the programme scales up. Such information is a prerequisite for the LF programme, and will allow for other factors to be included into planning, as well as monitoring and evaluation activities given the broad spectrum impact of the drugs used.

  5. Cost-effectiveness of hemodialysis and peritoneal dialysis: A national cohort study with 14 years follow-up and matched for comorbidities and propensity score

    Science.gov (United States)

    Chang, Yu-Tzu; Hwang, Jing-Shiang; Hung, Shih-Yuan; Tsai, Min-Sung; Wu, Jia-Ling; Sung, Junne-Ming; Wang, Jung-Der

    2016-01-01

    Although treatment for the dialysis population is resource intensive, a cost-effectiveness analysis comparing hemodialysis (HD) and peritoneal dialysis (PD) by matched pairs is still lacking. After matching for clinical characteristics and propensity scores, we identified 4,285 pairs of incident HD and PD patients from a Taiwanese national cohort during 1998–2010. Survival and healthcare expenditure were calculated by data of 14-year follow-up and subsequently extrapolated to lifetime estimates under the assumption of constant excess hazard. We performed a cross-sectional EQ–5D survey on 179 matched pairs of prevalent HD and PD patients of varying dialysis vintages from 12 dialysis units. The product of survival probability and the mean utility value at each time point (dialysis vintage) were summed up throughout lifetime to obtain the quality-adjusted life expectancy (QALE). The results revealed the estimated life expectancy between HD and PD were nearly equal (19.11 versus 19.08 years). The QALE’s were also similar, whereas average lifetime healthcare costs were higher in HD than PD (237,795 versus 204,442 USD) and the cost-effectiveness ratios for PD and HD were 13,681 and 16,643 USD per quality-adjusted life year, respectively. In conclusion, PD is more cost-effective than HD, of which the major determinants were the costs for the dialysis modality and its associated complications. PMID:27461186

  6. 2006 Brookhaven National Laboratory Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Health, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2008-03-06

    The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of illness and injury surveillance activities that provide an early warning system to detect health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence, occupational injuries and illnesses, and disabilities and deaths among current workers.

  7. 2009 Argonne National Laboratory Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Security, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2010-08-19

    The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of epidemiologic surveillance activities that provide an early warning system for health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence of workdays, occupational injuries and illnesses, and disabilities and deaths among current workers.

  8. 2010 Idaho National Laboratory Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Health, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2011-09-26

    The U.S. Department of Energy's (DOE) commitment to assuring the health and safety of its workers includes the conduct of illness and injury surveillance activities that provide an early warning system to detect health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence, occupational injuries and illnesses, and disabilities and deaths among current workers.

  9. 2010 Brookhaven National Laboratory Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Health, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2011-08-16

    The U.S. Department of Energy's (DOE) commitment to assuring the health and safety of its workers includes the conduct of illness and injury surveillance activities that provide an early warning system to detect health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence, occupational injuries and illnesses, and disabilities and deaths among current workers.

  10. 2007 Idaho National Laboratory Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety, and Security

    2009-05-04

    The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of illness and injury surveillance activities that provide an early warning system to detect health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence, occupational injuries and illnesses, and disabilities and deaths among current workers.

  11. 2008 Sandia National Laboratory Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Health, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2009-09-17

    The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of epidemiologic surveillance activities that provide an early warning system for health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence of workdays, occupational injuries and illnesses, and disabilities and deaths among current workers.

  12. 2007 Sandia National Laboratory Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Health, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2009-02-04

    The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of epidemiologic surveillance activities that provide an early warning system for health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence of workdays, occupational injuries and illnesses, and disabilities and deaths among current workers.

  13. 2009 Brookhaven National Laboratory Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Security, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2010-11-24

    The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of epidemiologic surveillance activities that provide an early warning system for health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence of workdays, occupational injuries and illnesses, and disabilities and deaths among current workers.

  14. 2007 Brookhaven National Laboratory Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Health, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2008-07-31

    The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of illness and injury surveillance activities that provide an early warning system to detect health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence, occupational injuries and illnesses, and disabilities and deaths among current workers.

  15. 2008 Brookhaven National Laboratory Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Security, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2009-12-10

    The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of epidemiologic surveillance activities that provide an early warning system for health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence of workdays, occupational injuries and illnesses, and disabilities and deaths among current workers.

  16. 2008 Idaho National Laboratory Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Security, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2010-11-23

    The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of epidemiologic surveillance activities that provide an early warning system for health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence of workdays, occupational injuries and illnesses, and disabilities and deaths among current workers.

  17. 2010 Sandia National Laboratory Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Health, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2011-10-26

    The U.S. Department of Energy's (DOE) commitment to assuring the health and safety of its workers includes the conduct of illness and injury surveillance activities that provide an early warning system to detect health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence, occupational injuries and illnesses, and disabilities and deaths among current workers.

  18. Optimal Management Strategies for Primary HPV Testing for Cervical Screening: Cost-Effectiveness Evaluation for the National Cervical Screening Program in Australia

    Science.gov (United States)

    Hall, Michaela; Lew, Jie-Bin; Hughes, Suzanne; Yuill, Susan; Hammond, Ian; Saville, Marion; Canfell, Karen

    2017-01-01

    Background Several countries are implementing a transition to HPV testing for cervical screening in response to the introduction of HPV vaccination and evidence indicating that HPV screening is more effective than cytology. In Australia, a 2017 transition from 2-yearly conventional cytology in 18–20 to 69 years to 5-yearly primary HPV screening in 25 to 74 years will involve partial genotyping for HPV 16/18 with direct referral to colposcopy for this higher risk group. The objective of this study was to determine the optimal management of women positive for other high-risk HPV types (not 16/18) ('OHR HPV'). Methods We used a dynamic model of HPV transmission, vaccination, natural history and cervical screening to determine the optimal management of women positive for OHR HPV. We assumed cytology triage testing was used to inform management in this group and that those with high-grade cytology would be referred to colposcopy and those with negative cytology would receive 12-month surveillance. For those with OHR HPV and low-grade cytology (considered to be a single low-grade category in Australia incorporating ASC-US and LSIL), we evaluated (1) the 20-year risk of invasive cervical cancer assuming this group are referred for 12-month follow-up vs. colposcopy, and compared this to the risk in women with low-grade cytology under the current program (i.e. an accepted benchmark risk for 12-month follow-up in Australia); (2) the population-level impact of the whole program, assuming this group are referred to 12-month surveillance vs. colposcopy; and (3) the cost-effectiveness of immediate colposcopy compared to 12-month follow-up. Evaluation was performed both for HPV-unvaccinated cohorts and cohorts offered vaccination (coverage ~72%). Findings The estimated 20-year risk of cervical cancer is ≤1.0% at all ages if this group are referred to colposcopy vs. ≤1.2% if followed-up in 12 months, both of which are lower than the ≤2.6% benchmark risk in women with low

  19. Nation-wide, web-based, geographic information system for the integrated surveillance and control of dengue fever in Mexico.

    Science.gov (United States)

    Hernández-Ávila, Juan Eugenio; Rodríguez, Mario-Henry; Santos-Luna, René; Sánchez-Castañeda, Veronica; Román-Pérez, Susana; Ríos-Salgado, Víctor Hugo; Salas-Sarmiento, Jesús Alberto

    2013-01-01

    Dengue fever incidence and its geographical distribution are increasing throughout the world. Quality and timely information is essential for its prevention and control. A web based, geographically enabled, dengue integral surveillance system (Dengue-GIS) was developed for the nation-wide collection, integration, analysis and reporting of geo-referenced epidemiologic, entomologic, and control interventions data. Consensus in the design and practical operation of the system was a key factor for its acceptance. Working with information systems already implemented as a starting point facilitated its acceptance by officials and operative personnel. Dengue-GIS provides the geographical detail needed to plan, asses and evaluate the impact of control activities. The system is beginning to be adopted as a knowledge base by vector control programs. It is used to generate evidence on impact and cost-effectiveness of control activities, promoting the use of information for decision making at all levels of the vector control program. Dengue-GIS has also been used as a hypothesis generator for the academic community. This GIS-based model system for dengue surveillance and the experience gathered during its development and implementation could be useful in other dengue endemic countries and extended to other infectious or chronic diseases.

  20. Nation-wide, web-based, geographic information system for the integrated surveillance and control of dengue fever in Mexico.

    Directory of Open Access Journals (Sweden)

    Juan Eugenio Hernández-Ávila

    Full Text Available Dengue fever incidence and its geographical distribution are increasing throughout the world. Quality and timely information is essential for its prevention and control. A web based, geographically enabled, dengue integral surveillance system (Dengue-GIS was developed for the nation-wide collection, integration, analysis and reporting of geo-referenced epidemiologic, entomologic, and control interventions data. Consensus in the design and practical operation of the system was a key factor for its acceptance. Working with information systems already implemented as a starting point facilitated its acceptance by officials and operative personnel. Dengue-GIS provides the geographical detail needed to plan, asses and evaluate the impact of control activities. The system is beginning to be adopted as a knowledge base by vector control programs. It is used to generate evidence on impact and cost-effectiveness of control activities, promoting the use of information for decision making at all levels of the vector control program. Dengue-GIS has also been used as a hypothesis generator for the academic community. This GIS-based model system for dengue surveillance and the experience gathered during its development and implementation could be useful in other dengue endemic countries and extended to other infectious or chronic diseases.

  1. Efficient national surveillance for health-care-associated infections

    NARCIS (Netherlands)

    van Bunnik, B. A. D.; Ciccolini, M.; Gibbons, C. L.; Edwards, G.; Fitzgerald, R.; McAdam, P. R.; Ward, M. J.; Laurenson, I. F.; Woolhouse, M. E. J.

    2015-01-01

    Background: Detecting novel healthcare-associated infections (HCAI) as early as possible is an important public health priority. However, there is currently no evidence base to guide the design of efficient and reliable surveillance systems. Here we address this issue in the context of a novel patho

  2. An overview of environmental surveillance of waste management activities at the Idaho National Engineering Laboratory

    Science.gov (United States)

    Smith, T.H.; Chew, E.W.; Hedahl, T.G.; Mann, L.J.; Pointer, T.F.; Wiersma, G.B.

    1986-01-01

    The Idaho National Engineering Laboratory (INEL), in southeastern Idaho, is a principal center for nuclear energy development for the Department of Energy (DOE) and the U.S. Nuclear Navy. Fifty-two reactors have been built at the INEL, with 15 still operable. Extensive environmental surveillance is conducted at the INEL by DOE's Radiological Environmental Sciences Laboratory (RESL), and the U.S. Geological Survey (USGS), the National Oceanic and Atmospheric Administration (NOAA), EG&G Idaho, Inc., and Westinghouse Idaho Nuclear Company (WINCO). Surveillance of waste management facilities radiation is integrated with the overall INEL Site surveillance program. Air, warer, soil, biota, and environmental radiation are monitored or sampled routinely at INEL. Results to date indicate very small or no impacts from INEL on the surrounding environment. Environmental surveillance activities are currently underway to address key environmental issues at the INEL.

  3. 1995 annual epidemiologic surveillance report for Idaho National Engineering and Environmental Laboratory

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-12-31

    The US Department of Energy's (DOE) conduct of epidemiologic surveillance provides an early warning system for health problems among workers. This program monitors illnesses and health conditions that result in an absence of five or more consecutive workdays, occupational injuries and illnesses, and disabilities and deaths among current workers. This report summarizes epidemiologic surveillance data collected from the Idaho National Engineering and Environmental Laboratory (INEEL) from January 1, 1995 through December 31, 1995. The data were collected by a coordinator at INEEL and submitted to the Epidemiologic Surveillance Data Center, located at Oak Ridge Institute for Science and Education, where quality control procedures and data analyses were carried out.

  4. Amended annual report for Brookhaven National Laboratory: Epidemiologic surveillance - 1994

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-12-31

    Epidemiologic surveillance at DOE facilities consists of regular and systematic collection, analysis, and interpretation of data on absences due to illness and injury in the work force. Its purpose is to provide an early warning system for health problems occurring among employees at participating sites. Data are collected by coordinators at each site and submitted to the Epidemiologic Surveillance Data Center, located at the Oak Ridge Institute for Science and Education, where quality control procedures and analyses are carried out. Rates of absences and rates of diagnoses associated with absences are analyzed by occupation and other relevant variables. They may be compared with the disease experience of different groups within the DOE work force and with populations and do not work for DOE to identify disease patterns or clusters that may be associated work activities. This report provides a final summary for BNL.

  5. 2003 Los Alamos National Laboratory Annual Illness and Injury Surveillance Report, Revised September 2007

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Security, Office of Illness and Injury Prevention Programs

    2007-10-04

    Annual Illness and Injury Surveillance Program report for 2003 for Los Alamos National Lab. The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of epidemiologic surveillance activities that provide an early warning system for health problems among workers. The IISP monitors illnesses and health conditions that result in an absence of workdays, occupational injuries and illnesses, and disabilities and deaths among current workers.

  6. 2003 Sandia National Laboratories--Albuquerque Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Security, Office of Illness and Injury Prevention Programs

    2007-05-23

    Annual Illness and Injury Surveillance Program report for 2003 for Sandia National Laboratories-Albuquerque. The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of epidemiologic surveillance activities that provide an early warning system for health problems among workers. The IISP monitors illnesses and health conditions that result in an absence of workdays, occupational injuries and illnesses, and disabilities and deaths among current workers.

  7. 2003 Lawrence Livermore National Laboratory Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Security, Office of Illness and Injury Prevention Programs

    2007-05-23

    Annual Illness and Injury Surveillance Program report for 2003 for Lawrence Livermore National Lab. The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of epidemiologic surveillance activities that provide an early warning system for health problems among workers. The IISP monitors illnesses and health conditions that result in an absence of workdays, occupational injuries and illnesses, and disabilities and deaths among current workers.

  8. 2003 Brookhaven National Laboratory Annual Illness and Injury Surveillance Report, Revised September 2007

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Security, Office of Illness and Injury Prevention Programs

    2007-10-02

    Annual Illness and Injury Surveillance Program report for 2003 for Brookhaven National Lab. The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of epidemiologic surveillance activities that provide an early warning system for health problems among workers. The IISP monitors illnesses and health conditions that result in an absence of workdays, occupational injuries and illnesses, and disabilities and deaths among current workers.

  9. [Analysis of costs and cost-effectiveness of preferred GESIDA/National AIDS Plan regimens for initial antiretroviral therapy in human immunodeficiency virus infected adult patients in 2013].

    Science.gov (United States)

    Blasco, Antonio Javier; Llibre, Josep M; Arribas, José Ramón; Boix, Vicente; Clotet, Bonaventura; Domingo, Pere; González-García, Juan; Knobel, Hernando; López, Juan Carlos; Lozano, Fernando; Miró, José M; Podzamczer, Daniel; Santamaría, Juan Miguel; Tuset, Montserrat; Zamora, Laura; Lázaro, Pablo; Gatell, Josep M

    2013-11-01

    The GESIDA and National AIDS Plan panel of experts have proposed "preferred regimens" of antiretroviral treatment (ART) as initial therapy in HIV infected patients for 2013. The objective of this study is to evaluate the costs and effectiveness of initiating treatment with these "preferred regimens". An economic assessment of costs and effectiveness (cost/effectiveness) was performed using decision tree analysis models. Effectiveness was defined as the probability of having viral load <50copies/mL at week48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regime was defined as the costs of ART and its consequences (adverse effects, changes of ART regime and drug resistance analyses) during the first 48weeks. The perspective of the analysis is that of the National Health System was applied, only taking into account differential direct costs: ART (official prices), management of adverse effects, resistance studies, and determination of HLA B*5701. The setting is Spain and the costs are those of 2013. A sensitivity deterministic analysis was performed, constructing three scenarios for each regimen: baseline, most favourable, and most unfavourable cases. In the baseline case scenario, the cost of initiating treatment ranges from 6,747euros for TDF/FTC+NVP to 12,059euros for TDF/FTC+RAL. The effectiveness ranges between 0.66 for ABC/3TC+LPV/r and ABC/3TC+ATV/r, and 0.87 for TDF/FTC+RAL and ABC/3TC+RAL. Effectiveness, in terms of cost/effectiveness, varies between 8,396euros and 13,930euros per responder at 48weeks, for TDF/FTC/RPV and TDF/FTC+RAL, respectively. Taking ART at official prices, the most effective regimen was TDF/FTC/RPV, followed by the rest of non-nucleoside containing regimens. The sensitivity analysis confirms the robustness of these findings. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  10. Improving national surveillance of Lyme neuroborreliosis in Denmark through electronic reporting of specific antibody index testing from 2010 to 2012

    DEFF Research Database (Denmark)

    Dessau, Ram Benny; Espenhain, L; Mølbak, K

    2015-01-01

    Our aim was to evaluate the results of automated surveillance of Lyme neuroborreliosis (LNB) in Denmark using the national microbiology database (MiBa), and to describe the epidemiology of laboratory-confirmed LNB at a national level. MiBa-based surveillance includes electronic transfer of labora......Our aim was to evaluate the results of automated surveillance of Lyme neuroborreliosis (LNB) in Denmark using the national microbiology database (MiBa), and to describe the epidemiology of laboratory-confirmed LNB at a national level. MiBa-based surveillance includes electronic transfer...

  11. Annual report for Brookhaven National Laboratory 1994 epidemiologic surveillance

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-01-01

    Epidemiologic surveillance at DOE facilities consists of regular and systematic collection, analysis, and interpretation of data on absences due to illness and injury in the work force. Its purpose is to provide an early warning system for health problems occurring among employees at participating sites. Data are collected by coordinators at each site and submitted to the Epidemiologic Surveillance Data Center, located at the Oak Ridge Institute for Science and Education, where quality control procedures and analyses are carried out. Rates of absences and rates of diagnoses associated with absences are analyzed by occupation and other relevant variables. They may be compared with the disease experience of different groups within the DOE work force and with populations that do not work for DOE to identify disease patterns or clusters that may be associated with work activities. In this annual report, the 1994 morbidity data for BNL are summarized. These analyses focus on absences of 5 or more consecutive workdays occurring among workers aged 16-80 years. They are arranged in five sets of tables that present: (1) the distribution of the labor force by occupational category and salary status; (2) the absences per person, diagnoses per absence, and diagnosis rates for the whole work force; (3) diagnosis rates by type of disease or injury; (4) diagnosis rates by occupational category; and (5) relative risks for specific types of disease or injury by occupational category.

  12. Cost effectiveness analysis of fesoterodine compared to mirabegron in first-line therapy setting for overactive bladder with urge urinary incontinence, from the Spanish National Health System perspective.

    Science.gov (United States)

    Angulo, J C; Sánchez-Ballester, F; Peral, C; Rejas, J; Ramos, J; Snedecor, S J; Sudharshan, L; Liu, S; Luo, X

    2016-10-01

    To evaluate the cost-effectiveness of first-line treatment of Overactive Bladder (OAB) with fesoterodine relative to mirabegron, from the Spanish National Health System (NHS) perspective. A decision tree model was developed to represent a typical clinical process of 52-week of treatment for an OAB patient with urge urinary incontinence (UUI) initiating first-line therapy with fesoterodine 4mg, including optional titration to 8mg, vs.mirabegron 50mg. Efficacy data were obtained from a Bayesian indirect treatment meta-analysis. Patients with UUI of less than one episode/day were defined as treatment responder and persistence was assessed at weeks 4, 12 and 24. At week 12, non-responders discontinued treatment permanently. Quality-adjusted life years (QALYs) were calculated based on time spent in responder and non-responder states. OAB-related drug and medical care costs including physician visits, laboratory tests, incontinence pads, and comorbidities (fracture, skin infection, urinary tract infections and depression) were modeled and expressed in €2015. At week 52, the percentage of responders was 20.8% for patients starting on fesoterodine 4mg who optionally titrated to 8mg and 19.4% for patients treated with mirabegron. QALYs were slightly higher with fesoterodine than mirabegron (0.7703vs. 0.7668, difference=0.0035). Fesoterodine treatment also had slightly higher total costs than mirabegron (3,296€vs. 3,217, difference=79€), resulting in a cost of 22,523/QALY€ gained for fesoterodine versus mirabegron. Probabilistic sensitivity analysis confirmed the slight advantage of fesoterodine with a 61.1% probability of being cost-effective at the 30,000€ willingness-to-pay for 1QALY threshold. Given the relatively small 1-year cost difference between the two treatments, fesoterodine can be considered a cost-effective option relative to mirabegron for the first-line management of OAB with UUI in Spain. Copyright © 2016 AEU. Publicado por Elsevier España, S

  13. Environmental surveillance for Waste Management Facilities at the Idaho National Engineering Laboratory. Annual report 1994

    Energy Technology Data Exchange (ETDEWEB)

    Wright, K.C.; Wilhelmsen, R.N.; Borsella, B.W.; Miles, M.

    1995-08-01

    This report describes calendar year 1994 environmental surveillance activities of Environmental Monitoring of Lockheed Martin Idaho Technologies, performed at Waste Management Facilities at the Idaho National Engineering Laboratory (INEL). The major facilities monitored include the Radioactive Waste Management Complex, the Waste Experimental Reduction Facility, the Mixed Waste Storage Facility, and two surplus facilities. Included are results of the sampling performed by the Radiological Environmental Surveillance Program, INEL Environmental Surveillance Program, and the United States Geological Survey. The primary purposes of monitoring are to evaluate environmental conditions, to provide and interpret data, to ensure compliance with applicable regulations or standards, and to ensure protection of human health and the environment. This report compares 1994 environmental surveillance data with US Department of Energy derived concentration guides and with data from previous years.

  14. Design and implementation of a national public health surveillance system in Jordan.

    Science.gov (United States)

    Sheikhali, Sami Adel; Abdallat, Mohammed; Mabdalla, Sultan; Al Qaseer, Bashir; Khorma, Rania; Malik, Mamunur; Profili, Maria Cristina; Rø, Gunnar; Haskew, John

    2016-04-01

    Understanding and improving the health status of communities depend on effective public health surveillance. Adoption of new technologies, standardised case definitions and clinical guidelines for accurate diagnosis, and access to timely and reliable data, remains a challenge for public health surveillance systems however and existing public health surveillance systems are often fragmented, disease specific, inconsistent and of poor quality. We describe the application of an enterprise architecture approach to the design, planning and implementation of a national public health surveillance system in Jordan. This enabled a well planned and collaboratively supported system to be built and implemented using consistent standards for data collection, management, reporting and use. The system is case-based and integrated and employs mobile information technology to aid collection of real-time, standardised data to inform and improve decision-making at different levels of the health system.

  15. The majority of surgical departments adhere to national Danish guidelines for surveillance after colorectal cancer surgery

    DEFF Research Database (Denmark)

    Lykke, Jakob; Roikjær, Ole; Jess, Per

    2013-01-01

    In 2003 the use of post-operative surveillance (POS) after surgery for colorectal cancer (CRC) in Denmark was studied. Diversity in the choice and frequency of surveillance modalities was found. Subsequently, the Danish Colorectal Cancer Group (DCCG) has published guidelines for POS. In the same...... period, the number of departments performing CRC surgery has been reduced by 50% nationally. The aim of the present study was to describe the POS after CRC in Denmark following a reduction in the number of departments performing operations for CRC and the DCCG's publication of national recommendations...

  16. Prevention--a cost-effective way to fight the non-communicable disease epidemic: an academic perspective of the United Nations High-level NCD Meeting.

    Science.gov (United States)

    Probst-Hensch, Nicole; Tanner, Marcel; Kessler, Claudia; Burri, Christian; Künzli, Nino

    2011-09-07

    The United Nations General Assembly has convened a Summit on non-communicable diseases (NCDs), an historic moment in the global combat of these disorders. Lifestyles in increasingly urban and globalised environments have led to a steep surge in NCD incidence in low and middle income countries, where two thirds of all NCD deaths occur (most importantly from cancer, cardiovascular and respiratory disease as well as diabetes). Treatment of NCDs is usually long term and expensive, thus threatening patients' and nations' budgets and putting them at high risk for poverty. The NCD Summit offers an opportunity for strengthening and shaping primary prevention, the most cost-effective instrument to fight major risk factors such as tobacco smoking, alcohol abuse, physical inactivity and unhealthy diet. From a Swiss perspective, we also emphasised the efforts for new laws on prevention and diagnosis registration, in accordance with the recommendations of the NCD summit in order to strengthen primary prevention and disease monitoring. In addition, the need for structural prevention across all policy sectors with leadership in environmental policy making to prevent NCDs as well as the need to adapt and strengthen primary health care are equally relevant for Switzerland. To compliment efforts in primary prevention, the field of NCDs requires special R&D platforms for affordable NCD drugs and diagnostics for neglected population segments in both Switzerland and low and middle income countries. Switzerland has a track record in research and development against diseases of poverty on a global scale that now needs to be applied to NCDs.

  17. Costs and cost-effectiveness analysis of 2015 GESIDA/Spanish AIDS National Plan recommended guidelines for initial antiretroviral therapy in HIV-infected adults.

    Science.gov (United States)

    Berenguer, Juan; Rivero, Antonio; Blasco, Antonio Javier; Arribas, José Ramón; Boix, Vicente; Clotet, Bonaventura; Domingo, Pere; González-García, Juan; Knobel, Hernando; Lázaro, Pablo; López, Juan Carlos; Llibre, Josep M; Lozano, Fernando; Miró, José M; Podzamczer, Daniel; Tuset, Montserrat; Gatell, Josep M

    2016-01-01

    GESIDA and the AIDS National Plan panel of experts suggest a preferred (PR), alternative (AR) and other regimens (OR) for antiretroviral treatment (ART) as initial therapy in HIV-infected patients for 2015. The objective of this study is to evaluate the costs and the effectiveness of initiating treatment with these regimens. Economic assessment of costs and effectiveness (cost/effectiveness) based on decision tree analyses. Effectiveness was defined as the probability of reporting a viral load <50 copies/mL at week 48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regimen was defined as the costs of ART and its consequences (adverse effects, changes of ART regimen, and drug resistance studies) during the first 48 weeks. The payer perspective (National Health System) was applied, only taking into account differential direct costs: ART (official prices), management of adverse effects, studies of resistance, and HLA B*5701 testing. The setting is Spain and the costs correspond to those of 2015. A deterministic sensitivity analysis was conducted, building three scenarios for each regimen: base case, most favourable and least favourable. In the base case scenario, the cost of initiating treatment ranges from 4663 Euros for 3TC+LPV/r (OR) to 10,902 Euros for TDF/FTC+RAL (PR). The effectiveness varies from 0.66 for ABC/3TC+ATV/r (AR) and ABC/3TC+LPV/r (OR), to 0.89 for TDF/FTC+DTG (PR) and TDF/FTC/EVG/COBI (AR). The efficiency, in terms of cost/effectiveness, ranges from 5280 to 12,836 Euros per responder at 48 weeks, for 3TC+LPV/r (OR) and RAL+DRV/r (OR), respectively. The most efficient regimen was 3TC+LPV/r (OR). Among the PR and AR, the most efficient regimen was TDF/FTC/RPV (AR). Among the PR regimes, the most efficient was ABC/3TC+DTG. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  18. RAISIN - a national programme for early warning, investigation and surveillance of healthcare-associated infection in France.

    Science.gov (United States)

    Desenclos, Jean-Claude

    2009-11-19

    Surveillance is a key component of the French plan for prevention of healthcare-associated infection (HAI) and has progressively evolved in the past decades. We describe the development and current organisation of surveillance of HAI in France and summarise key achievements and results. Surveillance of HAI is under the auspice of the national institute for public health surveillance through a central coordinating structure, the Reseau d alerte, d investigation et de surveillance des infections nosocomiales (RAISIN), which consists of five regional coordinating structures, two national advisory committees of the Ministry of Health and public health agencies. Surveillance includes the performance of national prevalence surveys every five years (latest in 2006), specific surveillance networks to follow trends and characterise HAI that are national priority, and mandatory reporting of HAI that meet specific criteria for alert purposes. RAISIN prioritises activities, defines technical specifications of surveillance systems, coordinates their implementation, and supports response to alerts, emergences or outbreaks of HAI. We demonstrate that the French surveillance program of HAI has become comprehensive and contributes to evaluating the impact of control and prevention of HAI. Data from RAISIN indicate a general decrease in the risk of HAI in acute care in France. They show a decrease in HAI during recent years, particularly of those related to methicillin-resistant Staphylococcus aureus (MRSA) for which a drop of 38% was documented between 2001 and 2006. RAISIN is also integrated into European surveillance of HAI coordinated by the European Centre for Disease Control.

  19. Five years of Kawasaki disease in the Netherlands a national surveillance study

    NARCIS (Netherlands)

    Tacke, C.E.; Breunis, W.B.; Pereira, R.R.; Breur, J.M.; Kuipers, I.M.; Kuijpers, T.W.

    2014-01-01

    Background: The aim of this study was to evaluate the incidence, disease presentation, treatment and cardiac outcome of Kawasaki disease (KD) in The Netherlands. Methods: The national Dutch Pediatric Surveillance Unit was used to prospectively register new KD cases from 2008 through 2012.

  20. National Surveillance of Occupational Exposure to the Human Immunodeficiency Virus

    Directory of Open Access Journals (Sweden)

    Maura Ricketts

    1992-01-01

    Full Text Available In September 1985, a prospective study was initiated to monitor the occurrence of occupational exposures to human immunodeficiency virus (HIV-infected blood and body fluids in Canada. This program was coordinated by the Federal Centre for acquired immune deficiency syndrome (AIDS (now the Division of HIV/AIDS Epidemiology at the Laboratory Centre for Disease Control. The objective was to determine the risk to workers of acquiring HIV infection as a result of exposure to HIV-infected blood and other body fluids. To be eligible, a worker must have sustained a documented parenteral, mucous membrane or skin contact exposure to blood or body fluids from an HIV-infected person. A baseline specimen was collected within a week of the exposure and then at six weeks, 12 weeks, six months and 12 months. Information concerning the type of exposure, precautions used and post exposure treatment was submitted to the Federal Centre for AIDS on standard data collection forms. All information was anonymous, identified only by a code number. Guidelines for counselling an exposed employee were provided with enrollment material. As of July 29, 1991, 414 employees have been included in the study. Two hundred and thirty-seven of the 414 exposures (57% were needlestick injuries of which 167 (70% were sustained by nurses. Other exposures consisted of open wound contamination, eye splashes, scalpel wounds and skin contact with blood and body fluids. To date, there have been no seroconversions among workers enrolled in the surveillance program.

  1. National laboratory surveillance of viral agents of gastroenteritis in Brazil.

    Science.gov (United States)

    Pereira, H G; Linhares, A C; Candeias, J A; Glass, R I

    1993-01-01

    In 1984 an enzyme immunoassay for rotavirus and adenovirus developed in the Virology Department of the Oswaldo Cruz Foundation was distributed to laboratories in 14 Brazilian states as part of a project to survey viral agents in fecal specimens from children with diarrhea. The ensuing surveillance continued for 3 to 5 years, and in 1991 the results obtained by all laboratories that tested 300 or more fecal specimens were reviewed at a workshop held in Belém. These results showed that rotavirus had been detected in 13% to 20% of the specimens tested, with positive specimens appearing to peak in the May to September "winter" or dry season in Brazil's central and southern states but not in the more tropical northern areas. Adenovirus, detected in 0.7% to 5.5% of the specimens tested for it, showed no seasonal variations. Many other viral agents known to cause gastroenteritis (e.g., astrovirus, small round-structured viruses, calcivirus, and group C rotavirus) were detected at centers that used electron microscopy. Picobirnavirus, a novel agent not yet associated with gastroenteritis in humans, was found by polyacrylamide gel electrophoresis in specimens from a number of centers using this technique. Vaccines to prevent rotavirus that are currently under development would be of great use in Brazil, where rotavirus is the most common cause of childhood diarrhea. Improved diagnostics will be required to assess the importance of the other viral agents.

  2. Los Alamos National Laboratory SAVY-4000 Field Surveillance Plan Update for 2016

    Energy Technology Data Exchange (ETDEWEB)

    Kelly, Elizabeth J. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Stone, Timothy Amos [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Smith, Paul Herrick [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Prochnow, David Adrian [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Weis, Eric M. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-06-17

    The Packaging Surveillance Program section of the Department of Energy (DOE) Manual 441.1-1, Nuclear Material Packaging Manual (DOE 2008), requires DOE contractors to “ensure that a surveillance program is established and implemented to ensure the nuclear material storage package continues to meet its design criteria.” The Los Alamos National Laboratory (LANL) SAVY-4000 Field Surveillance Plan was first issued in FY 2013 (Kelly et al. 2013). The surveillance plan is reviewed annually and updated as necessary based on SAVY-4000 surveillance and other surveillance findings, as well as results of the lifetime extension studies (Blair et al. 2012, Weis et al. 2015a). The LANL SAVY-4000 Field Surveillance Plan Update was issued in 2014 (Kelly et al. 2014). This 2016 update reflects changes to the surveillance plan resulting from restrictions on handling residue materials greater than 500 g, the addition of specific engineering judgment containers, and 2015 surveillance findings. The SAVY-4000 container has a design life of five years, which was chosen as a conservative estimate of the functional properties of the materials used in the construction of the SAVY 4000 when exposed to the potential insults including temperature, corrosive materials and gases, and radiation. The SAVY-4000 container design basis is described in a safety analysis report (Anderson et al. 2013). In the National Nuclear Security Administration's (NNSA’s) approval of the safety analysis report, it was recommended that the design life clock begin on March 2014 (Nez et al. 2014). However, it is expected that a technical basis can be developed to extend the design life of the SAVY-4000 containers to approximately 40 years (Blair et al. 2012, Weis et al. 2015a). This surveillance plan update covers five years (2015–2019) and is developed to ensure SAVY-4000 containers meet their design criteria over the current five-year design life and to gather data that can be used in developing the

  3. Correlation between national influenza surveillance data and google trends in South Korea.

    Directory of Open Access Journals (Sweden)

    Sungjin Cho

    Full Text Available BACKGROUND: In South Korea, there is currently no syndromic surveillance system using internet search data, including Google Flu Trends. The purpose of this study was to investigate the correlation between national influenza surveillance data and Google Trends in South Korea. METHODS: Our study was based on a publicly available search engine database, Google Trends, using 12 influenza-related queries, from September 9, 2007 to September 8, 2012. National surveillance data were obtained from the Korea Centers for Disease Control and Prevention (KCDC influenza-like illness (ILI and virologic surveillance system. Pearson's correlation coefficients were calculated to compare the national surveillance and the Google Trends data for the overall period and for 5 influenza seasons. RESULTS: The correlation coefficient between the KCDC ILI and virologic surveillance data was 0.72 (p<0.05. The highest correlation was between the Google Trends query of H1N1 and the ILI data, with a correlation coefficient of 0.53 (p<0.05, for the overall study period. When compared with the KCDC virologic data, the Google Trends query of bird flu had the highest correlation with a correlation coefficient of 0.93 (p<0.05 in the 2010-11 season. The following queries showed a statistically significant correlation coefficient compared with ILI data for three consecutive seasons: Tamiflu (r = 0.59, 0.86, 0.90, p<0.05, new flu (r = 0.64, 0.43, 0.70, p<0.05 and flu (r = 0.68, 0.43, 0.77, p<0.05. CONCLUSIONS: In our study, we found that the Google Trends for certain queries using the survey on influenza correlated with national surveillance data in South Korea. The results of this study showed that Google Trends in the Korean language can be used as complementary data for influenza surveillance but was insufficient for the use of predictive models, such as Google Flu Trends.

  4. Characteristics of national and statewide health care-associated infection surveillance programs: A qualitative study.

    Science.gov (United States)

    Russo, Philip L; Havers, Sally M; Cheng, Allen C; Richards, Michael; Graves, Nicholas; Hall, Lisa

    2016-12-01

    There are many well-established national health care-associated infection surveillance programs (HAISPs). Although validation studies have described data quality, there is little research describing important characteristics of large HAISPs. The aim of this study was to broaden our understanding and identify key characteristics of large HAISPs. Semi-structured interviews were conducted with purposively selected leaders from national and state-based HAISPs. Interview data were analyzed following an interpretive description process. Seven semi-structured interviews were conducted over a 6-month period during 2014-2015. Analysis of the data generated 5 distinct characteristics of large HAISPs: (1) triggers: surveillance was initiated by government or a cooperative of like-minded people, (2) purpose: a clear purpose is needed and determines other surveillance mechanisms, (3) data measures: consistency is more important than accuracy, (4) processes: a balance exists between the volume of data collected and resources, and (5) implementation and maintenance: a central coordinating body is crucial for uniformity and support. National HAISPs are complex and affect a broad range of stakeholders. Although the overall goal of health care-associated infection surveillance is to reduce the incidence of health care-associated infection, there are many crucial factors to be considered in attaining this goal. The findings from this study will assist the development of new HAISPs and could be used as an adjunct to evaluate existing programs. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  5. The Danish National Veterinary Institute and disease surveillance

    DEFF Research Database (Denmark)

    Andresen, Lars Ole; Strandbygaard, Bertel; Lauritsen, Klara Tølbøl

    The National Veterinary Institute at the Technical University of Denmark, DTU-Vet, conducts research in infectious diseases in livestock, wildlife and fish, and diagnoses diseased animals. We give advice to public authorities and cooperate with these on the Danish veterinary contingency plan....... The research at DTU-Vet covers methods for detection, control and prevention of many infectious diseases in animals, including use of animal disease models for comparative studies of human diseases. However, our main focus is on notifiable diseases, as well as other severe infectious diseases that affect farm...... for the laboratory component of the Danish veterinary contingency plan, which puts emergency procedures into action in the event of suspected or actual outbreaks of serious infectious animal diseases. The contingency plan is supported by our activities in conjunction with a range of national monitoring programs...

  6. National Status and Trends, Benthic Surveillance Project Fluorescent Aromatic Compounds (FAC) Data, 1984-1991, National Centers for Coastal Ocean Science

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The National Status and Trends (NSandT) Benthic Surveillance Fluorescent Aromatic Compounds (FAC) file reports the trace concentrations of Fluorescent Aromatic...

  7. Surveillance of nosocomial infections in Dr. Cipto Mangunkusumo National General Hospital, Jakarta, 1999-2002

    Directory of Open Access Journals (Sweden)

    Djoko Widodo

    2004-06-01

    Full Text Available Nosocomial infection are one of the main problem in hospital which are associated with significant morbidity, mortality and increased economic cost. Surveillance should be attempted regularly to obtain local data of incidence of nosocomial infections, types of infection, pathogen and resistance pattern. We reported the results of nosocomial surveillance in Dr. Cipto Mangunkusumo National General Hospital, Jakarta, in year 1999 to 2002. The data were obtained from surveillance, conducted by Nosocomial Infection Control Committee. Surveillance were performed to patient in risk of nosocomial infections such as underwent surgical procedure, urinary catheter, peripheral or central venous catheter, ventilator and other invasive procedure. Criteria for nosocomial infection which were used, based on technical guidelines of nosocomial infection in Dr. Cipto Mangunkusumo National General Hospital, year 1999; which referred to CDC definition of nosocomial infections. Incidence rate of nosocomial infections in year 1999, 2000, 2001 and 2002 were 1.1, 0.9, 0.6 and 0.4 % respectively. Type of nosocomial infection include catheter related, surgical wound, urinary tract and respiratory tract infections, ranged between 0 to 5.6 %. Gram negative bacteria consist of Pseudomonas sp, Enterobacter aerogenes, Escherichia coli, Proteus mirabilis were the most common nosocomial pathogen. Gram positive bacteria consist of Staphylococcus epidermidis, Staphylococcus aureus and Streptococcus anhemolyticus. Trend of increasing incidence of Gram positive nosocomial infection also showed in our surveillance. Mostly Gram negative bacteria had been resistant to penicillin, co amoxicillin-clavulanic acid and 3rd generation cephalosporin, but still sensitive to 4th generation cephalosporin and aminoglycoside. The Gram positive bacteria were still sensitive to penicillin, co amoxicillin-clavulanic acid, 4th generation cephalosporin and aminoglycoside. (Med J Indones 2004; 13: 107

  8. Adenovirus surveillance, 1982-1993, Japan. A report of the National Epidemiological Surveillance of Infectious Agents in Japan.

    Science.gov (United States)

    Yamadera, S; Yamashita, K; Akatsuka, M; Kato, N; Hashido, M; Inouye, S; Yamazaki, S

    1995-08-01

    The Infectious Agents Surveillance Center, the National Institute of Health, Japan, received 17,265 reports from 1982 to 1993 on cases from whom adenovirus was isolated or detected; 85% from 57 public health institutes and the other 15% from two national hospitals and two commercial diagnostic laboratories. The followings were found. Three major diseases caused by adenovirus were upper respiratory tract infection, gastroenteritis, and conjunctivitis. Patients of upper respiratory tract infection numbered 6,837 (40% of all patients due to adenovirus), the identified serotypes being in order of frequency types 3, 2, 1, and 5. Those of gastroenteritis numbered 1,636 (9.5%). From 40% of the gastroenteritis patients, adenovirus was detected by electron microscopy or immunochemical methods without cultivation. From the remaining 60%, virus was isolated in tissue culture; the serotypes of the isolates resembled those causing upper respiratory tract infection. Patients of conjunctivitis numbered 3,437 (20%), the frequency being in order of types 3, 4, 8, 37, and 19. Conjunctivitis due to types 3 and 4 prevailed every summer; type 3 was isolated often from children with pharyngo-conjunctival fever and the other four types were mostly from adults with epidemic keratoconjunctivitis. Type 3 had a unique feature not seen in other types: it was most frequently isolated, causing upper respiratory tract infection, gastroenteritis, conjunctivitis, and pharyngo-conjunctival fever. Reports on isolation of type 7, which has been reported to cause severe pneumonia in many other countries, were as few as 28 (0.2%).

  9. Enhanced surveillance for the Third United Nations Conference on Small Island Developing States, Apia, Samoa, September 2014

    Science.gov (United States)

    Saketa, Salanieta; Durand, Alexis; Vaai-Nielsen, Saine; Leong-Lui, Tile Ah; Naseri, Take; Matalima, Ailuai; Amosa, Filipina; Mercier, Alize; Lepers, Christelle; Lal, Vjesh; Wojcik, Richard; Lewis, Sheri; Roth, Adam; Souares, Yvan; Merilles, Onofre Edwin; Hoy, Damian

    2017-01-01

    The Ministry of Health in Samoa, in partnership with the Pacific Community, successfully implemented enhanced surveillance for the high-profile Third United Nations Conference on Small Island Developing States held concurrently with the popular local Teuila festival during a widespread chikungunya outbreak in September 2014. Samoa’s weekly syndromic surveillance system was expanded to 12 syndromes and 10 sentinel sites from four syndromes and seven sentinel sites; sites included the national hospital, four private health clinics and three national health service clinics. Daily situation reports were produced and were disseminated through PacNet (the e-mail alert and communication tool of the Pacific Public Health Surveillance Network) together with daily prioritized line lists of syndrome activity to facilitate rapid response and investigation by the Samoan EpiNet team. Standard operating procedures for surveillance and response were introduced, together with a sustainability plan, including a monitoring and evaluation framework, to facilitate the transition of the mass gathering surveillance improvements to routine surveillance. The enhanced surveillance performed well, providing vital disease early warning and health security assurance. A total of 2386 encounters and 708 syndrome cases were reported. Influenza-like illness was the most frequently seen syndrome (17%). No new infectious disease outbreaks were recorded. The experience emphasized: (1) the need for a long lead time to pilot the surveillance enhancements and to maximize their sustainability; (2) the importance of good communication between key stakeholders; and (3) having sufficient staff dedicated to both surveillance and response. PMID:28409055

  10. Enhanced surveillance for the Third United Nations Conference on Small Island Developing States, Apia, Samoa, September 2014

    Directory of Open Access Journals (Sweden)

    Paul White

    2017-02-01

    Full Text Available The Ministry of Health in Samoa, in partnership with the Pacific Community, successfully implemented enhanced surveillance for the high-profile Third United Nations Conference on Small Island Developing States held concurrently with the popular local Teuila festival during a widespread chikungunya outbreak in September 2014. Samoa’s weekly syndromic surveillance system was expanded to 12 syndromes and 10 sentinel sites from four syndromes and seven sentinel sites; sites included the national hospital, four private health clinics and three national health service clinics. Daily situation reports were produced and were disseminated through PacNet (the email alert and communication tool of the Pacific Public Health Surveillance Network together with daily prioritized line lists of syndrome activity to facilitate rapid response and investigation by the Samoan EpiNet team. Standard operating procedures for surveillance and response were introduced, together with a sustainability plan, including a monitoring and evaluation framework, to facilitate the transition of the mass gathering surveillance improvements to routine surveillance. The enhanced surveillance performed well, providing vital disease early warning and health security assurance. A total of 2386 encounters and 708 syndrome cases were reported. Influenza-like illness was the most frequently seen syndrome (17%. No new infectious disease outbreaks were recorded. The experience emphasized: (1 the need for a long lead time to pilot the surveillance enhancements and to maximize their sustainability; (2 the importance of good communication between key stakeholders; and (3 having sufficient staff dedicated to both surveillance and response.

  11. Comparative review of three cost-effectiveness models for rotavirus vaccines in national immunization programs; a generic approach applied to various regions in the world

    Directory of Open Access Journals (Sweden)

    Tu Hong-Anh

    2011-07-01

    Full Text Available Abstract Background This study aims to critically review available cost-effectiveness models for rotavirus vaccination, compare their designs using a standardized approach and compare similarities and differences in cost-effectiveness outcomes using a uniform set of input parameters. Methods We identified various models used to estimate the cost-effectiveness of rotavirus vaccination. From these, results using a standardized dataset for four regions in the world could be obtained for three specific applications. Results Despite differences in the approaches and individual constituting elements including costs, QALYs Quality Adjusted Life Years and deaths, cost-effectiveness results of the models were quite similar. Differences between the models on the individual components of cost-effectiveness could be related to some specific features of the respective models. Sensitivity analysis revealed that cost-effectiveness of rotavirus vaccination is highly sensitive to vaccine prices, rotavirus-associated mortality and discount rates, in particular that for QALYs. Conclusions The comparative approach followed here is helpful in understanding the various models selected and will thus benefit (low-income countries in designing their own cost-effectiveness analyses using new or adapted existing models. Potential users of the models in low and middle income countries need to consider results from existing studies and reviews. There will be a need for contextualization including the use of country specific data inputs. However, given that the underlying biological and epidemiological mechanisms do not change between countries, users are likely to be able to adapt existing model designs rather than developing completely new approaches. Also, the communication established between the individual researchers involved in the three models is helpful in the further development of these individual models. Therefore, we recommend that this kind of comparative study

  12. Towards evidence-based, GIS-driven national spatial health information infrastructure and surveillance services in the United Kingdom.

    Science.gov (United States)

    Boulos, Maged N Kamel

    2004-01-28

    The term "Geographic Information Systems" (GIS) has been added to MeSH in 2003, a step reflecting the importance and growing use of GIS in health and healthcare research and practices. GIS have much more to offer than the obvious digital cartography (map) functions. From a community health perspective, GIS could potentially act as powerful evidence-based practice tools for early problem detection and solving. When properly used, GIS can: inform and educate (professionals and the public); empower decision-making at all levels; help in planning and tweaking clinically and cost-effective actions, in predicting outcomes before making any financial commitments and ascribing priorities in a climate of finite resources; change practices; and continually monitor and analyse changes, as well as sentinel events. Yet despite all these potentials for GIS, they remain under-utilised in the UK National Health Service (NHS). This paper has the following objectives: (1) to illustrate with practical, real-world scenarios and examples from the literature the different GIS methods and uses to improve community health and healthcare practices, e.g., for improving hospital bed availability, in community health and bioterrorism surveillance services, and in the latest SARS outbreak; (2) to discuss challenges and problems currently hindering the wide-scale adoption of GIS across the NHS; and (3) to identify the most important requirements and ingredients for addressing these challenges, and realising GIS potential within the NHS, guided by related initiatives worldwide. The ultimate goal is to illuminate the road towards implementing a comprehensive national, multi-agency spatio-temporal health information infrastructure functioning proactively in real time. The concepts and principles presented in this paper can be also applied in other countries, and on regional (e.g., European Union) and global levels.

  13. Towards evidence-based, GIS-driven national spatial health information infrastructure and surveillance services in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Boulos Maged

    2004-01-01

    Full Text Available Abstract The term "Geographic Information Systems" (GIS has been added to MeSH in 2003, a step reflecting the importance and growing use of GIS in health and healthcare research and practices. GIS have much more to offer than the obvious digital cartography (map functions. From a community health perspective, GIS could potentially act as powerful evidence-based practice tools for early problem detection and solving. When properly used, GIS can: inform and educate (professionals and the public; empower decision-making at all levels; help in planning and tweaking clinically and cost-effective actions, in predicting outcomes before making any financial commitments and ascribing priorities in a climate of finite resources; change practices; and continually monitor and analyse changes, as well as sentinel events. Yet despite all these potentials for GIS, they remain under-utilised in the UK National Health Service (NHS. This paper has the following objectives: (1 to illustrate with practical, real-world scenarios and examples from the literature the different GIS methods and uses to improve community health and healthcare practices, e.g., for improving hospital bed availability, in community health and bioterrorism surveillance services, and in the latest SARS outbreak; (2 to discuss challenges and problems currently hindering the wide-scale adoption of GIS across the NHS; and (3 to identify the most important requirements and ingredients for addressing these challenges, and realising GIS potential within the NHS, guided by related initiatives worldwide. The ultimate goal is to illuminate the road towards implementing a comprehensive national, multi-agency spatio-temporal health information infrastructure functioning proactively in real time. The concepts and principles presented in this paper can be also applied in other countries, and on regional (e.g., European Union and global levels.

  14. CollAborative care and active surveillance for Screen-Positive EldeRs with subthreshold depression (CASPER): a multicentred randomised controlled trial of clinical effectiveness and cost-effectiveness.

    Science.gov (United States)

    Lewis, Helen; Adamson, Joy; Atherton, Katie; Bailey, Della; Birtwistle, Jacqueline; Bosanquet, Katharine; Clare, Emily; Delgadillo, Jaime; Ekers, David; Foster, Deborah; Gabe, Rhian; Gascoyne, Samantha; Haley, Lesley; Hargate, Rebecca; Hewitt, Catherine; Holmes, John; Keding, Ada; Lilley-Kelly, Amanda; Maya, Jahnese; McMillan, Dean; Meer, Shaista; Meredith, Jodi; Mitchell, Natasha; Nutbrown, Sarah; Overend, Karen; Pasterfield, Madeline; Richards, David; Spilsbury, Karen; Torgerson, David; Traviss-Turner, Gemma; Trépel, Dominic; Woodhouse, Rebecca; Ziegler, Friederike; Gilbody, Simon

    2017-02-01

    participants (83%; collaborative care 76%, usual care 90%) followed up at 4 months and 519 participants (74%; collaborative care 68%, usual care 79%) followed up at 12 months. Attrition was markedly greater in the collaborative care arm. Model estimates at the primary end point of 4 months revealed a statistically significant effect in favour of collaborative care compared with usual care [mean difference 1.31 score points, 95% confidence interval (CI) 0.67 to 1.95 score points; p effect size of 0.30, for which the trial was powered. Treatment differences measured by the PHQ-9 were maintained at 12 months' follow-up (mean difference 1.33 score points, 95% CI 0.55 to 2.10 score points; p = 0.001). Base-case cost-effectiveness analysis found that the incremental cost-effectiveness ratio was £9633 per quality-adjusted life-year (QALY). On average, participants allocated to collaborative care displayed significantly higher QALYs than those allocated to the control group (annual difference in adjusted QALYs of 0.044, 95% bias-corrected CI 0.015 to 0.072; p = 0.003). Collaborative care has been shown to be clinically effective and cost-effective for older adults with subthreshold depression and to reduce the proportion of people who go on to develop case-level depression at 12 months. This intervention could feasibly be delivered in the NHS at an acceptable cost-benefit ratio. Important future work would include investigating the longer-term effect of collaborative care on the CASPER population, which could be conducted by introducing an extension to follow-up, and investigating the impact of collaborative care on managing multimorbidities in people with subthreshold depression. Current Controlled Trials ISRCTN02202951. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 8. See the NIHR Journals Library website for further project

  15. Congenital anomaly surveillance in England—ascertainment deficiencies in the national system

    OpenAIRE

    Boyd, PA; Armstrong, B; Dolk, H; Botting, B; Pattenden, S.; Abramsky, L.; Rankin, J.; Vrijheid, M; Wellesley, D

    2005-01-01

    Objective Firstly, to assess the completeness of ascertainment in die National Congenital Anomaly System (NCAS), the basis for congenital anomaly surveillance in England and Wales, and its variation by defect geographical area, and socioeconomic deprivation. Secondly, to assess die impact of the lack of data on pregnancies terminated because of fetal anomaly. Design Comparison of the NCAS with four local congenital anomaly registers in England. Setting Four regions in England covering some 10...

  16. Cost-effectiveness comparison between non-penetrating deep sclerectomy and maximum-tolerated medical therapy for glaucoma within the Brazilian National Health System (SUS

    Directory of Open Access Journals (Sweden)

    Ricardo Augusto Paletta Guedes

    2012-02-01

    Full Text Available PURPOSE: Non-penetrating deep sclerectomy (NPDS has emerged as a viable option in the surgical management of open-angle glaucoma. Our aim is to assess the cost-effectiveness of NPDS and to compare it to maximum medical treatment in a 5-year follow-up. METHODS: A decision analysis model was built. Surgical (NPDS arm of the decision tree was observational (consecutive retrospective case series and maximum medical treatment arm was hypothetical. Maximum medical therapy was considered a three-drug regimen (association of a fixed combination of timolol/dorzolamide [FCTD] and a prostaglandin analogue [bimatoprost, latanoprost or travoprost]. Cost-effectiveness ratio was defined as direct cost (US dollars for each percentage of intraocular pressure (IOP reduction. Horizon was 5 years and perspective is from the public health care service in Brazil (SUS. Incremental cost-effectiveness ratio (ICER was calculated. RESULTS: Direct cost for each percentage of IOP reduction in 5 years (cost-effectiveness ratio was US$ 10.19 for NPDS; US$ 37.45 for the association of a FCTD and bimatoprost; US$ 39.33 for FCTD and travoprost; and US$ 41.42 for FCTD and latanoprost. NPDS demonstrated a better cost-effectiveness ratio, compared to maximum medical therapy. The ICER was negative for all medical treatment options; therefore NPDS was dominant. CONCLUSIONS: Despite some limitations, NPDS was both less costly and more effective than maximum medical therapy. From the Brazilian public health perspective, it was the most cost-effective treatment option when compared to maximum medical therapy (FCTD and prostaglandin.

  17. Incidents of potential public health significance identified using national surveillance of US poison center data (2008–2012)

    Science.gov (United States)

    LAW, R. K.; SHEIKH, S.; BRONSTEIN, A.; THOMAS, R.; SPILLER, H. A.; SCHIER, J. G.

    2015-01-01

    Background The Centers for Disease Control and Prevention (CDC) and the American Association of Poison Control Centers conduct national surveillance on data collected by US poison centers to identify incidents of potential public health significance (IPHS). The overarching goals of this collaboration are to improve CDC’s national surveillance capacity for public health threats, identify early markers of public health incidents and enhance situational awareness. The National Poison Data System (NPDS) is used as a surveillance system to automatically identify data anomalies. Purpose To characterize data anomalies and IPHS captured by national surveillance of poison center data over 5 years. Methods Data anomalies are identified through three surveillance methodologies: call-volume, clinical effect, and case-based. Anomalies are reviewed by a team of epidemiologists and clinical toxicologists to determine IPHS using standardized criteria. The authors reviewed IPHS identified by these surveillance activities from 2008 through 2012. Results Call-volume surveillance identified 384 IPHS; most were related to gas and fume exposures (n=229; 59.6%) with the most commonly implicated substance being carbon monoxide (CO) (n=92; 22.8%). Clinical-effect surveillance identified 138 IPHS; the majority were related to gas and fume exposures (n=58; 42.0%) and gastrointestinal complaints (n=84; 16.2%), and the most commonly implicated substance was CO (n=20; 14.4%). Among the 11 case-based surveillance definitions, the botulism case definition yielded the highest percentage of identified agent-specific illness. Conclusions A small proportion of data anomalies were designated as IPHS. Of these, CO releases were the most frequently reported IPHS and gastrointestinal syndromes were the most commonly reported illness manifestations. poison center data surveillance may be used as an approach to identify exposures, illnesses, and incidents of importance at the national and state level

  18. National Public Health Surveillance in China:Implications for Public Health in China and the United States

    Institute of Scientific and Technical Information of China (English)

    YANGGONG-HUAN; DONNAF·STROUP

    1997-01-01

    Study Objective:Throughout the world,political developments have brought new demands to communities to prevent and intervene in the incidence of infectious and noninfectious conditions.Historically,these developments have required new and more effective public health surveillance ac-tivities.This report describes public health surveillance practice in the People's Republic of China,making comparisons with selected aspects of surveillance in the United States with respect to collec-tion,analysis,dissemination,and use of data.Main results:In both the People's Republc of China and the United States.political change has affected health,and multiple surveillance system are used in public health practice.Surveillance of acute infectious diseases based on the reporting of legally notifiable diseases and the use of vital records for surveillance have the longest established history in both countries.In both countries,da-ta from the surveillance systems have been used to affect public health policy.Conclusions:in comparing surveillance practices in these countries,we find similarities in con-ditions reported and in the dissemination of the data.At the same time,legal,social,cultural,and economic differences between the nations have affected the practice of surveillance in analysis and evaluation.We make explicit recommendations for improement and evaluation of systems in both countries,including sentinel surveillance system and data quality measures in China and computer networking and data analysis in the United States.

  19. From planning to practice: building the national network for the surveillance of severe maternal morbidity

    Directory of Open Access Journals (Sweden)

    Bahamondes Maria V

    2011-05-01

    Full Text Available Abstract Background Improving maternal health is one of the Millennium Development Goals for 2015. Recently some progress has been achieved in reducing mortality. On the other hand, in developed regions, maternal death is a relatively rare event compared to the number of cases of morbidity; hence studying maternal morbidity has become more relevant. Electronic surveillance systems may improve research by facilitating complete data reporting and reducing the time required for data collection and analysis. Therefore the purpose of this study was to describe the methods used in elaborating and implementing the National Network for the Surveillance of Severe Maternal Morbidity in Brazil. Methods The project consisted of a multicenter, cross-sectional study for the surveillance of severe maternal morbidity including near-miss, in Brazil. Results Following the development of a conceptual framework, centers were selected for inclusion in the network, consensus meetings were held among the centers, an electronic data collection system was identified, specific software and hardware tools were developed, research material was prepared, and the implementation process was initiated and analyzed. Conclusion The conceptual framework developed for this network was based on the experience acquired in various studies carried out in the area over recent years and encompasses maternal and perinatal health. It is innovative especially in the context of a developing country. The implementation of the project represents the first step towards this planned management. The system online elaborated for this surveillance network may be used in further studies in reproductive and perinatal health.

  20. Surveillance of acute flaccid paralysis (AFP) in Lombardy, Northern Italy, from 1997 to 2011 in the context of the national AFP surveillance system.

    Science.gov (United States)

    Pellegrinelli, Laura; Primache, Valeria; Fiore, Lucia; Amato, Concetta; Fiore, Stefano; Bubba, Laura; Pariani, Elena; Amendola, Antonella; Barbi, Maria; Binda, Sandro

    2015-01-01

    An Acute Flaccid Paralysis (AFP) surveillance system was set up in Lombardy (Northern Italy) in 1997 in the framework of the national AFP surveillance system, as part of the polio eradication initiative by the World Health Organization (WHO). This surveillance system can now be used to detect Poliovirus (PV) reintroductions from endemic countries. This study aimed at describing the results of the AFP surveillance in Lombardy, from 1997 to 2011.   Overall, 131 AFP cases in Lombardy were reported with a mean annual incidence rate of 0.7/100 000 children AFP cases was typical with peaks in November, in January, and in March. The major clinical diagnoses associated with AFP were Guillain-Barré Syndrome (GBS, 40%) and encephalomyelitis/myelitis (13%). According to the virological results, no poliomyelitis cases were caused by wild PV infections, but two Vaccine-Associated Paralytic Paralysis (VAPP) cases were reported in 1997 when the Sabin oral polio vaccine (OPV) was still being administered in Italy. Since a surveillance system is deemed sensitive if at least one case of AFP per 100,000 children <15 years of age is detected each year, our surveillance system needs some improvement and must be maintained until global poliovirus eradication will be declared.

  1. Emerging infectious diseases in free-ranging wildlife-Australian zoo based wildlife hospitals contribute to national surveillance.

    Directory of Open Access Journals (Sweden)

    Keren Cox-Witton

    Full Text Available Emerging infectious diseases are increasingly originating from wildlife. Many of these diseases have significant impacts on human health, domestic animal health, and biodiversity. Surveillance is the key to early detection of emerging diseases. A zoo based wildlife disease surveillance program developed in Australia incorporates disease information from free-ranging wildlife into the existing national wildlife health information system. This program uses a collaborative approach and provides a strong model for a disease surveillance program for free-ranging wildlife that enhances the national capacity for early detection of emerging diseases.

  2. Emerging Infectious Diseases in Free-Ranging Wildlife–Australian Zoo Based Wildlife Hospitals Contribute to National Surveillance

    Science.gov (United States)

    Cox-Witton, Keren; Reiss, Andrea; Woods, Rupert; Grillo, Victoria; Baker, Rupert T.; Blyde, David J.; Boardman, Wayne; Cutter, Stephen; Lacasse, Claude; McCracken, Helen; Pyne, Michael; Smith, Ian; Vitali, Simone; Vogelnest, Larry; Wedd, Dion; Phillips, Martin; Bunn, Chris; Post, Lyndel

    2014-01-01

    Emerging infectious diseases are increasingly originating from wildlife. Many of these diseases have significant impacts on human health, domestic animal health, and biodiversity. Surveillance is the key to early detection of emerging diseases. A zoo based wildlife disease surveillance program developed in Australia incorporates disease information from free-ranging wildlife into the existing national wildlife health information system. This program uses a collaborative approach and provides a strong model for a disease surveillance program for free-ranging wildlife that enhances the national capacity for early detection of emerging diseases. PMID:24787430

  3. Operational research to inform a sub-national surveillance intervention for malaria elimination in Solomon Islands

    Directory of Open Access Journals (Sweden)

    Atkinson Jo-An

    2012-03-01

    Full Text Available Abstract Background Successful reduction of malaria transmission to very low levels has made Isabel Province, Solomon Islands, a target for early elimination by 2014. High malaria transmission in neighbouring provinces and the potential for local asymptomatic infections to cause malaria resurgence highlights the need for sub-national tailoring of surveillance interventions. This study contributes to a situational analysis of malaria in Isabel Province to inform an appropriate surveillance intervention. Methods A mixed method study was carried out in Isabel Province in late 2009 and early 2010. The quantitative component was a population-based prevalence survey of 8,554 people from 129 villages, which were selected using a spatially stratified sampling approach to achieve uniform geographical coverage of populated areas. Diagnosis was initially based on Giemsa-stained blood slides followed by molecular analysis using polymerase chain reaction (PCR. Local perceptions and practices related to management of fever and treatment-seeking that would impact a surveillance intervention were also explored using qualitative research methods. Results Approximately 33% (8,554/26,221 of the population of Isabel Province participated in the survey. Only one subject was found to be infected with Plasmodium falciparum (Pf (96 parasites/μL using Giemsa-stained blood films, giving a prevalence of 0.01%. PCR analysis detected a further 13 cases, giving an estimated malaria prevalence of 0.51%. There was a wide geographical distribution of infected subjects. None reported having travelled outside Isabel Province in the previous three months suggesting low-level indigenous malaria transmission. The qualitative findings provide warning signs that the current community vigilance approach to surveillance will not be sufficient to achieve elimination. In addition, fever severity is being used by individuals as an indicator for malaria and a trigger for timely treatment

  4. Surgical Site Infection (SSI) Rates in the United States, 1992-1998: The National Nosocomial Infections Surveillance System Basic SSI Risk Index

    National Research Council Canada - National Science Library

    Robert P. Gaynes; David H. Culver; Teresa C. Horan; Jonathan R. Edwards; Chesley Richards; James S. Tolson; The National Nosocomial Infections Surveillance System

    2001-01-01

    By use of the National Nosocomial Infections Surveillance (NNIS) System's surgical patient surveillance component protocol, the NNIS basic risk index was examined to predict the risk of a surgical site infection (SSI...

  5. The Italian National Seismic Network and the earthquake and tsunami monitoring and surveillance systems

    Science.gov (United States)

    Michelini, Alberto; Margheriti, Lucia; Cattaneo, Marco; Cecere, Gianpaolo; D'Anna, Giuseppe; Delladio, Alberto; Moretti, Milena; Pintore, Stefano; Amato, Alessandro; Basili, Alberto; Bono, Andrea; Casale, Paolo; Danecek, Peter; Demartin, Martina; Faenza, Licia; Lauciani, Valentino; Mandiello, Alfonso Giovanni; Marchetti, Alessandro; Marcocci, Carlo; Mazza, Salvatore; Mariano Mele, Francesco; Nardi, Anna; Nostro, Concetta; Pignone, Maurizio; Quintiliani, Matteo; Rao, Sandro; Scognamiglio, Laura; Selvaggi, Giulio

    2016-11-01

    The Istituto Nazionale di Geofisica e Vulcanologia (INGV) is an Italian research institution, with focus on Earth Sciences. INGV runs the Italian National Seismic Network (Rete Sismica Nazionale, RSN) and other networks at national scale for monitoring earthquakes and tsunami as a part of the National Civil Protection System coordinated by the Italian Department of Civil Protection (Dipartimento di Protezione Civile, DPC). RSN is composed of about 400 stations, mainly broadband, installed in the Country and in the surrounding regions; about 110 stations feature also co-located strong motion instruments, and about 180 have GPS receivers and belong to the National GPS network (Rete Integrata Nazionale GPS, RING). The data acquisition system was designed to accomplish, in near-real-time, automatic earthquake detection, hypocenter and magnitude determination, moment tensors, shake maps and other products of interest for DPC. Database archiving of all parametric results are closely linked to the existing procedures of the INGV seismic monitoring environment and surveillance procedures. INGV is one of the primary nodes of ORFEUS (Observatories & Research Facilities for European Seismology) EIDA (European Integrated Data Archive) for the archiving and distribution of continuous, quality checked seismic data. The strong motion network data are archived and distributed both in EIDA and in event based archives; GPS data, from the RING network are also archived, analyzed and distributed at INGV. Overall, the Italian earthquake surveillance service provides, in quasi real-time, hypocenter parameters to the DPC. These are then revised routinely by the analysts of the Italian Seismic Bulletin (Bollettino Sismico Italiano, BSI). The results are published on the web, these are available to both the scientific community and the general public. The INGV surveillance includes a pre-operational tsunami alert service since INGV is one of the Tsunami Service providers of the North

  6. Comparison of surveillance sample demographics over two cycles of the National HIV Behavioral Surveillance Project, Houston, Texas.

    Science.gov (United States)

    Risser, Jan M H; Montealegre, Jane R

    2014-04-01

    We examined differences in sample demographics across cycles of the National HIV Behavioral Surveillance project, that examines HIV risk behaviors among men who have sex with men (MSM), injection drug users (IDU), and heterosexuals living in areas of high HIV prevalence (HET). MSM were recruited through venue-based sampling, and IDU and HET through respondent driven sampling (RDS). RDS data were weighted to account for sampling bias. We compared crude prevalence estimates from MSM1 (2004) to those from MSM2 (2008) for demographic factors known to influence risky sexual and drug-use behaviors. We compared crude and adjusted prevalence estimates for IDU1 (2005) and IDU2 (2009) and HET1 (2006) and HET2 (2010). In the MSM cycle, we found differences in age, and the proportions seeking medical care and reporting a recent arrest. There were no differences in the comparison of crude and weighted estimates for the RDS collected samples, nor were there differences comparing HET1 and HET2 weighted estimates. IDU2 recruited a larger proportion of males, and had a higher percent who graduated from high school and who reported recent medical care and a previous HIV test. Differences across MSM cycles may be related to differences in venues identified for each cycle. Differences in the IDU cycles may be due to an effort on our part to increase the racial/ethnic and drug-use diversity of the sample in IDU2. Our findings show the importance of formative work for both venue-based and RDS samples to increase understanding of the dimensions that affect social networks and the dynamics of populations in space and time. With familiarity of the target population, we believe that both venue-based and RDS recruitment approaches for NHBS work well and can be used to evaluate changes in risky sexual and drug use behaviors and in HIV testing behaviors.

  7. An assessment of national surveillance systems for malaria elimination in the Asia Pacific.

    Science.gov (United States)

    Mercado, Chris Erwin G; Ekapirat, Nattwut; Dondorp, Arjen M; Maude, Richard J

    2017-03-21

    Heads of Government from Asia and the Pacific have committed to a malaria-free region by 2030. In 2015, the total number of confirmed cases reported to the World Health Organization by 22 Asia Pacific countries was 2,461,025. However, this was likely a gross underestimate due in part to incidence data not being available from the wide variety of known sources. There is a recognized need for an accurate picture of malaria over time and space to support the goal of elimination. A survey was conducted to gain a deeper understanding of the collection of malaria incidence data for surveillance by National Malaria Control Programmes in 22 countries identified by the Asia Pacific Leaders Malaria Alliance. In 2015-2016, a short questionnaire on malaria surveillance was distributed to 22 country National Malaria Control Programmes (NMCP) in the Asia Pacific. It collected country-specific information about the extent of inclusion of the range of possible sources of malaria incidence data and the role of the private sector in malaria treatment. The findings were used to produce recommendations for the regional heads of government on improving malaria surveillance to inform regional efforts towards malaria elimination. A survey response was received from all 22 target countries. Most of the malaria incidence data collected by NMCPs originated from government health facilities, while many did not collect comprehensive data from mobile and migrant populations, the private sector or the military. All data from village health workers were included by 10/20 countries and some by 5/20. Other sources of data included by some countries were plantations, police and other security forces, sentinel surveillance sites, research or academic institutions, private laboratories and other government ministries. Malaria was treated in private health facilities in 19/21 countries, while anti-malarials were available in private pharmacies in 16/21 and private shops in 6/21. Most countries use

  8. Asthma surveillance using Medicaid administrative data: a call for a national framework.

    Science.gov (United States)

    Dombkowski, Kevin J; Wasilevich, Elizabeth A; Lyon-Callo, Sarah; Nguyen, Trang Q; Medvesky, Michael G; Lee, Mary Alice

    2009-01-01

    Connecticut, Michigan, and New York have successfully used Medicaid administrative data to conduct surveillance of asthma prevalence, related health service utilization and costs, and quality of asthma care. Since these assessments utilize beneficiary-level data, a wide range of population-based summaries is feasible. Opportunities exist to build upon the collective experiences of these three states to establish a national framework for asthma surveillance using Medicaid administrative data. This framework could be designed to respond to each state's unique data considerations and asthma management priorities, while establishing standardized criteria to enhance the comparability of asthma surveillance data among states. Importantly, a common asthma case definition using comparable methods is necessary to enable comparisons of prevalence estimates between states. Case definitions that could serve as the foundation for such a framework are presented. Mechanisms to foster sharing of methodologies and experiences will be instrumental for broad implementation across states. This collaboration will be of increasing importance as states experience mounting financial pressures due to increasing Medicaid enrollment and dwindling resources.

  9. Cost-effectiveness analysis of the national implementation of integrated community case management and community-based health planning and services in Ghana for the treatment of malaria, diarrhoea and pneumonia.

    Science.gov (United States)

    Escribano Ferrer, Blanca; Hansen, Kristian Schultz; Gyapong, Margaret; Bruce, Jane; Narh Bana, Solomon A; Narh, Clement T; Allotey, Naa-Korkor; Glover, Roland; Azantilow, Naa-Charity; Bart-Plange, Constance; Sagoe-Moses, Isabella; Webster, Jayne

    2017-07-05

    Ghana has developed two main community-based strategies that aim to increase access to quality treatment for malaria, diarrhoea and suspected pneumonia: the integrated community case management (iCCM) and the community-based health planning and services (CHPS). The aim of the study was to assess the cost-effectiveness of these strategies under programme conditions. A cost-effectiveness analysis was conducted. Appropriate diagnosis and treatment given was the effectiveness measure used. Appropriate diagnosis and treatment data was obtained from a household survey conducted 2 and 8 years after implementation of iCCM in the Volta and Northern Regions of Ghana, respectively. The study population was carers of children under-5 years who had fever, diarrhoea and/or cough in the last 2 weeks prior to the interview. Costs data was obtained mainly from the National Malaria Control Programme (NMCP), the Ministry of Health, CHPS compounds and from a household survey. Appropriate diagnosis and treatment of malaria, diarrhoea and suspected pneumonia was more cost-effective under the iCCM than under CHPS in the Volta Region, even after adjusting for different discount rates, facility costs and iCCM and CHPS utilization, but not when iCCM appropriate treatment was reduced by 50%. Due to low numbers of carers visiting a CBA in the Northern Region it was not possible to conduct a cost-effectiveness analysis in this region. However, the cost analysis showed that iCCM in the Northern Region had higher cost per malaria, diarrhoea and suspected pneumonia case diagnosed and treated when compared to the Volta Region and to the CHPS strategy in the Northern Region. Integrated community case management was more cost-effective than CHPS for the treatment of malaria, diarrhoea and suspected pneumonia when utilized by carers of children under-5 years in the Volta Region. A revision of the iCCM strategy in the Northern Region is needed to improve its cost-effectiveness. Long-term financing

  10. National surveillance for influenza and influenza-like illness in Vietnam, 2006-2010.

    Science.gov (United States)

    Nguyen, Yen T; Graitcer, Samuel B; Nguyen, Tuan H; Tran, Duong N; Pham, Tho D; Le, Mai T Q; Tran, Huu N; Bui, Chien T; Dang, Dat T; Nguyen, Long T; Uyeki, Timothy M; Dennis, David; Kile, James C; Kapella, Bryan K; Iuliano, A D; Widdowson, Marc-Alain; Nguyen, Hien T

    2013-09-13

    Influenza virus infections result in considerable morbidity and mortality both in the temperate and tropical world. Influenza surveillance over multiple years is important to determine the impact and epidemiology of influenza and to develop a national vaccine policy, especially in countries developing influenza vaccine manufacturing capacity, such as Vietnam. We conducted surveillance of influenza and influenza-like illness in Vietnam through the National Influenza Surveillance System during 2006-2010. At 15 sentinel sites, the first two patients presenting each weekday with influenza-like illness (ILI), defined as fever and cough and/or sore throat with illness onset within 3 days, were enrolled and throat specimens were collected and tested for influenza virus type and influenza A subtype by RT-PCR. De-identified demographic and provider reported subsequent hospitalization information was collected on each patient. Each site also collected information on the total number of patients with influenza-like illness evaluated per week. Of 29,804 enrolled patients presenting with influenza-like illness, 6516 (22%) were influenza positive. Of enrolled patients, 2737 (9.3%) were reported as subsequently hospitalized; of the 2737, 527 (19%) were influenza positive. Across all age groups with ILI, school-aged children had the highest percent of influenza infection (29%) and the highest percent of subsequent hospitalizations associated with influenza infection (28%). Influenza viruses co-circulated throughout most years in Vietnam during 2006-2010 and often reached peak levels multiple times during a year, when >20% of tests were influenza positive. Influenza is an important cause of all influenza-like illness and provider reported subsequent hospitalization among outpatients in Vietnam, especially among school-aged children. These findings may have important implications for influenza vaccine policy in Vietnam.

  11. First Use of Multiple Imputation with the National Tuberculosis Surveillance System

    Directory of Open Access Journals (Sweden)

    Christopher Vinnard

    2013-01-01

    Full Text Available Aims. The purpose of this study was to compare methods for handling missing data in analysis of the National Tuberculosis Surveillance System of the Centers for Disease Control and Prevention. Because of the high rate of missing human immunodeficiency virus (HIV infection status in this dataset, we used multiple imputation methods to minimize the bias that may result from less sophisticated methods. Methods. We compared analysis based on multiple imputation methods with analysis based on deleting subjects with missing covariate data from regression analysis (case exclusion, and determined whether the use of increasing numbers of imputed datasets would lead to changes in the estimated association between isoniazid resistance and death. Results. Following multiple imputation, the odds ratio for initial isoniazid resistance and death was 2.07 (95% CI 1.30, 3.29; with case exclusion, this odds ratio decreased to 1.53 (95% CI 0.83, 2.83. The use of more than 5 imputed datasets did not substantively change the results. Conclusions. Our experience with the National Tuberculosis Surveillance System dataset supports the use of multiple imputation methods in epidemiologic analysis, but also demonstrates that close attention should be paid to the potential impact of missing covariates at each step of the analysis.

  12. Evaluation of the national Notifiable Diseases Surveillance System for dengue fever in Taiwan, 2010-2012.

    Directory of Open Access Journals (Sweden)

    Caoimhe McKerr

    2015-03-01

    Full Text Available In Taiwan, around 1,500 cases of dengue fever are reported annually and incidence has been increasing over time. A national web-based Notifiable Diseases Surveillance System (NDSS has been in operation since 1997 to monitor incidence and trends and support case and outbreak management. We present the findings of an evaluation of the NDSS to ascertain the extent to which dengue fever surveillance objectives are being achieved.We extracted the NDSS data on all laboratory-confirmed dengue fever cases reported during 1 January 2010 to 31 December 2012 to assess and describe key system attributes based on the Centers for Disease Control and Prevention surveillance evaluation guidelines. The system's structure and processes were delineated and operational staff interviewed using a semi-structured questionnaire. Crude and age-adjusted incidence rates were calculated and key demographic variables were summarised to describe reporting activity. Data completeness and validity were described across several variables.Of 5,072 laboratory-confirmed dengue fever cases reported during 2010-2012, 4,740 (93% were reported during July to December. The system was judged to be simple due to its minimal reporting steps. Data collected on key variables were correctly formatted and usable in > 90% of cases, demonstrating good data completeness and validity. The information collected was considered relevant by users with high acceptability. Adherence to guidelines for 24-hour reporting was 99%. Of 720 cases (14% recorded as travel-related, 111 (15% had an onset >14 days after return, highlighting the potential for misclassification. Information on hospitalization was missing for 22% of cases. The calculated PVP was 43%.The NDSS for dengue fever surveillance is a robust, well maintained and acceptable system that supports the collection of complete and valid data needed to achieve the surveillance objectives. The simplicity of the system engenders compliance leading to

  13. Evaluation of the National Notifiable Diseases Surveillance System for Dengue Fever in Taiwan, 2010–2012

    Science.gov (United States)

    McKerr, Caoimhe; Lo, Yi-Chun; Edeghere, Obaghe; Bracebridge, Sam

    2015-01-01

    Background In Taiwan, around 1,500 cases of dengue fever are reported annually and incidence has been increasing over time. A national web-based Notifiable Diseases Surveillance System (NDSS) has been in operation since 1997 to monitor incidence and trends and support case and outbreak management. We present the findings of an evaluation of the NDSS to ascertain the extent to which dengue fever surveillance objectives are being achieved. Methodology We extracted the NDSS data on all laboratory-confirmed dengue fever cases reported during 1 January 2010 to 31 December 2012 to assess and describe key system attributes based on the Centers for Disease Control and Prevention surveillance evaluation guidelines. The system’s structure and processes were delineated and operational staff interviewed using a semi-structured questionnaire. Crude and age-adjusted incidence rates were calculated and key demographic variables were summarised to describe reporting activity. Data completeness and validity were described across several variables. Principal Findings Of 5,072 laboratory-confirmed dengue fever cases reported during 2010–2012, 4,740 (93%) were reported during July to December. The system was judged to be simple due to its minimal reporting steps. Data collected on key variables were correctly formatted and usable in > 90% of cases, demonstrating good data completeness and validity. The information collected was considered relevant by users with high acceptability. Adherence to guidelines for 24-hour reporting was 99%. Of 720 cases (14%) recorded as travel-related, 111 (15%) had an onset >14 days after return, highlighting the potential for misclassification. Information on hospitalization was missing for 22% of cases. The calculated PVP was 43%. Conclusions/Significance The NDSS for dengue fever surveillance is a robust, well maintained and acceptable system that supports the collection of complete and valid data needed to achieve the surveillance objectives. The

  14. Evaluation of the national Notifiable Diseases Surveillance System for dengue fever in Taiwan, 2010-2012.

    Science.gov (United States)

    McKerr, Caoimhe; Lo, Yi-Chun; Edeghere, Obaghe; Bracebridge, Sam

    2015-03-01

    In Taiwan, around 1,500 cases of dengue fever are reported annually and incidence has been increasing over time. A national web-based Notifiable Diseases Surveillance System (NDSS) has been in operation since 1997 to monitor incidence and trends and support case and outbreak management. We present the findings of an evaluation of the NDSS to ascertain the extent to which dengue fever surveillance objectives are being achieved. We extracted the NDSS data on all laboratory-confirmed dengue fever cases reported during 1 January 2010 to 31 December 2012 to assess and describe key system attributes based on the Centers for Disease Control and Prevention surveillance evaluation guidelines. The system's structure and processes were delineated and operational staff interviewed using a semi-structured questionnaire. Crude and age-adjusted incidence rates were calculated and key demographic variables were summarised to describe reporting activity. Data completeness and validity were described across several variables. Of 5,072 laboratory-confirmed dengue fever cases reported during 2010-2012, 4,740 (93%) were reported during July to December. The system was judged to be simple due to its minimal reporting steps. Data collected on key variables were correctly formatted and usable in > 90% of cases, demonstrating good data completeness and validity. The information collected was considered relevant by users with high acceptability. Adherence to guidelines for 24-hour reporting was 99%. Of 720 cases (14%) recorded as travel-related, 111 (15%) had an onset >14 days after return, highlighting the potential for misclassification. Information on hospitalization was missing for 22% of cases. The calculated PVP was 43%. The NDSS for dengue fever surveillance is a robust, well maintained and acceptable system that supports the collection of complete and valid data needed to achieve the surveillance objectives. The simplicity of the system engenders compliance leading to timely and

  15. Australia's notifiable disease status, 2014: Annual report of the National Notifiable Diseases Surveillance System.

    Science.gov (United States)

    2016-03-31

    In 2014, 69 diseases and conditions were nationally notifiable in Australia. States and territories reported a total of 275,581 notifications of communicable diseases to the National Notifiable Diseases Surveillance System, an increase of 22% on the number of notifications in 2013. In 2014, the most frequently notified diseases were sexually transmissible infections (105,719 notifications, 38% of total notifications), vaccine preventable diseases (101,400 notifications, 37% of total notifications), and gastrointestinal diseases (40,367 notifications, 15% of total notifications). There were 17,411 notifications of bloodborne diseases; 8,125 notifications of vectorborne diseases; 1,942 notifications of other bacterial infections; 615 notifications of zoonoses and 2 notifications of quarantinable diseases.

  16. HIV-1 Subtype distribution in morocco based on national sentinel surveillance data 2004-2005

    Directory of Open Access Journals (Sweden)

    Akrim Mohammed

    2012-02-01

    Full Text Available Abstract Background Little is known about HIV-1 subtype distribution in Morocco. Some data suggest an emergence of new HIV subtypes. We conducted phylogenetic analysis on a nationally representative sample of 60 HIV-1 viral specimens collected during 2004-2005 through the Morocco national HIV sentinel surveillance survey. Results While subtype B is still the most prevalent, 23.3% of samples represented non-B subtypes, the majority of which were classified as CRF02_AG (15%. Molecular clock analysis confirmed that the initial introduction of HIV-1B in Morocco probably came from Europe in the early 1980s. In contrast, the CRF02_AG strain appeared to be introduced from sub-Saharan Africa in two separate events in the 1990s. Conclusions Subtype CRF02_AG has been emerging in Morocco since the 1990s. More information about the factors introducing HIV subtype-specific transmission will inform the prevention strategy in the region.

  17. [The National Health Surveillance Agency, ANVISA, and clinical research in Brazil].

    Science.gov (United States)

    Nishioka, Sérgio de Andrade; Sá, Paula Frassineti Guimarães de

    2006-01-01

    Conduction of clinical trials with drugs in Brazil requires prior approval by Committees for Ethics in Research (CEPs) and, in certain cases, by the National Commission for Ethics in Research (CONEP). Approval by the National Health Surveillance Agency (ANVISA), through its Office for New Drugs, Research and Clinical Trials (GEPEC), is currently required only for drugs and medical devices manufactured in other countries and therefore need permission to be imported. This article briefly reviews the history of clinical research regulation in Brazil, then presents an overview of the current regulatory role of ANVISA and its future prospective. Major points discussed are the new forthcoming ANVISA regulations, with emphasis on adverse event notifications and inspections/audits on clinical trials and their impact on clinical research in Brazil, from the standpoint of the industry, university, contract research organizations, physicians and other health professionals. It should be stressed that to decide upon the licensing of new drugs ANVISA must obtain information from clinical trials.

  18. Nation-wide Salmonella enterica surveillance and control in Danish slaughter swine herds

    DEFF Research Database (Denmark)

    Mousing, Jan; Jensen, P.T.; Halgaard, C.

    1997-01-01

    A nation-wide Salmonella enterica surveillance and control programme was initiated in Danish finishing herds over the first quarter of 1995, In Denmark, all swine for slaughter are identifiable by a unique herd code. For each herd code, and depending on the herd's annual kill, random samples...... ranging from four to more than 60 swine are obtained quarterly at the abattoir. A meat sample from each pig is frozen, and meat juice (harvested after thawing) is examined for specific antibodies against S. enterica using an indirect enzyme-linked immunosorbent assay (ELISA). The ELISA combines several S.......0% of the total kill. In December 1995, 15 522 herds (representing > 90% of the national production) were categorized into one of the three levels: 14 551 herds (93.7%) in Level 1; 610 herds (3.9%) in Level 2; 361 herds (2.3%) in Level 3. The proportion of serologically positive meat-juice samples collected...

  19. Advancing environmental health surveillance in the US through a national human biomonitoring network.

    Science.gov (United States)

    Latshaw, Megan Weil; Degeberg, Ruhiyyih; Patel, Surili Sutaria; Rhodes, Blaine; King, Ewa; Chaudhuri, Sanwat; Nassif, Julianne

    2016-09-17

    The United States lacks a comprehensive, nationally-coordinated, state-based environmental health surveillance system. This lack of infrastructure leads to: • varying levels of understanding of chemical exposures at the state & local levels • often inefficient public health responses to chemical exposure emergencies (such as those that occurred in the Flint drinking water crisis, the Gold King mine spill, the Elk river spill and the Gulf Coast oil spill) • reduced ability to measure the impact of public health interventions or environmental policies • less efficient use of resources for cleaning up environmental contamination Establishing the National Biomonitoring Network serves as a step toward building a national, state-based environmental health surveillance system. The Network builds upon CDC investments in emergency preparedness and environmental public health tracking, which have created advanced chemical analysis and information sharing capabilities in the state public health systems. The short-term goal of the network is to harmonize approaches to human biomonitoring in the US, thus increasing the comparability of human biomonitoring data across states and communities. The long-term goal is to compile baseline data on exposures at the state level, similar to data found in CDC's National Report on Human Exposure to Environmental Chemicals. Barriers to success for this network include: available resources, effective risk communication strategies, data comparability & sharing, and political will. Anticipated benefits include high quality data on which to base public health and environmental decisions, data with which to assess the success of public health interventions, improved risk assessments for chemicals, and new ways to prioritize environmental health research.

  20. Antimicrobial Use and Resistance in Australia (AURA) surveillance system: coordinating national data on antimicrobial use and resistance for Australia.

    Science.gov (United States)

    Turnidge, John D; Meleady, Kathy T

    2017-06-22

    Objective The aim of the present study was to describe the process of establishment and coordination of the national Antimicrobial Use and Resistance in Australia (AURA) surveillance system.Methods Existing surveillance programs conducted by health organisations at state or multi-jurisdictional levels were reviewed, and gaps and opportunities identified for the development of a national system. In view of the time frame available as part of the Australian Government Department of Health funding agreement, the strategy used by the Australian Commission on Safety and Quality in Health Care was to commence work with existing surveillance programs, expanding and enhancing them and developing new systems where gaps were identified. Using the specifications of the AURA national system, the data from each of these elements were then analysed and reported. The system provides coverage for the acute and community sectors for antimicrobial use and antimicrobial resistance.Results The AURA surveillance system integrates eight streams of surveillance activities, including passive and targeted surveillance of antimicrobial use and resistance from hospitals (public and private) and the community (general practitioners and aged care homes). A gap was identified in timely surveillance of critical antimicrobial resistances (CARs), which resulted in the development of the national CARAlert system. The first comprehensive analyses of data across the surveillance programs was published in June 2016, providing baseline data for future reports to build on.Conclusion The AURA surveillance system has established the framework and foundation systems for an integrated and comprehensive picture of both antimicrobial use and resistance in Australia over time. National coordination and support will improve data collection, standardisation and analysis, and will facilitate collaboration across the states and territories, the Australian Government and the private sector. AURA publications will

  1. Cost effective solar Inverter

    Directory of Open Access Journals (Sweden)

    Nagarathna M

    2015-06-01

    Full Text Available Solar energy the most efficient, eco-friendly and abundantly available energy source in the nature. It can be converted into electrical energy in cost effective manner. In recent years, the interest in solar energy has risen due to surging oil prices and environmental concern. In many remote or underdeveloped areas, direct access to an electric grid is impossible and a photovoltaic inverter system would make life much simpler and more convenient. With this in mind, it is aimed to design, build, and test a solar panel inverter. This inverter system could be used as backup power during outages, battery charging, or for typical household applications. The main components of this solar system are solar cell, dc to dc boost converters, and inverter. Sine wave push pull inverter topology is used for inverter. In this topology only two MOSFETs are used and isolation requirement between control circuit and power circuit is also less which helps to decrease the cost of solar inverter.

  2. 1995 annual epidemiologic surveillance report for Sandia National Laboratory-Albuquerque

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-12-31

    The US Department of Energy`s (DOE`s) conduct of epidemiologic surveillance provides an early warning system for health problems among workers. This program monitors illnesses and injuries that result in an absence of five or more consecutive workdays, occupational injuries and illnesses, and disabilities and deaths among current workers. This report provides a summary of epidemiologic surveillance data collected from the Sandia National Laboratory-Albuquerque (SNL-AL) from January 1, 1995 through December 31, 1995. The data were collected by a coordinator at SNL-AL and submitted to the Epidemiologic Surveillance Data Center, located at Oak Ridge Institute for Science and Education, where quality control procedures and data analyses were carried out. The annual report for 1995 has been redesigned from reports for previous years. Most of the information in the previous reports is also in this report, but some material now appears in the appendices instead of the main body of the report. The information presented in the main body of the report provides a descriptive analysis of the data collected from the site and the appendices provide more detail. A new section of the report presents trends in health over time. The Glossary and an Explanation of Diagnostic Categories have been expanded with more examples of diagnoses to illustrate the content of each category. The data presented here apply only to SNL-AL. The DOE sites are varied, so comparisons of SNL-AL with other DOE sites should be made with caution. It is important to keep in mind that many factors can affect the completeness and accuracy of health information collected at the sites as well as affect patterns of illness and injury observed.

  3. Radioactive contamination in the marine environment. Report no. 3 from the national surveillance programme

    Energy Technology Data Exchange (ETDEWEB)

    Brungot, A.L.; Foeyn, L.; Caroll, J.L.; Kolstad, A.K.; Brown, J.; Rudjord, A.L.; Boee, B.; Hellstroem, T

    1999-07-01

    The data collected as part of the National Surveillance Programme indicate that radioactivity in the water surrounding Norway remains at low levels. In fish and shrimps, {sup 137}Cs activity concentrations are approximately 1.2 Bq/kg or less. {sup 137}Cs levels in the water surrounding Norway have decreased significantly since their peak concentrations detected around 1980. However, in recent years the variation in radiocesium concentration in the sea water can largely be explained by variations in the water exchange with the Baltic Sea. The influence of Chernobyl fallout on the concentrations of these radionuclides is clearly seen. The levels decrease with increasing distance away from the Baltic Sea. Other radionuclides, i.e. {sup 238}Pu, {sup 239,240}Pu, {sup 60}Co and {sup 241}Am were found in low concentrations only. The reprocessing plant at Sellafield in United Kingdom began operating a new waste treatment in 1994. This has resulted in changes in the composition of radionuclides being discharged into the sea as waste. As a result, the concentration of {sup 99}Tc in the waters surrounding Norway has increased in recent years and the highest levels of radioactivity detected in marine biota during the surveillance program were for {sup 99}Tc in lobster. The increase in {sup 99}Tc is also clearly observed in seaweed.

  4. State health department perceived utility of and satisfaction with ArboNET, the U.S. National Arboviral Surveillance System.

    Science.gov (United States)

    Lindsey, Nicole P; Brown, Jennifer A; Kightlinger, Lon; Rosenberg, Lauren; Fischer, Marc

    2012-01-01

    We assessed the perceived utility of data collected through ArboNET, the national arboviral surveillance system, and evaluated state health department user satisfaction with system function. We used an online assessment tool to collect information about types of arboviral surveillance conducted, user satisfaction with ArboNET's performance, and use of data collected by the system. Representatives of all 53 reporting jurisdictions were asked to complete the assessment during spring 2009. Representatives of 48 (91%) jurisdictions completed the assessment. Two-thirds of respondents were satisfied with ArboNET's overall performance. Most concerns were related to data transmission, particularly the lack of compatibility with the National Electronic Disease Surveillance System (NEDSS). Users found mosquito (85%), human disease (80%), viremic blood donor (79%), and veterinary disease (75%) surveillance data to be useful. While there was disagreement about the usefulness of avian mortality and sentinel animal surveillance, only 15% of users supported eliminating these categories. Respondents found weekly maps and tables posted on the U.S. Geological Survey (92%) and CDC (88%) websites to be the most useful reports generated from ArboNET data. Although many jurisdictions were willing to report additional clinical or laboratory data, time and resource constraints were considerations. Most respondents (71%) supported review and possible revision of the national case definition for human arboviral disease. As a result of this assessment, CDC and partner organizations have made ArboNET NEDSS-compatible and revised national case definitions for arboviral disease. Alternative data-sharing and reporting options are also being considered. Continued evaluation of ArboNET will help ensure that it continues to be a useful tool for national arboviral disease surveillance.

  5. National Automated Surveillance of Hospital-Acquired Bacteremia in Denmark Using a Computer Algorithm.

    Science.gov (United States)

    Gubbels, Sophie; Nielsen, Jens; Voldstedlund, Marianne; Kristensen, Brian; Schønheyder, Henrik C; Ellermann-Eriksen, Svend; Engberg, Jørgen H; Møller, Jens K; Østergaard, Christian; Mølbak, Kåre

    2017-03-09

    BACKGROUND In 2015, Denmark launched an automated surveillance system for hospital-acquired infections, the Hospital-Acquired Infections Database (HAIBA). OBJECTIVE To describe the algorithm used in HAIBA, to determine its concordance with point prevalence surveys (PPSs), and to present trends for hospital-acquired bacteremia SETTING Private and public hospitals in Denmark METHODS A hospital-acquired bacteremia case was defined as at least 1 positive blood culture with at least 1 pathogen (bacterium or fungus) taken between 48 hours after admission and 48 hours after discharge, using the Danish Microbiology Database and the Danish National Patient Registry. PPSs performed in 2012 and 2013 were used for comparison. RESULTS National trends showed an increase in HA bacteremia cases between 2010 and 2014. Incidence was higher for men than women (9.6 vs 5.4 per 10,000 risk days) and was highest for those aged 61-80 years (9.5 per 10,000 risk days). The median daily prevalence was 3.1% (range, 2.1%-4.7%). Regional incidence varied from 6.1 to 8.1 per 10,000 risk days. The microorganisms identified were typical for HA bacteremia. Comparison of HAIBA with PPS showed a sensitivity of 36% and a specificity of 99%. HAIBA was less sensitive for patients in hematology departments and intensive care units. Excluding these departments improved the sensitivity of HAIBA to 44%. CONCLUSIONS Although the estimated sensitivity of HAIBA compared with PPS is low, a PPS is not a gold standard. Given the many advantages of automated surveillance, HAIBA allows monitoring of HA bacteremia across the healthcare system, supports prioritizing preventive measures, and holds promise for evaluating interventions. Infect Control Hosp Epidemiol 2017;1-8.

  6. [Integration of health surveillance and women's health care: a study on comprehensiveness in the Unified National Health System].

    Science.gov (United States)

    Maia, Christiane; Guilhem, Dirce; Lucchese, Geraldo

    2010-04-01

    Comprehensiveness is a key principle in Brazil's Unified National Health System (SUS), approached from various perspectives, including linkage between services. The debate on this principle appears in health care, especially in the area of Women's Health, and in Health Surveillance guidelines. Since both areas target quality of health services, the aim of this study is to analyze the integration between Health Surveillance and Women's Health Care. This is a qualitative case study that interviewed Health Surveillance staff in health services and coordinators of Women's Health services. The findings point to the isolation of Health Surveillance within the health secretariats. The importance of integrating the two areas is cited by Women's Health administrators, but it is difficult to implement. Collaborative relations only occur in emergency situations. The Health Surveillance professionals believe that this lack of integration is due to the fact that women's health issues do not require their participation, and that at any rate they collaborate with the area through health inspections and talks. The study detected difficulties in achieving integration between the two areas, with the persistent challenge of linking health actions, especially with Health Surveillance.

  7. Economic impact of dengue illness and the cost-effectiveness of future vaccination programs in Singapore.

    Directory of Open Access Journals (Sweden)

    Luis R Carrasco

    2011-12-01

    Full Text Available BACKGROUND: Dengue illness causes 50-100 million infections worldwide and threatens 2.5 billion people in the tropical and subtropical regions. Little is known about the disease burden and economic impact of dengue in higher resourced countries or the cost-effectiveness of potential dengue vaccines in such settings. METHODS AND FINDINGS: We estimate the direct and indirect costs of dengue from hospitalized and ambulatory cases in Singapore. We consider inter alia the impacts of dengue on the economy using the human-capital and the friction cost methods. Disease burden was estimated using disability-adjusted life years (DALYs and the cost-effectiveness of a potential vaccine program was evaluated. The average economic impact of dengue illness in Singapore from 2000 to 2009 in constant 2010 US$ ranged between $0.85 billion and $1.15 billion, of which control costs constitute 42%-59%. Using empirically derived disability weights, we estimated an annual average disease burden of 9-14 DALYs per 100 000 habitants, making it comparable to diseases such as hepatitis B or syphilis. The proportion of symptomatic dengue cases detected by the national surveillance system was estimated to be low, and to decrease with age. Under population projections by the United Nations, the price per dose threshold for which vaccines stop being more cost-effective than the current vector control program ranged from $50 for mass vaccination requiring 3 doses and only conferring 10 years of immunity to $300 for vaccination requiring 2 doses and conferring lifetime immunity. The thresholds for these vaccine programs to not be cost-effective for Singapore were $100 and $500 per dose respectively. CONCLUSIONS: Dengue illness presents a serious economic and disease burden in Singapore. Dengue vaccines are expected to be cost-effective if reasonably low prices are adopted and will help to reduce the economic and disease burden of dengue in Singapore substantially.

  8. Road traffic related mortality in Vietnam: Evidence for policy from a national sample mortality surveillance system

    Directory of Open Access Journals (Sweden)

    Ngo Anh D

    2012-07-01

    Full Text Available Abstract Background Road traffic injuries (RTIs are among the leading causes of mortality in Vietnam. However, mortality data collection systems in Vietnam in general and for RTIs in particular, remain inconsistent and incomplete. Underlying distributions of external causes and body injuries are not available from routine data collection systems or from studies till date. This paper presents characteristics, user type pattern, seasonal distribution, and causes of 1,061 deaths attributable to road crashes ascertained from a national sample mortality surveillance system in Vietnam over a two-year period (2008 and 2009. Methods A sample mortality surveillance system was designed for Vietnam, comprising 192 communes in 16 provinces, accounting for approximately 3% of the Vietnamese population. Deaths were identified from commune level data sources, and followed up by verbal autopsy (VA based ascertainment of cause of death. Age-standardised mortality rates from RTIs were computed. VA questionnaires were analysed in depth to derive descriptive characteristics of RTI deaths in the sample. Results The age-standardized mortality rates from RTIs were 33.5 and 8.5 per 100,000 for males and females respectively. Majority of deaths were males (79%. Seventy three percent of all deaths were aged from 15 to 49 years and 58% were motorcycle users. As high as 80% of deaths occurred on the day of injury, 42% occurred prior to arrival at hospital, and a further 29% occurred on-site. Direct causes of death were identified for 446 deaths (42% with head injuries being the most common cause attributable to road traffic injuries overall (79% and to motorcycle crashes in particular (78%. Conclusion The VA method can provide a useful data source to analyse RTI mortality. The observed considerable mortality from head injuries among motorcycle users highlights the need to evaluate current practice and effectiveness of motorcycle helmet use in Vietnam. The high number of

  9. Social determinants and risk factors for tuberculosis in national surveillance systems in Europe.

    Science.gov (United States)

    de Colombani, P; Hovhannesyan, A

    2015-09-21

    Contexte : Programmes nationaux contre la tuberculose (PNT) des 53 états membres de la région Europe de l'Organisation Mondiale de la Santé (OMS).Objectifs: Identifier les déterminants sociaux et les facteurs de risque sous-jacents de la tuberculose (TB) tels qu'ils sont suivis en routine par les PNT et identifier ceux qui sont faciles à recueillir et appropriés pour les inclure dans le rapport annuel à la plate-forme conjointe du Centre européen de prévention et contrôle des maladies (CEPCM) et l'OMS.Schéma : Un questionnaire semi-structuré a été envoyé à 53 correspondants des programmes nationaux de surveillance de la TB.Résultats : Au total, 47 pays ont soumis leurs questionnaires ; la plupart des pays recueillent un certain nombre de déterminants sociaux et de facteurs de risque qui ne sont pas exigés dans les rapports destinés à la plate-forme conjointe CEPCM-OMS. Profession, absence de domicile fixe, diabète et consommation d'alcool sont recueillis par la majorité des pays, mais sans définitions standardisées.Conclusions : Quatre déterminants sociaux/facteurs de risque sont déjà inclus dans le système national de surveillance de la TB dans la majorité des pays et pourraient être incorporés dans le rapport annuel à la plate-forme conjointe CEPCM/OMS. Mais il faut adopter des définitions de cas épidémiologiques standardisées.

  10. Comparative cost-effectiveness of robot-assisted and standard laparoscopic prostatectomy as alternatives to open radical prostatectomy for treatment of men with localised prostate cancer: a health technology assessment from the perspective of the UK National Health Service.

    Science.gov (United States)

    Close, Andrew; Robertson, Clare; Rushton, Stephen; Shirley, Mark; Vale, Luke; Ramsay, Craig; Pickard, Robert

    2013-09-01

    Robot-assisted laparoscopic prostatectomy is increasingly used compared with a standard laparoscopic technique, but it remains uncertain whether potential benefits offset higher costs. To determine the cost-effectiveness of robotic prostatectomy. We conducted a care pathway description and model-based cost-utility analysis. We studied men with localised prostate cancer able to undergo either robotic or laparoscopic prostatectomy for cure. We used data from a meta-analysis, other published literature, and costs from the UK National Health Service and commercial sources. Care received by men for 10 yr following radical prostatectomy was modelled. Clinical events, their effect on quality of life, and associated costs were synthesised assuming 200 procedures were performed annually. Over 10 yr, robotic prostatectomy was on average (95% confidence interval [CI]) £1412 (€1595) (£1304 [€1473] to £1516 [€1713]) more costly than laparoscopic prostatectomy but more effective with mean (95% CI) gain in quality-adjusted life-years (QALYs) of 0.08 (0.01-0.15). The incremental cost-effectiveness ratio (ICER) was £18 329 (€20 708) with an 80% probability that robotic prostatectomy was cost effective at a threshold of £30 000 (€33 894)/QALY. The ICER was sensitive to the throughput of cases and the relative positive margin rate favouring robotic prostatectomy. Higher costs of robotic prostatectomy may be offset by modest health gain resulting from lower risk of early harms and positive margin, provided >150 cases are performed each year. Considerable uncertainty persists in the absence of directly comparative randomised data. Copyright © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  11. Antimalarial Drug Resistance: Surveillance and Molecular Methods for National Malaria Control Programmes

    Directory of Open Access Journals (Sweden)

    Umberto D'Alessandro

    1998-09-01

    Full Text Available National malaria control programmes have the responsibility to develop a policy for malaria disease management based on a set of defined criteria as efficacy, side effects, costs and compliance. These will fluctuate over time and national guidelines will require periodic re-assessment and revision. Changing a drug policy is a major undertaking that can take several years before being fully operational. The standard methods on which a decision can be taken are the in vivo and the in vitro tests. The latter allow a quantitative measurement of the drug response and the assessment of several drugs at once. However, in terms of drug policy change its results might be difficult to interpret although they may be used as an early warning system for 2nd or 3rd line drugs. The new WHO 14-days in vivo test addresses mainly the problem of treatment failure and of haematological parameters changes in sick children. It gives valuable information on whether a drug still `works'. None of these methods are well suited for large-scale studies. Molecular methods based on detection of mutations in parasite molecules targeted by antimalarial drugs could be attractive tools for surveillance. However, their relationship with in vivo test results needs to be established

  12. [Influenza surveillance in nine consecutive seasons, 2003-2012: results from National Influenza Reference Laboratory, Istanbul Faculty Of Medicine, Turkey].

    Science.gov (United States)

    Akçay Ciblak, Meral; Kanturvardar Tütenyurd, Melis; Asar, Serkan; Tulunoğlu, Merve; Fındıkçı, Nurcihan; Badur, Selim

    2012-10-01

    Influenza is a public health problem that affects 5-20% of the world population annually causing high morbidity and mortality especially in risk groups. In addition to determining prevention and treatment strategies with vaccines and antivirals, surveillance data plays an important role in combat against influenza. Surveillance provides valuable data on characteristics of influenza activity, on types, sub-types, antigenic properties and antiviral resistance profile of circulating viruses in a given region. The first influenza surveillance was initiated as a pilot study in 2003 by now named National Influenza Reference Laboratory, Istanbul Faculty of Medicine. Surveillance was launched at national level by Ministry of Health in 2004 and two National Influenza Laboratories, one in Istanbul and the other in Ankara, have been conducting surveillance in Turkey. Surveillance data obtained for nine consecutive years, 2003-2012, by National Influenza Reference Laboratory in Istanbul Faculty of Medicine have been summarized in this report. During 2003-2012 influenza surveillance seasons, a total of 11.077 nasal swabs collected in viral transport medium were sent to the National Influenza Reference Laboratory, Istanbul for analysis. Immun-capture ELISA followed by MDCK cell culture was used for detection of influenza viruses before 2009 and real-time RT-PCR was used thereafter. Antigenic characterizations were done by hemagglutination inhibition assay with the reactives supplied by World Health Organization. Analysis of the results showed that influenza B viruses have entered the circulation in 2005-2006 seasons, and have contributed to the epidemics at increasing rates every year except in the 2009 pandemic season. Influenza B Victoria and Yamagata lineages were cocirculating for two seasons. For other seasons either lineage was in circulation. Antigenic characterization revealed that circulating B viruses matched the vaccine composition either partially or totally for only

  13. The Cost-Effectiveness of NBPTS Teacher Certification

    Science.gov (United States)

    Yeh, Stuart S.

    2010-01-01

    A cost-effectiveness analysis of the National Board for Professional Teaching Standards (NBPTS) program suggests that Board certification is less cost-effective than a range of alternative approaches for raising student achievement, including comprehensive school reform, class size reduction, a 10% increase in per pupil expenditure, the use of…

  14. Challenges in designing a national surveillance program for inflammatory bowel disease in the United States.

    Science.gov (United States)

    Long, Millie D; Hutfless, Susan; Kappelman, Michael D; Khalili, Hamed; Kaplan, Gilaad G; Bernstein, Charles N; Colombel, Jean Frederic; Gower-Rousseau, Corinne; Herrinton, Lisa; Velayos, Fernando; Loftus, Edward V; Nguyen, Geoffrey C; Ananthakrishnan, Ashwin N; Sonnenberg, Amnon; Chan, Andrew; Sandler, Robert S; Atreja, Ashish; Shah, Samir A; Rothman, Kenneth J; Leleiko, Neal S; Bright, Renee; Boffetta, Paolo; Myers, Kelly D; Sands, Bruce E

    2014-02-01

    This review describes the history of U.S. government funding for surveillance programs in inflammatory bowel diseases (IBD), provides current estimates of the incidence and prevalence of IBD in the United States, and enumerates a number of challenges faced by current and future IBD surveillance programs. A rationale for expanding the focus of IBD surveillance beyond counts of incidence and prevalence, to provide a greater understanding of the burden of IBD, disease etiology, and pathogenesis, is provided. Lessons learned from other countries are summarized, in addition to potential resources that may be used to optimize a new form of IBD surveillance in the United States. A consensus recommendation on the goals and available resources for a new model for disease surveillance are provided. This new model should focus on "surveillance of the burden of disease," including (1) natural history of disease and (2) outcomes and complications of the disease and/or treatments.

  15. 2003 Oak Ridge National Laboratory Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Security, Office of Illness and Injury Prevention Programs

    2007-05-23

    Annual Illness and Injury Surveillance Program report for 2003 for ORNL. The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of epidemiologic surveillance activities that provide an early warning system for health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence of workdays, occupational injuries and illnesses, and disabilities and deaths among current workers.

  16. 2012 Sexually Transmitted Diseases Surveillance

    Science.gov (United States)

    ... National Summary Chlamydia Gonorrhea Syphilis Chancroid Selected STDs Appendix Appendix Interpreting STD Surveillance Data Appendix Tables A1 - A4 STD Surveillance Case Definitions Contributors ...

  17. [Role of the National Poliovirus Laboratory for the Program of eradication and poliomyelitis surveillance].

    Science.gov (United States)

    Trallero, Gloria; Cabrerizo, María; Avellón, Ana

    2013-01-01

    The Spanish acute flaccid paralysis surveillance network is coordinated by the National Poliovirus Laboratory (NPL), which, since 1998, carries out polioviruses (PV) and other enteroviruses detected characterization by cell culture and molecular techniques. A total of 110,725 (70046+40679) samples were studied between 1998-2012 and enteroviruses were detected in 8% of these. Among these enteroviruses 241 PV were characterized as PV Sabin-like, except samples belong to an imported poliomyelitis case, all of which were characterised as vaccine derived PV type 2. The NPL has carried out the serotyping and the intratypic differentiation of all the isolated PV in Spain of any syndrome. It is shown that wild PV has not circulated in our country during the 15 years studied and that has led to the signing of the Act of the "eradication of poliomyelitis in Spain" by WHO in 2001, and the /"certification of the eradication of wild PV free for European countries" on 21 June 2002. Currently only 3 countries have endemic transmission of wild PV (Pakistan, Afghanistan and Nigeria). Until a complete worldwide eradication, was achieved, Spain will actively continue to participate in the maintenance of the poliomyelitis eradication infrastructure by monitoring and vaccination as well as the wild PV containment plan to avoid the spread of wild PV.

  18. [The Brazilian National Health Surveillance Agency performance evaluation at the management contract model].

    Science.gov (United States)

    Moreira, Elka Maltez de Miranda; Costa, Ediná Alves

    2010-11-01

    The Brazilian National Health Surveillance Agency (Anvisa) is supervised by the Ministry of Health by means of a management contract, a performance evaluation tool. This case study was aimed at describing and analyzing Anvisa's performance evaluation model based on the agency's institutional purpose, according to the following analytical categories: the management contract formalization, evaluation tools, evaluators and institutional performance. Semi-structured interviews and document analysis revealed that Anvisa signed only one management contract with the Ministry of Health in 1999, updated by four additive terms. The Collegiate Board of Directors and the Advisory Center for Strategic Management play the role of Anvisa's internal evaluators and an Assessing Committee, comprising the Ministry of Health, constitutes its external evaluator. Three phases were identified in the evaluation model: the structuring of the new management model (1999-2000), legitimation regarding the productive segment (2001-2004) and widespread legitimation (2005). The best performance was presented in 2000 (86.05%) and the worst in 2004 (40.00%). The evaluation model was shown to have contributed little towards the agency's institutional purpose and the effectiveness measurement of the implemented actions.

  19. Integrated Disease Investigations and Surveillance planning: a systems approach to strengthening national surveillance and detection of events of public health importance in support of the International Health Regulations.

    Science.gov (United States)

    Taboy, Celine H; Chapman, Will; Albetkova, Adilya; Kennedy, Sarah; Rayfield, Mark A

    2010-12-03

    The international community continues to define common strategic themes of actions to improve global partnership and international collaborations in order to protect our populations. The International Health Regulations (IHR[2005]) offer one of these strategic themes whereby World Health Organization (WHO) Member States and global partners engaged in biosecurity, biosurveillance and public health can define commonalities and leverage their respective missions and resources to optimize interventions. The U.S. Defense Threat Reduction Agency's Cooperative Biological Engagement Program (CBEP) works with partner countries across clinical, veterinary, epidemiological, and laboratory communities to enhance national disease surveillance, detection, diagnostic, and reporting capabilities. CBEP, like many other capacity building programs, has wrestled with ways to improve partner country buy-in and ownership and to develop sustainable solutions that impact integrated disease surveillance outcomes. Designing successful implementation strategies represents a complex and challenging exercise and requires robust and transparent collaboration at the country level. To address this challenge, the Laboratory Systems Development Branch of the U.S. Centers for Disease Control and Prevention (CDC) and CBEP have partnered to create a set of tools that brings together key leadership of the surveillance system into a deliberate system design process. This process takes into account strengths and limitations of the existing system, how the components inter-connect and relate to one another, and how they can be systematically refined within the local context. The planning tools encourage cross-disciplinary thinking, critical evaluation and analysis of existing capabilities, and discussions across organizational and departmental lines toward a shared course of action and purpose. The underlying concepts and methodology of these tools are presented here.

  20. Integrated Disease Investigations and Surveillance planning: a systems approach to strengthening national surveillance and detection of events of public health importance in support of the International Health Regulations

    Directory of Open Access Journals (Sweden)

    Kennedy Sarah

    2010-12-01

    Full Text Available Abstract The international community continues to define common strategic themes of actions to improve global partnership and international collaborations in order to protect our populations. The International Health Regulations (IHR[2005] offer one of these strategic themes whereby World Health Organization (WHO Member States and global partners engaged in biosecurity, biosurveillance and public health can define commonalities and leverage their respective missions and resources to optimize interventions. The U.S. Defense Threat Reduction Agency’s Cooperative Biologica Engagement Program (CBEP works with partner countries across clinical, veterinary, epidemiological, and laboratory communities to enhance national disease surveillance, detection, diagnostic, and reporting capabilities. CBEP, like many other capacity building programs, has wrestled with ways to improve partner country buy-in and ownership and to develop sustainable solutions that impact integrated disease surveillance outcomes. Designing successful implementation strategies represents a complex and challenging exercise and requires robust and transparent collaboration at the country level. To address this challenge, the Laboratory Systems Development Branch of the U.S. Centers for Disease Control and Prevention (CDC and CBEP have partnered to create a set of tools that brings together key leadership of the surveillance system into a deliberate system design process. This process takes into account strengths and limitations of the existing system, how the components inter-connect and relate to one another, and how they can be systematically refined within the local context. The planning tools encourage cross-disciplinary thinking, critical evaluation and analysis of existing capabilities, and discussions across organizational and departmental lines toward a shared course of action and purpose. The underlying concepts and methodology of these tools are presented here.

  1. CCS in the North Sea region: A comparison on the cost-effectiveness of storing CO2 in the Utsira formation at regional and national scales

    DEFF Research Database (Denmark)

    Strachan, N.; Hoefnagels, R.; Ramirez, A.

    2011-01-01

    The potential scale of carbon dioxide capture and storage (CCS) under long-term decarbonisation scenarios means that analysis on the contribution of large international CO2 storage reservoirs is critical. This paper compares the potentially key role of CCS within cost-optimizing energy systems...... modelling at the national level (ensuring country-specific technical, economic and policy detail), and the regional level (ensuring transboundary electricity and CO2 trade). Analysis at alternate model scales investigates the full range of drivers on the feasibility and trade-offs in using the Utsira...... formation as a common North Sea CO2 storage resource. A robust finding is that low carbon electricity is a primary decarbonisation pathway and that CCS plays a key role (32–40%) within this portfolio. This paper confirms that the overall driver of the amount of CCS utilized is the climate policy...

  2. Low-Cost National Media-Based Surveillance System for Public Health Events, Bangladesh.

    Science.gov (United States)

    Ao, Trong T; Rahman, Mahmudur; Haque, Farhana; Chakraborty, Apurba; Hossain, M Jahangir; Haider, Sabbir; Alamgir, A S M; Sobel, Jeremy; Luby, Stephen P; Gurley, Emily S

    2016-04-01

    We assessed a media-based public health surveillance system in Bangladesh during 2010-2011. The system is a highly effective, low-cost, locally appropriate, and sustainable outbreak detection tool that could be used in other low-income, resource-poor settings to meet the capacity for surveillance outlined in the International Health Regulations 2005.

  3. Introducing infant and young child feeding indicators into national nutrition surveillance systems: lessons from Vietnam.

    Science.gov (United States)

    Hajeebhoy, Nemat; Nguyen, Phuong Hong; Tran, Do Thanh; de Onis, Mercedes

    2013-09-01

    A comprehensive set of infant and young child feeding (IYCF) indicators for international use was published in 2008. We describe the process followed to incorporate these indicators into Vietnam's National Nutrition Surveillance System (NNSS). Following its establishment in 1980, the National Institute of Nutrition introduced the Vietnam NNSS to provide an evidence base for nutrition interventions. While anthropometric indicators based on international standards were regularly used for programme purposes, data on IYCF could not be collected with similar rigor until 2010. In 2009, with support from Alive & Thrive and UNICEF, the NNSS questionnaire was reviewed and additional content incorporated to measure IYCF practices. The tool was pilot-tested in 10 provinces and revised before nationwide roll-out in 2010.The tool comprises four pages, the first three of which focus on collecting data relating to maternal nutrition and IYCF. The last page is flexibly designed to incorporate planners' data requests for other relevant activities (e.g. mass media interventions, food security). Once analysed, the data are presented in a report comprising provincial profiles and maps illustrating IYCF practices. Importantly, the IYCF data have been used for policy advocacy (e.g. maternity leave legislation, advertisement law), programme planning, trend monitoring and capacity building. Adoption of the IYCF indicators was successful due to strategic timing, a phased approach, buy-in from stakeholders and capacity building at all levels to ensure the quality and use of data. Further revisions to the NNSS (e.g. sampling methodology, quality assurance systems) will be important to ensure the reliability of indicators.

  4. Costs and cost-effectiveness of alternative tuberculosis ...

    African Journals Online (AJOL)

    Costs and cost-effectiveness of alternative tuberculosis management strategies in South ... important national implications, supporting the goals of the new tuberculosis control programme. ... DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT ...

  5. National Energy with Weather System Simultator (NEWS) Sets Bounds on Cost Effective Wind and Solar PV Deployment in the USA without the Use of Storage.

    Science.gov (United States)

    Clack, C.; MacDonald, A. E.; Alexander, A.; Dunbar, A. D.; Xie, Y.; Wilczak, J. M.

    2014-12-01

    The importance of weather-driven renewable energies for the United States energy portfolio is growing. The main perceived problems with weather-driven renewable energies are their intermittent nature, low power density, and high costs. In 2009, we began a large-scale investigation into the characteristics of weather-driven renewables. The project utilized the best available weather data assimilation model to compute high spatial and temporal resolution power datasets for the renewable resources of wind and solar PV. The weather model used is the Rapid Update Cycle for the years of 2006-2008. The team also collated a detailed electrical load dataset for the contiguous USA from the Federal Energy Regulatory Commission for the same three-year period. The coincident time series of electrical load and weather data allows the possibility of temporally correlated computations for optimal design over large geographic areas. The past two years have seen the development of a cost optimization mathematic model that designs electric power systems. The model plans the system and dispatches it on an hourly timescale. The system is designed to be reliable, reduce carbon, reduce variability of renewable resources and move the electricity about the whole domain. The system built would create the infrastructure needed to reduce carbon emissions to 0 by 2050. The advantages of the system is reduced water demain, dual incomes for farmers, jobs for construction of the infrastructure, and price stability for energy. One important simplified test that was run included existing US carbon free power sources, natural gas power when needed, and a High Voltage Direct Current power transmission network. This study shows that the costs and carbon emissions from an optimally designed national system decrease with geographic size. It shows that with achievable estimates of wind and solar generation costs, that the US could decrease its carbon emissions by up to 80% by the early 2030s, without an

  6. A new surveillance indicator identifying optimal timeliness and accuracy: application to the Korean National Notifiable Disease Surveillance System for 2001-2007.

    Science.gov (United States)

    Yoo, H S; Cho, S I; Lee, J K; Park, H K; Lee, E G; Kwon, J W

    2013-12-01

    Although immediate notification of a case is crucial for epidemic control, clinicians may delay notification due to uncertainties in diagnosis, reflecting a trade-off between timeliness and the accuracy of surveillance. We assessed this trade-off for four epidemic-prone diseases that require immediate notification of suspected cases: shigellosis, typhoid fever, paratyphoid fever, and cholera in the Korean National Notifiable Disease Surveillance System data for 2001-2007. Timeliness was measured as the time to registration (T R), being the time interval from symptom onset to notification by the clinician to the local public health centre. We introduced a new index, 'time-accuracy trade-off ratio' to indicate time saved by clinical vs. laboratory-based notifications. Clinical notifications comprised 34.4% of total notifications, and these showed a shorter median T R than laboratory-based notifications (1-4 days). The trade-off ratio was greatest for shigellosis (3.3 days), and smallest for typhoid fever (0.6 days). A higher trade-off ratio provides stronger evidence for clinical notification without waiting for laboratory confirmation.

  7. Accounting for incomplete postdischarge follow-up during surveillance of surgical site infection by use of the National Nosocomial Infections Surveillance system's risk index.

    Science.gov (United States)

    Biscione, Fernando Martín; Couto, Renato Camargos; Pedrosa, Tânia M G

    2009-05-01

    We examined the usefulness of a simple method to account for incomplete postdischarge follow-up during surveillance of surgical site infection (SSI) by use of the National Nosocomial Infections Surveillance (NNIS) system's risk index. Retrospective cohort study that used data prospectively collected from 1993 through 2006. Five private, nonuniversity healthcare facilities in Belo Horizonte, Brazil. Consecutive patients undergoing the following NNIS operative procedures: 20,981 operations on the genitourinary system, 11,930 abdominal hysterectomies, 7,696 herniorraphies, 6,002 cholecystectomies, and 6,892 laparotomies. For each operative procedure category, 2 SSI risk models were specified. First, a model based on the NNIS system's risk index variables was specified (hereafter referred to as the NNIS-based model). Second, a modified model (hereafter referred to as the modified NNIS-based model), which was also based on the NNIS system's risk index, was specified with a postdischarge surveillance indicator, which was assigned the value of 1 if the patient could be reached during follow-up and a value of 0 if the patient could not be reached. A formal comparison of the capabilities of the 2 models to assess the risk of SSI was conducted using measures of calibration (by use of the Pearson goodness-of-fit test) and discrimination (by use of receiver operating characteristic curves). Goodman-Kruskal correlations (G) were also calculated. The rate of incomplete postdischarge follow-up varied between 29.8% for abdominal hysterectomies and 50.5% for cholecystectomies. The modified NNIS-based model for laparotomy did not show any significant benefit over the NNIS-based model in any measure. For all other operative procedures, the modified NNIS-based model showed a significantly improved discriminatory ability and higher G statistics, compared with the NNIS-based model, with no significant impairment in calibration, except if used to assess the risk of SSI after operations

  8. A national surveillance project on chronic kidney disease management in Canadian primary care: a study protocol.

    Science.gov (United States)

    Bello, Aminu K; Ronksley, Paul E; Tangri, Navdeep; Singer, Alexander; Grill, Allan; Nitsch, Dorothea; Queenan, John A; Lindeman, Cliff; Soos, Boglarka; Freiheit, Elizabeth; Tuot, Delphine; Mangin, Dee; Drummond, Neil

    2017-08-04

    Effective chronic disease care is dependent on well-organised quality improvement (QI) strategies that monitor processes of care and outcomes for optimal care delivery. Although healthcare is provincially/territorially structured in Canada, there are national networks such as the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) as important facilitators for national QI-based studies to improve chronic disease care. The goal of our study is to improve the understanding of how patients with chronic kidney disease (CKD) are managed in primary care and the variation across practices and provinces and territories to drive improvements in care delivery. The CPCSSN database contains anonymised health information from the electronic medical records for patients of participating primary care practices (PCPs) across Canada (n=1200). The dataset includes information on patient sociodemographics, medications, laboratory results and comorbidities. Leveraging validated algorithms, case definitions and guidelines will help define CKD and the related processes of care, and these enable us to: (1) determine prevalent CKD burden; (2) ascertain the current practice pattern on risk identification and management of CKD and (3) study variation in care indicators (eg, achievement of blood pressure and proteinuria targets) and referral pattern for specialist kidney care. The process of care outcomes will be stratified across patients' demographics as well as provider and regional (provincial/territorial) characteristics. The prevalence of CKD stages 3-5 will be presented as age-sex standardised prevalence estimates stratified by province and as weighted averages for population rates with 95% CIs using census data. For each PCP, age-sex standardised prevalence will be calculated and compared with expected standardised prevalence estimates. The process-based outcomes will be defined using established methods. The CPCSSN is committed to high ethical standards when dealing with

  9. Horicon and Fox River National Wildlife Refuge: Chronic Wasting Disease Surveillance and Management Plan

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This CWD Plan for Horicon and Fox River NWRs provides background information on the disease and a summary of surveillance and history of CWD in Wisconsin and...

  10. Idaho National Engineering Laboratory Radiological Environmental Surveillance Program 1995 annual report

    Energy Technology Data Exchange (ETDEWEB)

    Miles, M.; Wilhelmsen, R.N.; Borsella, B.W.; Wright, K.C.

    1996-08-01

    This report describes calendar year 1995 environmental surveillance activities of Environmental Monitoring and Water Resources of Lockheed Martin Idaho Technologies Company, performed at the following Waste Management Facilities: the Radioactive Waste Management Complex, the Waste Experimental Reduction Facility, the Mixed Waste Storage Facility, and tow surplus facilities. Results of the sampling performed by the Radiological Environmental Surveillance Program, Site Environmental Surveillance Program, and the United States Geological Survey at these facilities are included in this report. The primary purposes of monitoring are to evaluate environmental conditions, to provide and interpret data, to verify compliance with applicable regulations or standards and to ensure protection of human health and the environment. This report compares 1995 environmental surveillance data with US DOE Derived Concentration Guides and with data form previous years.

  11. Report on HPAI Surveillance Activities for 2007-08 on Pocosin Lakes National Wildlife Refuge

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The Pungo Unit in Pocosin Lakes NWR hosts large populations of waterfowl species that have been identified for live bird or mortality surveillance for the Highly...

  12. National post-market surveillance assessment of veterinary medicines in Korea during the past decade.

    Science.gov (United States)

    Kang, JeongWoo; Park, Hae-Chul; Jang, Yang Ho; Hossain, Md Akil; Jeong, Kyunghun; Jeong, Mi Young; Yun, Seon-Jong; Park, Sung-Won; Kim, Dae Gyun; Lee, Kwang-Jick

    2017-05-22

    Veterinary medicines have been widely used for the prevention and treatment of diseases, growth promotion, and to promote feeding efficacy in livestock. As the veterinary medicine industry has steadily grown, it is crucial to set up a baseline for the quality of medicine as well as the insufficiency or excessiveness of the active ingredients in drug products to ensure the compliance, safety and efficacy of these medicines. Thus, the 10 years data of post-marketing quality control study was summarized to determine the rate and extent of non-compliance of these medicines and to establish baseline data for future quality control measures of veterinary medicine. In this study, 1650 drugs for veterinary use were collected per year from each city and province in Korea and analysed for the quantity of active ingredients according to the "national post-market surveillance (NPMS) system" over the past decade. The NPMS assessment was performed using liquid and gas chromatography, titration, UV/Vis spectrophotometry, and bioassays. A total of 358 cases were deemed noncompliant, with the average noncompliance rate for all medicine types being 2.0%. The average noncompliance rates for antibiotics, biologics and other chemical drugs except antibiotics (OCD) were 1.1%, 1.2%, and 3.0%, respectively. The first leading cause for noncompliant products was insufficient quantity of major ingredients (283 cases), and the second leading cause was the existence of excess amount of active ingredients (60 cases). Tylosin, spiramycin, ampicillin, tetracyclines and penicillins were most frequently found to be noncompliant among antibiotics. Among the OCD, the noncompliance was found commonly in vitamin A. The overall trend presented gradually decreasing violation rates, suggesting that the quality of veterinary medicines has improved. Consistent application of the NPMS assessment and the establishment of the Korea Veterinary Good Manufacturing Practice (KVGMP) will help to maintain the good

  13. 2006 Y-12 National Security Complex Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Health, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2008-04-17

    The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of illness and injury surveillance activities that provide an early warning system to detect health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence, occupational injuries and illnesses, and disabilities and deaths among current workers.

  14. 2006 Oak Ridge National Laboratory Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Health, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2008-05-16

    The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of illness and injury surveillance activities that provide an early warning system to detect health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence, occupational injuries and illnesses, and disabilities and deaths among current workers.

  15. 2006 Lawrence Livermore National Laboratory Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Health, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2008-03-27

    The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of illness and injury surveillance activities that provide an early warning system to detect health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence, occupational injuries and illnesses, and disabilities and deaths among current workers.

  16. 2007 Los Alamos National Laboratory Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Health, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2009-06-30

    The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of epidemiologic surveillance activities that provide an early warning system for health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence of workdays, occupational injuries and illnesses, and disabilities and deaths among current workers.

  17. 2008 Lawrence Livermore National Laboratory Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Health, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2009-09-21

    The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of epidemiologic surveillance activities that provide an early warning system for health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence of workdays, occupational injuries and illnesses, and disabilities and deaths among current workers.

  18. 2010 Nevada National Security Site Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Health, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2011-07-28

    The U.S. Department of Energy's (DOE) commitment to assuring the health and safety of its workers includes the conduct of illness and injury surveillance activities that provide an early warning system to detect health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence, occupational injuries and illnesses, and disabilities and deaths among current workers.

  19. 2010 Lawrence Livermore National Laboratory Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Health, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2011-08-16

    The U.S. Department of Energy's (DOE) commitment to assuring the health and safety of its workers includes the conduct of illness and injury surveillance activities that provide an early warning system to detect health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence, occupational injuries and illnesses, and disabilities and deaths among current workers.

  20. 2007 Lawrence Livermore National Laboratory Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Health, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2008-05-20

    The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of illness and injury surveillance activities that provide an early warning system to detect health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence, occupational injuries and illnesses, and disabilities and deaths among current workers.

  1. 2008 Oak Ridge National Laboratory Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Security, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2009-12-14

    The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of epidemiologic surveillance activities that provide an early warning system for health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence of workdays, occupational injuries and illnesses, and disabilities and deaths among current workers.

  2. 2008 Y-12 National Security Complex Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Security, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2009-12-11

    The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of epidemiologic surveillance activities that provide an early warning system for health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence of workdays, occupational injuries and illnesses, and disabilities and deaths among current workers.

  3. 2007 Oak Ridge National Laboratory Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Health, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2009-03-04

    The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of epidemiologic surveillance activities that provide an early warning system for health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence of workdays, occupational injuries and illnesses, and disabilities and deaths among current workers.

  4. 2009 Y-12 National Security Complex Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Security, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2010-07-09

    The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of epidemiologic surveillance activities that provide an early warning system for health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence of workdays, occupational injuries and illnesses, and disabilities and deaths among current workers.

  5. 2007 Y-12 National Security Complex Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Health, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2009-07-01

    The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of epidemiologic surveillance activities that provide an early warning system for health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence of workdays, occupational injuries and illnesses, and disabilities and deaths among current workers.

  6. 2006 Los Alamos National Laboratory Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Health, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2008-06-13

    The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of illness and injury surveillance activities that provide an early warning system to detect health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence, occupational injuries and illnesses, and disabilities and deaths among current workers.

  7. 2003 Y-12 National Security Complex Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Security, Office of Illness and Injury Prevention Programs

    2007-05-23

    Annual Illness and Injury Surveillance Program report for 2003 for Y-12. The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of epidemiologic surveillance activities that provide an early warning system for health problems among workers. The IISP monitors illnesses and health conditions that result in an absence of workdays, occupational injuries and illnesses, and disabilities and deaths among current workers.

  8. 2006 Sandia National Laboratories--Albuquerque Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Health, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2008-05-13

    The U.S. Department of Energy’s (DOE) commitment to assuring the health and safety of its workers includes the conduct of illness and injury surveillance activities that provide an early warning system to detect health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence, occupational injuries and illnesses, and disabilities and deaths among current workers.

  9. 2010 Oak Ridge National Laboratory Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Health, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2011-07-28

    The U.S. Department of Energy's (DOE) commitment to assuring the health and safety of its workers includes the conduct of illness and injury surveillance activities that provide an early warning system to detect health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence, occupational injuries and illnesses, and disabilities and deaths among current workers.

  10. 2010 Y-12 National Security Complex Annual Illness and Injury Surveillance Report

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Office of Health, Safety and Health, Office of Health and Safety, Office of Illness and Injury Prevention Programs

    2011-08-31

    The U.S. Department of Energy's (DOE) commitment to assuring the health and safety of its workers includes the conduct of illness and injury surveillance activities that provide an early warning system to detect health problems among workers. The Illness and Injury Surveillance Program monitors illnesses and health conditions that result in an absence, occupational injuries and illnesses, and disabilities and deaths among current workers.

  11. Evaluation of ADS-B Surveillance Data to Identify Flight Operations with Reduced Safety Margin in the National Airspace System Project

    Data.gov (United States)

    National Aeronautics and Space Administration — As part of the FAA's plans for modernization of the Air Traffic Control (ATC) system, Automatic Dependent Surveillance - Broadcast (ADS-B) will be the basis of the...

  12. Completeness of Reporting of Race and Ethnicity Data in the Nationally Notifiable Diseases Surveillance System, United States, 2006–2010

    Science.gov (United States)

    Adekoya, Nelson; Truman, Benedict I.; Ajani, Umed A.

    2015-01-01

    Context During 1994–1997, approximately 70% and 60% of the cases of conditions reported to the National Notifiable Diseases Surveillance System included persons of known race and ethnicity, respectively. A major goal of the Healthy People 2020 initiative is to eliminate health disparities. Objective To describe trends in the completeness of race and ethnicity in case reports of the National Notifiable Diseases Surveillance System during 2006–2010. Methods The National Notifiable Diseases Surveillance System is a public health surveillance system that aggregates case reports of infectious diseases and conditions that are designated nationally notifiable and are collected by US states and territories. The Centers for Disease Control and Prevention (Atlanta, Georgia) maintains this surveillance system in collaboration with the Council of State and Territorial Epidemiologists. We used Cochran-Armitage Trend Test (SAS, version 9.2) to test the hypothesis that the percentage of case reports with the completeness of race and ethnicity data increased or decreased linearly during 2006–2010. Main Outcome Measure Completeness of race and ethnicity variables. Results The 32 conditions reviewed included 1 030 804 case records. Seventy percent of records included a known value for race, and 49% of records included ethnicity during 2006–2010. During 2006–2010, race was known in 70% or more of records in 24 of 32 conditions and in 23 of 51 jurisdictions. During 2006–2010, the systemwide reporting of race remained at the same level of completeness (70%) but the reporting of ethnicity increased slightly from 48% in 2006 to 53% in 2010. In comparison with race, the proportions of records coded to ethnicity were less among all conditions. Conclusions Significant change has occurred in the completeness of reporting of ethnicity but not race during 2006–2010. However, the reporting of ethnicity still lags substantially behind the reporting of race. Jurisdictions that

  13. Environmental surveillance for EG&G Idaho Waste Management facilities at the Idaho National Engineering Laboratory. 1993 annual report

    Energy Technology Data Exchange (ETDEWEB)

    Wilhelmsen, R.N.; Wright, K.C.; McBride, D.W.; Borsella, B.W.

    1994-08-01

    This report describes calendar year 1993 environmental surveillance activities of Environmental Monitoring of EG&G Idaho, Inc., performed at EG&G Idaho operated Waste Management facilities at the Idaho National Engineering Laboratory (INEL). The major facilities monitored include the Radioactive Waste Management Complex, the Waste Experimental Reduction Facility, the Mixed Waste Storage Facility, and two surplus facilities. Included are results of the sampling performed by the Radiological and Environmental Sciences Laboratory and the United States Geological Survey. The primary purposes of monitoring are to evaluate environmental conditions, to provide and interpret data, to ensure compliance with applicable regulations or standards, and to ensure protection of human health and the environment. This report compares 1993 environmental surveillance data with US Department of Energy derived concentration guides and with data from previous years.

  14. Annual report on surveillance and maintenance activities at Oak Ridge National Laboratory, Oak Ridge, Tennessee, fiscal year 1996

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-11-01

    In fiscal year (FY) 1995, the sites and facilities from both the Remedial Action (RA) and Decontamination and Decommissioning (D and D) programs were combined to form the Oak Ridge National Laboratory (ORNL) Environmental Restoration (ER) Surveillance and Maintenance (S and M) Program. Surveillance and Maintenance activities were conducted throughout FY 1996 at the RA facilities. Overall, the RA S and M Program consists of approximately 650 acres that include 14 waste area groupings with approximately 200 sites. These sites include 46 major facilities, several leak and contaminated soil sites, 38 inactive tanks, approximately 50 environmental study areas and approximately 2,973 wells and boreholes. Site inspections were conducted at established frequencies on appropriate sites in the RA S and M Program in accordance with the established S and M FY 1996 Incentive Task Order (ITO).

  15. National capacity for surveillance, prevention, and control of West Nile virus and other arbovirus infections--United States, 2004 and 2012.

    Science.gov (United States)

    Hadler, James L; Patel, Dhara; Bradley, Kristy; Hughes, James M; Blackmore, Carina; Etkind, Paul; Kan, Lilly; Getchell, Jane; Blumenstock, James; Engel, Jeffrey

    2014-04-04

    In the first 5 years after its introduction in the United States in 1999, West Nile virus (WNV) spread to the 48 contiguous states, resulting in 667 reported deaths. To establish detection and response capacity, WNV surveillance and prevention was supported through CDC Epidemiology and Laboratory Capacity (ELC) cooperative agreements with all 50 states and six large cities/counties. In 2005, the Council of State and Territorial Epidemiologists (CSTE) conducted an assessment of ELC recipients and determined that, since 1999, all had developed WNV surveillance and control programs, resulting in a national arboviral surveillance infrastructure. From 2004 to 2012, ELC funding for WNV surveillance decreased by 61%. In 2012, the United States had its most severe WNV season since 2003, prompting a follow-up assessment of the capacity of ELC-supported WNV programs. Since the first assessment, 22% of jurisdictions had stopped conducting active human surveillance, 13% had stopped mosquito surveillance, 70% had reduced mosquito trapping and testing, and 64% had eliminated avian mortality surveillance. Reduction in early detection capacity compromises local and national ability to rapidly detect changes in WNV and other arboviral activity and to initiate prevention measures. Each jurisdiction is encouraged to review its current surveillance systems in light of the local threat of WNV and emerging arboviruses (e.g., dengue and chikungunya) and ensure it is able to rapidly detect and respond to critical changes in arbovirus activity.

  16. Influenza in outpatient ILI case-patients in national hospital-based surveillance, Bangladesh, 2007-2008.

    Directory of Open Access Journals (Sweden)

    Rashid Uz Zaman

    Full Text Available BACKGROUND: Recent population-based estimates in a Dhaka low-income community suggest that influenza was prevalent among children. To explore the epidemiology and seasonality of influenza throughout the country and among all age groups, we established nationally representative hospital-based surveillance necessary to guide influenza prevention and control efforts. METHODOLOGY/PRINCIPAL FINDINGS: We conducted influenza-like illness and severe acute respiratory illness sentinel surveillance in 12 hospitals across Bangladesh during May 2007-December 2008. We collected specimens from 3,699 patients, 385 (10% which were influenza positive by real time RT-PCR. Among the sample-positive patients, 192 (51% were type A and 188 (49% were type B. Hemagglutinin subtyping of type A viruses detected 137 (71% A/H1 and 55 (29% A/H3, but no A/H5 or other novel influenza strains. The frequency of influenza cases was highest among children aged under 5 years (44%, while the proportions of laboratory confirmed cases was highest among participants aged 11-15 (18%. We applied kriging, a geo-statistical technique, to explore the spatial and temporal spread of influenza and found that, during 2008, influenza was first identified in large port cities and then gradually spread to other parts of the country. We identified a distinct influenza peak during the rainy season (May-September. CONCLUSIONS/SIGNIFICANCE: Our surveillance data confirms that influenza is prevalent throughout Bangladesh, affecting a wide range of ages and causing considerable morbidity and hospital care. A unimodal influenza seasonality may allow Bangladesh to time annual influenza prevention messages and vaccination campaigns to reduce the national influenza burden. To scale-up such national interventions, we need to quantify the national rates of influenza and the economic burden associated with this disease through further studies.

  17. Implementing school malaria surveys in Kenya: towards a national surveillance system

    Directory of Open Access Journals (Sweden)

    Snow Robert W

    2010-10-01

    Full Text Available Abstract Objective To design and implement surveys of malaria infection and coverage of malaria control interventions among school children in Kenya in order to contribute towards a nationwide assessment of malaria. Methods The country was stratified into distinct malaria transmission zones based on a malaria risk map and 480 schools were visited between October 2008 and March 2010. Surveys were conducted in two phases: an initial opportunistic phase whereby schools were selected for other research purposes; and a second phase whereby schools were purposively selected to provide adequate spatial representation across the country. Consent for participation was based on passive, opt-out consent rather than written, opt-in consent because of the routine, low-risk nature of the survey. All children were diagnosed for Plasmodium infection using rapid diagnostic tests, assessed for anaemia and were interviewed about mosquito net usage, recent history of illness, and socio-economic and household indicators. Children's responses were entered electronically in the school and data transmitted nightly to Nairobi using a mobile phone modem connection. RDT positive results were corrected by microscopy and all results were adjusted for clustering using random effect regression modelling. Results 49,975 children in 480 schools were sampled, at an estimated cost of US$ 1,116 per school. The overall prevalence of malaria and anaemia was 4.3% and 14.1%, respectively, and 19.0% of children reported using an insecticide-treated net (ITN. The prevalence of infection showed marked variation across the country, with prevalence being highest in Western and Nyanza provinces, and lowest in Central, North Eastern and Eastern provinces. Nationally, 2.3% of schools had reported ITN use >60%, and low reported ITN use was a particular problem in Western and Nyanza provinces. Few schools reported having malaria health education materials or ongoing malaria control activities

  18. Implementing school malaria surveys in Kenya: towards a national surveillance system.

    Science.gov (United States)

    Gitonga, Caroline W; Karanja, Peris N; Kihara, Jimmy; Mwanje, Mariam; Juma, Elizabeth; Snow, Robert W; Noor, Abdisalan M; Brooker, Simon

    2010-10-30

    To design and implement surveys of malaria infection and coverage of malaria control interventions among school children in Kenya in order to contribute towards a nationwide assessment of malaria. The country was stratified into distinct malaria transmission zones based on a malaria risk map and 480 schools were visited between October 2008 and March 2010. Surveys were conducted in two phases: an initial opportunistic phase whereby schools were selected for other research purposes; and a second phase whereby schools were purposively selected to provide adequate spatial representation across the country. Consent for participation was based on passive, opt-out consent rather than written, opt-in consent because of the routine, low-risk nature of the survey. All children were diagnosed for Plasmodium infection using rapid diagnostic tests, assessed for anaemia and were interviewed about mosquito net usage, recent history of illness, and socio-economic and household indicators. Children's responses were entered electronically in the school and data transmitted nightly to Nairobi using a mobile phone modem connection. RDT positive results were corrected by microscopy and all results were adjusted for clustering using random effect regression modelling. 49,975 children in 480 schools were sampled, at an estimated cost of US$ 1,116 per school. The overall prevalence of malaria and anaemia was 4.3% and 14.1%, respectively, and 19.0% of children reported using an insecticide-treated net (ITN). The prevalence of infection showed marked variation across the country, with prevalence being highest in Western and Nyanza provinces, and lowest in Central, North Eastern and Eastern provinces. Nationally, 2.3% of schools had reported ITN use >60%, and low reported ITN use was a particular problem in Western and Nyanza provinces. Few schools reported having malaria health education materials or ongoing malaria control activities. School malaria surveys provide a rapid, cheap and

  19. Cost-Effectiveness of Rotavirus Vaccination in Bolivia from the State Perspective

    Science.gov (United States)

    Smith, Emily R.; Rowlinson, Emily E.; Iniguez, Volga; Etienne, Kizee A.; Rivera, Rosario; Mamani, Nataniel; Rheingans, Rick; Patzi, Maritza; Halkyer, Percy; Leon, Juan S.

    2011-01-01

    BACKGROUND In Bolivia, in 2008, the under-five mortality rate is 54 per 1000 live births. Diarrhea causes 15% of these deaths, and 40% of pediatric diarrhea-related hospitalizations are caused by rotavirus illness (RI). Rotavirus vaccination (RV), subsidized by international donors, is expected to reduce morbidity, mortality, and economic burden to the Bolivian state. Estimates of illness and economic burden of RI and their reduction by RV are essential to the Bolivian state’s policies on RV program financing. The goal of this report is to estimate the economic burden of RI and the cost-effectiveness of the RV program. METHODS To assess treatment costs incurred by the healthcare system, we abstracted medical records from 287 inpatients and 6,751 outpatients with acute diarrhea between 2005 and 2006 at 5 sentinel hospitals in 4 geographic regions. RI prevalence rates were estimated from 4 years of national hospital surveillance. We used a decision-analytic model to assess the potential cost-effectiveness of universal RV in Bolivia. RESULTS Our model estimates that, in a 5-year birth cohort, Bolivia will incur over US$3 million in direct medical costs due to RI. RV reduces, by at least 60%, outpatient visits, hospitalizations, deaths, and total direct medical costs associated with rotavirus diarrhea. Further, RV was cost-savings below a price of US$3.81 per dose and cost-effective below a price of US$194.10 per dose. Diarrheal mortality and hospitalization inputs were the most important drivers of rotavirus vaccine cost-effectiveness. DISCUSSION Our data will guide Bolivia’s funding allocation for RV as international subsidies change. PMID:21624421

  20. Cost-effectiveness of Lung Cancer Screening in Canada.

    Science.gov (United States)

    Goffin, John R; Flanagan, William M; Miller, Anthony B; Fitzgerald, Natalie R; Memon, Saima; Wolfson, Michael C; Evans, William K

    2015-09-01

    The US National Lung Screening Trial supports screening for lung cancer among smokers using low-dose computed tomographic (LDCT) scans. The cost-effectiveness of screening in a publically funded health care system remains a concern. To assess the cost-effectiveness of LDCT scan screening for lung cancer within the Canadian health care system. The Cancer Risk Management Model (CRMM) simulated individual lives within the Canadian population from 2014 to 2034, incorporating cancer risk, disease management, outcome, and cost data. Smokers and former smokers eligible for lung cancer screening (30 pack-year smoking history, ages 55-74 years, for the reference scenario) were modeled, and performance parameters were calibrated to the National Lung Screening Trial (NLST). The reference screening scenario assumes annual scans to age 75 years, 60% participation by 10 years, 70% adherence to screening, and unchanged smoking rates. The CRMM outputs are aggregated, and costs (2008 Canadian dollars) and life-years are discounted 3% annually. The incremental cost-effectiveness ratio. Compared with no screening, the reference scenario saved 51,000 quality-adjusted life-years (QALY) and had an incremental cost-effectiveness ratio of CaD $52,000/QALY. If smoking history is modeled for 20 or 40 pack-years, incremental cost-effectiveness ratios of CaD $62,000 and CaD $43,000/QALY, respectively, were generated. Changes in participation rates altered life years saved but not the incremental cost-effectiveness ratio, while the incremental cost-effectiveness ratio is sensitive to changes in adherence. An adjunct smoking cessation program improving the quit rate by 22.5% improves the incremental cost-effectiveness ratio to CaD $24,000/QALY. Lung cancer screening with LDCT appears cost-effective in the publicly funded Canadian health care system. An adjunct smoking cessation program has the potential to improve outcomes.

  1. 77 FR 52742 - Public Meeting-Strengthening the National Medical Device Postmarket Surveillance System; Request...

    Science.gov (United States)

    2012-08-30

    ... each presenter and the approximate time each oral presentation is to begin and will notify participants by September 4, 2012. All requests to make oral presentations must be received by August 31, 2012... Postmarket Surveillance System.'' The purpose of the meeting is to solicit public feedback regarding...

  2. Surveillance Plan for environmental monitoring in Waste Area Grouping 6 at Oak Ridge National Laboratory, Oak Ridge, Tennessee

    Energy Technology Data Exchange (ETDEWEB)

    1993-12-01

    This Surveillance Plan has been developed as part of the Environmental Monitoring Plan for Waste Area Grouping 6 at Oak Ridge National Laboratory, Oak Ridge, Tennessee. Environmental monitoring will be conducted in two phases: the baseline monitoring phase and the routine annual monitoring phase. The baseline monitoring phase will be conducted to establish the baseline contaminant release conditions at the Waste Area Grouping (WAG), to confirm the site-related chemicals of concern (COC), and to gather data to confirm the site hydrologic model The baseline monitoring phase is expected to begin in 1994 and continue for 12--18 months. The routine annual monitoring phase will consist of continued sampling and analyses of COC to determine off-WAG contaminant flux, to identify trends in releases, and to confirm the COC The routine annual monitoring phase will continue for {approximately}4 years after completion of the baseline monitoring phase. This Surveillance Plan presents the technical and quality assurance surveillance activities for the various WAG 6 environmental monitoring and data evaluation plans and implementing procedures.

  3. Institutional change and political decision-making in the creation of the Brazilian National Health Surveillance Agency.

    Science.gov (United States)

    Piovesan, Márcia Franke; Labra, Maria Eliana

    2007-06-01

    This article examines the decision-making process that led to the creation of the Brazilian National Health Surveillance Agency (ANVISA) in 1999. The authors begin by discussing the history of the Agency's predecessor, the Health Surveillance Secretariat, and the need for its modernization to adjust the quality of the products under its control to domestic and international demands. From the theoretical perspective of neo-institutionalism, the article goes on to analyze the social and political context surrounding the debate on the proposed alternatives to adjust Health Surveillance to new rules in line with such requirements, focusing especially on the formulation of the new policy, the decision-making arena, and the actors with specific interests in the sector. The research drew on extensive documentary and media material, plus interviews with key actors. The article concludes that a determinant factor for the creation of ANVISA was the favorable domestic political context, fostering a positive correlation of forces that (in an extremely short timeframe, 1998-1999) allowed the creation of the first regulatory agency in the social policies area in Brazil.

  4. High dengue case capture rate in four years of a cohort study in Nicaragua compared to national surveillance data.

    Directory of Open Access Journals (Sweden)

    Katherine Standish

    Full Text Available Dengue is a major public health problem in tropical and subtropical regions; however, under-reporting of cases to national surveillance systems hinders accurate knowledge of disease burden and costs. Laboratory-confirmed dengue cases identified through the Nicaraguan Pediatric Dengue Cohort Study (PDCS were compared to those reported from other health facilities in Managua to the National Epidemiologic Surveillance (NES program of the Nicaraguan Ministry of Health. Compared to reporting among similar pediatric populations in Managua, the PDCS identified 14 to 28 (average 21.3 times more dengue cases each year per 100,000 persons than were reported to the NES. Applying these annual expansion factors to national-level data, we estimate that the incidence of confirmed pediatric dengue throughout Nicaragua ranged from 300 to 1000 cases per 100,000 persons. We have estimated a much higher incidence of dengue than reported by the Ministry of Health. A country-specific expansion factor for dengue that allows for a more accurate estimate of incidence may aid governments and other institutions calculating disease burden, costs, resource needs for prevention and treatment, and the economic benefits of drug and vaccine development.

  5. Development and implementation of the first national data quality standards for population-based birth defects surveillance programs in the United States.

    Science.gov (United States)

    Anderka, Marlene; Mai, Cara T; Romitti, Paul A; Copeland, Glenn; Isenburg, Jennifer; Feldkamp, Marcia L; Krikov, Sergey; Rickard, Russel; Olney, Richard S; Canfield, Mark A; Stanton, Carol; Mosley, Bridget; Kirby, Russell S

    2015-09-19

    Population-based birth defects surveillance is a core public health activity in the United States (U.S.); however, the lack of national data quality standards has limited the use of birth defects surveillance data across state programs. Development of national standards will facilitate data aggregation and utilization across birth defects surveillance programs in the U.S. Based on national standards for other U.S. public health surveillance programs, existing National Birth Defects Prevention Network (NBDPN) guidelines for conducting birth defects surveillance, and information from birth defects surveillance programs regarding their current data quality practices, we developed 11 data quality measures that focused on data completeness (n = 5 measures), timeliness (n = 2), and accuracy (n = 4). For each measure, we established tri-level performance criteria (1 = rudimentary, 2 = essential, 3 = optimal). In January 2014, we sent birth defects surveillance programs in each state, District of Columbia, Puerto Rico, Centers for Disease Control and Prevention (CDC), and the U.S. Department of Defense Birth and Infant Health Registry an invitation to complete a self-administered NBDPN Standards Data Quality Assessment Tool. The completed forms were electronically submitted to the CDC for analyses. Of 47 eligible population-based surveillance programs, 45 submitted a completed assessment tool. Two of the 45 programs did not meet minimum inclusion criteria and were excluded; thus, the final analysis included information from 43 programs. Average scores for four of the five completeness performance measures were above level 2. Conversely, the average scores for both timeliness measures and three of the four accuracy measures were below level 2. Surveillance programs using an active case-finding approach scored higher than programs using passive case-finding approaches for the completeness and accuracy measures, whereas their average scores were lower

  6. Prevalence and variation of Chronic Kidney Disease in the Irish health system: initial findings from the National Kidney Disease Surveillance Programme.

    LENUS (Irish Health Repository)

    Stack, Austin G

    2014-01-01

    Chronic Kidney Disease (CKD) is a major non-communicable chronic disease that is associated with adverse clinical and economic outcomes. Passive surveillance systems are likely to improve efforts for prevention of chronic kidney disease (CKD) and inform national service planning. This study was conducted to determine the overall prevalence of CKD in the Irish health system, assess period trends and explore patterns of variation as part of a novel surveillance initiative.

  7. Expert knowledge sourcing for public health surveillance: national tsetse mapping in Uganda.

    Science.gov (United States)

    Berrang-Ford, Lea; Garton, Kelly

    2013-08-01

    In much of sub-Saharan Africa, availability of standardized and reliable public health data is poor or negligible. Despite continued calls for the prioritization of improved health datasets in poor regions, public health surveillance remains a significant global health challenge. Alternate approaches to surveillance and collection of public health data have thus garnered increasing interest, though there remains relatively limited research evaluating these approaches for public health. Herein, we present a case study applying and evaluating the use of expert knowledge sources for public health dataset development, using the case of vector distributions of Human African Trypanosomiasis (HAT) in Uganda. Specific objectives include: 1) Review the use of expert knowledge sourcing methods for public health surveillance, 2) Review current knowledge on tsetse vector distributions of public health importance in Uganda and the methods used for tsetse mapping in Africa; 3) Quantify confidence of the presence or absence of tsetse flies in Uganda based on expert informant reports, and 4) Assess the reliability and potential utility of expert knowledge sourcing as an alternative or complimentary method for public health surveillance in general and tsetse mapping in particular. Information on tsetse presence or absence, and associated confidence, was collected through interviews with District Entomologist and Veterinary Officers to develop a database of tsetse distributions for 952 sub-counties in Uganda. Results show high consistency with existing maps, indicating potential reliability of modeling approaches, though failing to provide evidence for successful tsetse control in past decades. Expert-sourcing methods provide a novel, low-cost and rapid complimentary approach for triangulating data from prediction modeling where field-based validation is not feasible. Data quality is dependent, however, on the level of expertise and documentation to support confidence levels for

  8. Hepatocellular carcinoma: cost-effectiveness of screening. A systematic review

    Directory of Open Access Journals (Sweden)

    Ruggeri M

    2012-06-01

    Full Text Available Matteo RuggeriFacoltà di Economia, Università Cattolica del Sacro Cuore – sede di Roma, Rome, ItalyAbstract: Hepatocellular carcinoma (HCC is one of the most common tumors worldwide. HCC is a potential target for cancer surveillance (or screening as it occurs in well-defined, at-risk populations. Curative therapy is possible only for small tumors and screening strategy has been recommended by the US, Italian, and other international liver societies and is practiced widely, but its benefits are not clearly established. The objective of this study was to review the available evidence with respect to the cost-effectiveness of key technologies in the prevention HCC. The literature search was conducted with the support of PubMed. Firstly we selected articles by reading the abstracts. Secondly, we read the articles and the revision was further restricted, with the following as inclusion criteria: (1 full economic evaluation of HCC screening programs; (2 comparison between HCC techniques; (3 outcome measures expressed in terms of quality adjusted life years (QALY; (4 full text availability. The initial review of the literature yielded 346 articles. Of those, 288 were excluded at the first stage. Of those excluded, 108 did not meet the target, 106 did not present the cost analysis, 33 did not analyze the treatment of the disease, and in 41 the abstract was not available. Of the 58 included in the first step, seven examined the cost-effectiveness of different HCC screening techniques, seven investigated the cost-effectiveness of HCC screening versus no screening, and one looked at the cost-effectiveness of timing for HCC surveillance and monitoring, while 43 were about HBV vaccination and screening. We included only the seven articles examining the cost-effectiveness of different HCC screening techniques. In general, incidence is the key parameter which determines the cost-effectiveness of HCC screening. Discrepancies in the results exist when

  9. National Status and Trends, Benthic Surveillance Project DNA-Xenobiotic Adducts Data, 1991, National Centers for Coastal Ocean Science

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — In order to determine the current status of and to detect any long-term trends in the environmental quality of U.S. nearshore waters, NOAA initiated the National...

  10. National Status and Trends, Benthic Surveillance Project Pathology, 1984-1992, National Centers for Coastal Ocean Science

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — In order to determine the current status of and to detect any long-term trends in the environmental quality of U.S. nearshore waters, NOAA initiated the National...

  11. The National Athletic Treatment, Injury and Outcomes Network (NATION): Methods of the Surveillance Program, 2011–2012 Through 2013–2014

    Science.gov (United States)

    Dompier, Thomas P.; Marshall, Stephen W.; Kerr, Zachary Y.; Hayden, Ross

    2015-01-01

    Context Previous epidemiologic researchers have examined time-loss (TL) injuries in high school student-athletes, but little is known about the frequency of non–time-loss (NTL) injuries in these athletes. Objective To describe the methods of the National Athletic Treatment, Injury and Outcomes Network (NATION) Surveillance Program and provide descriptive epidemiology of TL and NTL injuries across athletes in 27 high school sports. Design Descriptive epidemiology study. Setting Aggregate injury and exposure data collected from 147 high schools in 26 states. Patients or Other Participants High school student-athletes participating in 13 boys' sports and 14 girls' sports during the 2011–2012 through 2013–2014 academic years. Main Outcome Measure(s) Athletic trainers documented injuries and exposures using commercially available injury-tracking software packages. Standard injury-tracking software was modified by the software vendors to conform to the surveillance needs of this project. The modified software exported a set of common data elements, stripped of personally identifiable information, to a centralized automated verification and validation system before they were included in the centralized research database. Dependent measures were injury and exposure frequencies and injury rates with 95% confidence intervals stratified by sport, sex, and injury type (TL or NTL). Results Over the 3-year period, a total of 2337 team seasons across 27 sports resulted in 47 014 injuries and 5 146 355 athlete-exposures. The NTL injuries accounted for 38 765 (82.45%) and TL injuries for 8249 (17.55%) of the total. Conclusions The NTL injuries accounted for a substantial amount of the total number of injuries sustained by high school student-athletes. This project demonstrates the feasibility of creating large-scale injury surveillance systems using commercially available injury-tracking software. PMID:26067620

  12. Epidemiologic surveillance. [1994] amended annual report for Brookhaven National Laboratory. Revision 2

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1994-12-31

    Epidemiologic surveillance at DOE facilities consists of regular and systematic collection, analysis, and interpretation of data on absences due to illness and injury in the work force. Its purpose is to provide an early warning system for health problems occurring among employees at participating sites. Data are collected by coordinators at each site and submitted to the Epidemiologic Surveillance Data Center, located at the Oak Ridge Institute for Science and Education, where quality control procedures and analyses are carried out. Rates of absences and rates of diagnoses associated with absences are analyzed by occupation and other relevant variables. They may be compared with the disease experience of different groups within the DOE work force and with populations that do not work for DOE to identify disease patterns or clusters that may be associated with work activities. This amended annual report corrects errors in the initial release of the BNL report for 1994. In this annual report, the 1994 morbidity data for BNL are summarized.

  13. Cost-effectiveness of a genetic test for breast cancer risk.

    Science.gov (United States)

    Folse, Henry J; Green, Linda E; Kress, Andrea; Allman, Richard; Dinh, Tuan A

    2013-12-01

    Genetic testing of seven single-nucleotide polymorphisms (7SNP) can improve estimates of risk of breast cancer relative to the Gail risk test alone, for the purpose of recommending MRI screening for women at high risk. A simulation of breast cancer and health care processes was used to conduct a virtual trial comparing the use of the 7SNP test with the Gail risk test to categorize patients by risk. Average-risk patients received annual mammogram, whereas high-risk patients received annual MRI. Cancer incidence was based on Surveillance, Epidemiology, and End Results data and validated to Cancer Prevention Study II Nutrition Cohort data. Risk factor values were drawn from National Health and Nutrition Examination Survey (NHANES-4) and Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial data. Mammogram characteristics were derived from Breast Cancer Surveillance Consortium data. The test was most cost-effective when given to patients at an intermediate lifetime risk of breast cancer. For patients with a risk of 16% to 28%, it resulted in a 1.91% reduction in cancer deaths, saving 0.005 quality-adjusted life years per person at a cost of $163,264 per QALY. These results were sensitive to the age at which the test is given, the discount rate, and the costs of the genetic test and MRI. The cost effectiveness of using the 7SNP test for patients with intermediate Gail risk is similar to that of other recommended strategies, including annual MRI for patients with a lifetime risk greater than 20% or BRCA1/2 mutations.

  14. Cost effectiveness of abdominal aortic aneurysm screening and rescreening in men in a modern context

    DEFF Research Database (Denmark)

    Søgaard, Rikke; Laustsen, Jesper; Lindholt, Jes Sanddal

    2012-01-01

    To assess the cost effectiveness of different screening strategies for abdominal aortic aneurysm in men, from the perspective of a national health service.......To assess the cost effectiveness of different screening strategies for abdominal aortic aneurysm in men, from the perspective of a national health service....

  15. The Cost-Effectiveness of Atypicals in the UK

    NARCIS (Netherlands)

    Heeg, Bart; Buskens, Erik; Botteman, Marc; Caleo, Sue; Ingham, Mike; Damen, Joep; de Charro, Frank; van Hout, Ben

    2008-01-01

    Background: In 2002, the National Institute for Health and Clinical Excellence (NICE), recommended atypical antipsychotics over conventional ones for first-line schizophrenia treatment, based on their lower risk of extrapyramidal symptoms. Objective: To estimate the incremental cost-effectiveness of

  16. National Department of Defense Surveillance for Invasive Streptococcus Pneumoniae: Antibiotic Resistance, Serotype Distribution, and Arbitrarily Primed Polymerase Chain Reaction Analyses

    Science.gov (United States)

    2008-02-15

    penicillin -susceptible and peni- cillin-resistant Streptococcnspneuttmoniae serotypes in Canada. J Infect Dis Streptococcus pneumoniae Surveillance Group...Gray for the Streptococcus pneumonia Surveillance Group Report No. 00-44 Approved for public release; distribution unlimited. NAVAL HEALTH RESEARCH...Defense Surveillance for Invasive Streptococcus pneumoniae : Antibiotic Resistance, Serotype Distribution, and Arbitrarily Primed Polymerase Chain

  17. Congenital rubella still a public health problem in Italy: analysis of national surveillance data from 2005 to 2013.

    Science.gov (United States)

    Giambi, C; Filia, A; Rota, M C; Del Manso, M; Declich, S; Nacca, G; Rizzuto, E; Bella, A

    2015-04-23

    In accordance with the goal of the World Health Organization Regional Office for Europe, the Italian national measles and rubella elimination plan aims to reduce the incidence of congenital rubella cases to less than one case per 100,000 live births by the end of 2015. We report national surveillance data for congenital rubella and rubella in pregnancy from 2005 to 2013. A total of 75 congenital rubella infections were reported; the national annual mean incidence was 1.5/100,000 live births, including probable and confirmed cases according to European Union case definition. Two peaks occurred in 2008 and 2012 (5.0 and 3.6/100,000 respectively). Overall, 160 rubella infections in pregnancy were reported; 69/148 women were multiparous and 38/126 had had a rubella antibody test before pregnancy. Among reported cases, there were 62 infected newborns, 31 voluntary abortions, one stillbirth and one spontaneous abortion. A total of 24 newborns were unclassified and 14 women were lost to follow-up, so underestimation is likely. To improve follow-up of cases, systematic procedures for monitoring infected mothers and children were introduced in 2013. To prevent congenital rubella, antibody screening before pregnancy and vaccination of susceptible women, including post-partum and post-abortum vaccination, should be promoted. Population coverage of two doses of measles-mumps-rubella vaccination of ≥ 95% should be maintained and knowledge of health professionals improved.

  18. Bicyclist mortality between 2006 and 2010 in China: findings from national Disease Surveillance Points (DSP) data.

    Science.gov (United States)

    Zhou, Maigeng; Hu, Guoqing; Wang, Lijun; Ma, Sai; Wang, Lin; Li, Qingfeng; Hyder, Adnan A

    2014-02-01

    While road traffic mortality has been reported to be seriously undercounted by the police in China, non-police-reported data have not been explored previously to examine vulnerable road user mortality. To examine changes in bicyclist mortality between 2006 and 2010 in China, using the Disease Surveillance Points (DSP) data of China. Mortality data of 2006-2010 from DSP data, covering 73 million population, was analysed. Poisson regression was used to examine the significance of year after controlling for sex, age and urban/rural location. Mortality rate and mortality rate ratio (MRR). Between 2006 and 2010, the mortality rate for bicyclists increased from 1.1 to 1.6 per 100 000 population according to DSP data. Between 2006 and 2010, more than 90% of bicyclist deaths were undercounted by the police compared to the findings from DSP data. Contrary to the 34% increase between 2006 and 2010 reflected by DSP data (adjusted MRR: 1.34, 95% CI 1.23 to 1.46), police data revealed a 64% decrease in bicyclist mortality (unadjusted MRR: 0.36, 95% CI 0.32 to 0.40) in the study time period. Health data should be used to assess the road traffic injuries in China. The recent increase in bicyclist mortality merits attention from policy makers and researchers.

  19. Projectbeschrijving Surveillance Ziekenhuisinfecties 1996-1999

    NARCIS (Netherlands)

    Berg JMJ van den; Boer AS de; Mintjes-de Groot AJ; Sprenger MJW; Cucic S; Pelt W van; Centraal Begeleidingsorgaan; CIE

    1996-01-01

    In the Project Surveillance Hospital Acquired Infections a surveillance system in a national network of hospitals is being developed and implemented. In the project surveillance of hospital acquired infections is implemented in components: surveillance of surgical wound infections, surveillance of i

  20. National Antimicrobial Resistance Monitoring System: Two Decades of Advancing Public Health Through Integrated Surveillance of Antimicrobial Resistance.

    Science.gov (United States)

    Karp, Beth E; Tate, Heather; Plumblee, Jodie R; Dessai, Uday; Whichard, Jean M; Thacker, Eileen L; Robertson Hale, Kis; Wilson, Wanda; Friedman, Cindy R; Griffin, Patricia M; McDermott, Patrick F

    2017-08-09

    Drug-resistant bacterial infections pose a serious and growing public health threat globally. In this review, we describe the role of the National Antimicrobial Resistance Monitoring System (NARMS) in providing data that help address the resistance problem and show how such a program can have broad positive impacts on public health. NARMS was formed two decades ago to help assess the consequences to human health arising from the use of antimicrobial drugs in food animal production in the United States. A collaboration among the Centers for Disease Control and Prevention, the U.S. Food and Drug Administration, the United States Department of Agriculture, and state and local health departments, NARMS uses an integrated "One Health" approach to monitor antimicrobial resistance in enteric bacteria from humans, retail meat, and food animals. NARMS has adapted to changing needs and threats by expanding surveillance catchment areas, examining new isolate sources, adding bacteria, adjusting sampling schemes, and modifying antimicrobial agents tested. NARMS data are not only essential for ensuring that antimicrobial drugs approved for food animals are used in ways that are safe for human health but they also help address broader food safety priorities. NARMS surveillance, applied research studies, and outbreak isolate testing provide data on the emergence of drug-resistant enteric bacteria; genetic mechanisms underlying resistance; movement of bacterial populations among humans, food, and food animals; and sources and outcomes of resistant and susceptible infections. These data can be used to guide and evaluate the impact of science-based policies, regulatory actions, antimicrobial stewardship initiatives, and other public health efforts aimed at preserving drug effectiveness, improving patient outcomes, and preventing infections. Many improvements have been made to NARMS over time and the program will continue to adapt to address emerging resistance threats, changes in

  1. Measles elimination and immunisation: national surveillance trends in Japan, 2008-2015.

    Science.gov (United States)

    Inaida, S; Matsuno, S; Kobune, F

    2017-08-01

    Measles elimination relies on vaccination programmes. In Japan, a major outbreak started in 2007. In response, 5-year two-dose catch-up vaccination programme was initiated in April 2008 for children 13-16-years-old. In this study, we analysed the epidemic curves, incidence rates for each age group, virus genotype, vaccination coverage and ratio of measles gelatin particle agglutination (PA) antibody using surveillance data for 2008-2015. Monthly case counts markedly decreased as vaccination coverage increased. D5, which is the endemic virus type, disappeared after 2011, with the following epidemic caused by imported viruses. Most cases were confirmed to have a no-dose or single-dose vaccination status. Although the incidence rate among all age groups ⩾5-years-old decreased during the study period, for children <5-years-old, the incidence rate remained relatively high and increased in 2014. The ratio of PA antibody (⩾1:128 titres) increased for the majority of age groups, but with a decrease for specific age groups: the 0-5 months and the 2-4, 14, 19 and most of the 26-55- and the 60-year-old groups (-1 to -9%). This seems to be the result of higher vaccination coverage, which would result in decreasing natural immunity booster along with decreasing passive immunity in infants whose mothers did not have the natural immunity booster. The 20-29- and 30-39-year-old age groups had higher number of cases, suggesting that vaccination within these age groups might be important for eliminating imported viruses.

  2. Epidemiology and Microbiologic Characterization of Nosocomial Candidemia from a Brazilian National Surveillance Program.

    Science.gov (United States)

    Doi, André Mario; Pignatari, Antonio Carlos Campos; Edmond, Michael B; Marra, Alexandre Rodrigues; Camargo, Luis Fernando Aranha; Siqueira, Ricardo Andreotti; da Mota, Vivian Pereira; Colombo, Arnaldo Lopes

    2016-01-01

    Candidemia is a growing problem in hospitals all over the world. Despite advances in the medical support of critically ill patients, candidiasis leads to prolonged hospitalization, and has a crude mortality rate around 50%. We conducted a multicenter surveillance study in 16 hospitals distributed across five regions of Brazil to assess the incidence, species distribution, antifungal susceptibility, and risk factors for bloodstream infections due to Candida species. From June 2007 to March 2010, we studied a total of 2,563 nosocomial bloodstream infection (nBSI) episodes. Candida spp. was the 7th most prevalent agent. Most of the patients were male, with a median age of 56 years. A total of 64 patients (46.7%) were in the ICU when candidemia occurred. Malignancies were the most common underlying condition (32%). The crude mortality rate of candidemia during the hospital admission was 72.2%. Non-albicans species of Candida accounted for 65.7% of the 137 yeast isolates. C. albicans (34.3%), Candida parapsilosis (24.1%), Candida tropicalis (15.3%) and Candida glabrata (10.2%) were the most prevalent species. Only 47 out of 137 Candida isolates were sent to the reference laboratory for antifungal susceptibility testing. All C. albicans, C. tropicalis and C. parapsilosis isolates were susceptible to the 5 antifungal drugs tested. Among 11 C. glabrata isolates, 36% were resistant to fluconazole, and 64% SDD. All of them were susceptible to anidulafungin and amphotericin B. We observed that C. glabrata is emerging as a major player among non-albicans Candida spp. and fluconazole resistance was primarily confined to C. glabrata and C. krusei strains. Candida resistance to echinocandins and amphotericin B remains rare in Brazil. Mortality rates remain increasingly higher than that observed in the Northern Hemisphere countries, emphasizing the need for improving local practices of clinical management of candidemia, including early diagnosis, source control and precise

  3. Evaluation of national health-care related infection criteria for epidemiological surveillance in neonatology

    Directory of Open Access Journals (Sweden)

    Janita Ferreira

    2014-07-01

    Full Text Available OBJECTIVE: to assess the use of the Brazilian criteria for reporting of hospital-acquired infections (HAIs in the neonatal unit and compare them with the criteria proposed by the National Healthcare Safety Network (NHSN. METHODS: this was a cross-sectional study conducted from 2009 to 2011. It included neonates with HAI reporting by at least one of the criteria. Statistical analysis included calculation of incidence density of HAIs, distribution by weight, and by reporting criterion. Analysis of sensitivity, specificity, positive predictive value (PPV, and negative predictive value (NPV for the national criteria was performed considering the NHSN as the gold standard, with agreement assessed by kappa. RESULTS: a total of 882 newborns were followed, and 330 had at least one infection notified by at least one of the criteria. A total of 522 HAIs were reported, regardless of the criteria. An incidence density of 27.28 infections per 1,000 patient-days was observed, and the main topographies were sepsis (58.3%, candidiasis (15.1%, and conjunctivitis (6.5%. A total of 489 (93.7% were notified by both criteria, eight infections were notified only by the national criteria (six cases of necrotizing enterocolitis and two cases of conjunctivitis, and 25 cases of clinical sepsis were reported by NHSN criteria only. The sensitivity, specificity, PPV, and NPV were 95.1%, 98.6%, 98.4%, and 95.7%, respectively, for all topographies, and were 91.8%, 100%, 100%, and 96.3% for the analysis of sepsis. Kappa analysis showed an agreement of 96.9%. CONCLUSION: there was a high rate of agreement between the criteria. The use of the national criteria facilitates the reporting of sepsis in newborns, and can help to improve the specificity and PPV.

  4. Evaluation of national health-care related infection criteria for epidemiological surveillance in neonatology.

    Science.gov (United States)

    Ferreira, Janita; Bouzada, Maria C F; Jesus, Lenize A de; Cortes, Maria da Conceição Werneck; Armond, Guilherme A; Clemente, Wanessa T; Anchieta, Lêni M; Romanelli, Roberta M C

    2014-01-01

    to assess the use of the Brazilian criteria for reporting of hospital-acquired infections (HAIs) in the neonatal unit and compare them with the criteria proposed by the National Healthcare Safety Network (NHSN). this was a cross-sectional study conducted from 2009 to 2011. It included neonates with HAI reporting by at least one of the criteria. Statistical analysis included calculation of incidence density of HAIs, distribution by weight, and by reporting criterion. Analysis of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the national criteria was performed considering the NHSN as the gold standard, with agreement assessed by kappa. a total of 882 newborns were followed, and 330 had at least one infection notified by at least one of the criteria. A total of 522 HAIs were reported, regardless of the criteria. An incidence density of 27.28 infections per 1,000 patient-days was observed, and the main topographies were sepsis (58.3%), candidiasis (15.1%), and conjunctivitis (6.5%). A total of 489 (93.7%) were notified by both criteria, eight infections were notified only by the national criteria (six cases of necrotizing enterocolitis and two cases of conjunctivitis), and 25 cases of clinical sepsis were reported by NHSN criteria only. The sensitivity, specificity, PPV, and NPV were 95.1%, 98.6%, 98.4%, and 95.7%, respectively, for all topographies, and were 91.8%, 100%, 100%, and 96.3% for the analysis of sepsis. Kappa analysis showed an agreement of 96.9%. there was a high rate of agreement between the criteria. The use of the national criteria facilitates the reporting of sepsis in newborns, and can help to improve the specificity and PPV. Copyright © 2014 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  5. Cost-effectiveness thresholds: pros and cons.

    Science.gov (United States)

    Bertram, Melanie Y; Lauer, Jeremy A; De Joncheere, Kees; Edejer, Tessa; Hutubessy, Raymond; Kieny, Marie-Paule; Hill, Suzanne R

    2016-12-01

    Cost-effectiveness analysis is used to compare the costs and outcomes of alternative policy options. Each resulting cost-effectiveness ratio represents the magnitude of additional health gained per additional unit of resources spent. Cost-effectiveness thresholds allow cost-effectiveness ratios that represent good or very good value for money to be identified. In 2001, the World Health Organization's Commission on Macroeconomics in Health suggested cost-effectiveness thresholds based on multiples of a country's per-capita gross domestic product (GDP). In some contexts, in choosing which health interventions to fund and which not to fund, these thresholds have been used as decision rules. However, experience with the use of such GDP-based thresholds in decision-making processes at country level shows them to lack country specificity and this - in addition to uncertainty in the modelled cost-effectiveness ratios - can lead to the wrong decision on how to spend health-care resources. Cost-effectiveness information should be used alongside other considerations - e.g. budget impact and feasibility considerations - in a transparent decision-making process, rather than in isolation based on a single threshold value. Although cost-effectiveness ratios are undoubtedly informative in assessing value for money, countries should be encouraged to develop a context-specific process for decision-making that is supported by legislation, has stakeholder buy-in, for example the involvement of civil society organizations and patient groups, and is transparent, consistent and fair.

  6. A Departmental Cost-Effectiveness Model.

    Science.gov (United States)

    Holleman, Thomas, Jr.

    In establishing a departmental cost-effectiveness model, the traditional cost-effectiveness model was discussed and equipped with a distant and deflation equation for both benefits and costs. Next, the economics of costing was examined and program costing procedures developed. Then, the model construct was described as it was structured around the…

  7. Occupational exposures to antineoplastic drugs and ionizing radiation in Canadian veterinary settings: findings from a national surveillance project.

    Science.gov (United States)

    Hall, Amy L; Davies, Hugh W; Demers, Paul A; Nicol, Anne-Marie; Peters, Cheryl E

    2013-11-01

    Although veterinary workers may encounter various occupational health hazards, a national characterization of exposures is lacking in Canada. This study used secondary data sources to identify veterinary exposure prevalence for ionizing radiation and antineoplastic agents, as part of a national surveillance project. For ionizing radiation, data from the Radiation Protection Bureau of Health Canada were used to identify veterinarians and veterinary technicians monitored in 2006. This was combined with Census statistics to estimate a prevalence range and dose levels. For antineoplastic agents, exposure prevalence was estimated using statistics on employment by practice type and antineoplastic agent usage rates, obtained from veterinary licensing bodies and peer-reviewed literature. In 2006, 7,013 (37% of all) Canadian veterinary workers were monitored for ionizing radiation exposure. An estimated 3.3% to 8.2% of all veterinarians and 2.4% to 7.2% of veterinary technicians were exposed to an annual ionizing radiation dose above 0.1 mSv, representing a total of between 536 and 1,450 workers. All monitored doses were below regulatory limits. For antineoplastic agents, exposure was predicted in up to 5,300 (23%) of all veterinary workers, with an estimated prevalence range of 22% to 24% of veterinarians and 20% to 21% of veterinary technicians. This is the first national-level assessment of exposure to ionizing radiation and antineoplastic agents in Canadian veterinary settings. These hazards may pose considerable health risks. Exposures appeared to be low, however our estimates should be validated with comprehensive exposure monitoring and examination of determinants across practice areas, occupations, and tasks.

  8. Migration, settlement change and health in post-apartheid South Africa: triangulating health and demographic surveillance with national census data.

    Science.gov (United States)

    Collinson, Mark A; Tollman, Stephen M; Kahn, Kathleen

    2007-08-01

    World population growth will be increasingly concentrated in the urban areas of the developing world; however, some scholars caution against the oversimplification of African urbanization noting that there may be "counter-urbanization" and a prevailing pattern of circular rural-urban migration. The aim of the paper is to examine the ongoing urban transition in South Africa in the post-apartheid period, and to consider the health and social policy implications of prevailing migration patterns. Two data sets were analysed, namely the South African national census of 2001 and the Agincourt health and demographic surveillance system. A settlement-type transition matrix was constructed on the national data to show how patterns of settlement have changed in a five-year period. Using the sub-district data, permanent and temporary migration was characterized, providing migration rates by age and sex, and showing the distribution of origins and destinations. The comparison of national and sub-district data highlight the following features: urban population growth, particularly in metropolitan areas, resulting from permanent and temporary migration; prevailing patterns of temporary, circular migration, and a changing gender balance in this form of migration; stepwise urbanization; and return migration from urban to rural areas. Policy concerns include: rural poverty exacerbated by labour migration; explosive conditions for the transmission of HIV; labour migrants returning to die in rural areas; and the challenges for health information created by chronically ill migrants returning to rural areas to convalesce. Lastly, suggestions are made on how to address the dearth of relevant population information for policy-making in the fields of migration, settlement change and health.

  9. Influenza in outpatient ILI case-patients in national hospital-based surveillance, Bangladesh, 2007-2008

    National Research Council Canada - National Science Library

    Zaman, Rashid Uz; Alamgir, A S M; Rahman, Mustafizur; Azziz-Baumgartner, Eduardo; Gurley, Emily S; Sharker, M Abu Yushuf; Brooks, W Abdullah; Azim, Tasnim; Fry, Alicia M; Lindstrom, Stephen; Gubareva, Larisa V; Xu, Xiyan; Garten, Rebecca J; Hossain, M Jahangir; Khan, Salah Uddin; Faruque, Labib Imran; Ameer, Syeda Shegufta; Klimov, Alexander I; Rahman, Mahmudur; Luby, Stephen P

    2009-01-01

    ... influenza prevention and control efforts. We conducted influenza-like illness and severe acute respiratory illness sentinel surveillance in 12 hospitals across Bangladesh during May 2007-December 2008...

  10. Cost-effectiveness of rapid syphilis screening in prenatal HIV testing programs in Haiti.

    Directory of Open Access Journals (Sweden)

    Bruce R Schackman

    2007-05-01

    Full Text Available BACKGROUND: New rapid syphilis tests permit simple and immediate diagnosis and treatment at a single clinic visit. We compared the cost-effectiveness, projected health outcomes, and annual cost of screening pregnant women using a rapid syphilis test as part of scaled-up prenatal testing to prevent mother-to-child HIV transmission in Haiti. METHODS AND FINDINGS: A decision analytic model simulated health outcomes and costs separately for pregnant women in rural and urban areas. We compared syphilis syndromic surveillance (rural standard of care, rapid plasma reagin test with results and treatment at 1-wk follow-up (urban standard of care, and a new rapid test with immediate results and treatment. Test performance data were from a World Health Organization-Special Programme for Research and Training in Tropical Diseases field trial conducted at the GHESKIO Center Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes in Port-au-Prince. Health outcomes were projected using historical data on prenatal syphilis treatment efficacy and included disability-adjusted life years (DALYs of newborns, congenital syphilis cases, neonatal deaths, and stillbirths. Cost-effectiveness ratios are in US dollars/DALY from a societal perspective; annual costs are in US dollars from a payer perspective. Rapid testing with immediate treatment has a cost-effectiveness ratio of $6.83/DALY in rural settings and $9.95/DALY in urban settings. Results are sensitive to regional syphilis prevalence, rapid test sensitivity, and the return rate for follow-up visits. Integrating rapid syphilis testing into a scaled-up national HIV testing and prenatal care program would prevent 1,125 congenital syphilis cases and 1,223 stillbirths or neonatal deaths annually at a cost of $525,000. CONCLUSIONS: In Haiti, integrating a new rapid syphilis test into prenatal care and HIV testing would prevent congenital syphilis cases and stillbirths, and is cost-effective. A

  11. National Automated Surveillance of Hospital-Acquired Bacteremia in Denmark Using a Computer Algorithm

    DEFF Research Database (Denmark)

    Gubbels, Sophie; Nielsen, Jens; Voldstedlund, Marianne

    2017-01-01

    for hospital-acquired bacteremia SETTING Private and public hospitals in Denmark METHODS A hospital-acquired bacteremia case was defined as at least 1 positive blood culture with at least 1 pathogen (bacterium or fungus) taken between 48 hours after admission and 48 hours after discharge, using the Danish...... Microbiology Database and the Danish National Patient Registry. PPSs performed in 2012 and 2013 were used for comparison. RESULTS National trends showed an increase in HA bacteremia cases between 2010 and 2014. Incidence was higher for men than women (9.6 vs 5.4 per 10,000 risk days) and was highest for those...... aged 61-80 years (9.5 per 10,000 risk days). The median daily prevalence was 3.1% (range, 2.1%-4.7%). Regional incidence varied from 6.1 to 8.1 per 10,000 risk days. The microorganisms identified were typical for HA bacteremia. Comparison of HAIBA with PPS showed a sensitivity of 36% and a specificity...

  12. [Analysis on the characteristics of violence based on data from the Chinese National Injury Surveillance System from 2006 to 2013].

    Science.gov (United States)

    Gao, Xin; Ye, Pengpeng; Er, Yuliang; Wang, Linhong; Deng, Xiao; Wang, Yuan; Jin, Ye; Ji, Cuirong; Yang, Chao; Duan, Leilei

    2015-01-01

    To understand the characteristics of victims under violence that were enrolled from clinic and emergency room of the hospitals, to provide basis for the development of violence prevention strategies. Data from the National Injury Surveillance Program between 2006 and 2013 were used to analyze: 1) trend of violence proportion in injuries, 2) socio-demographic characteristics of the cases, 3)basic and clinic information on related violence. The proportion of victims of violence decreased during the past 8 years. The number of violence related cases in 2013 was 50 333, including 36 049 males and 14 284 females. Most cases had educational levels as junior (41.2%) or senior high schools (27.3%). 24.0% of the violence occurred between 22:00 PM and 02:59 AM. The proportions of domestic violence were 30.2% in the 0-4 age group and 28.5% in the 65- age group, both were higher than in the other age groups. Interventions on violence including children abuse and elderly abuse should be paid attention to.

  13. Active surveillance of visual impairment due to adverse drug reactions: findings from a national study in the United Kingdom.

    Science.gov (United States)

    Cumberland, Phillippa M; Russell-Eggitt, Isabelle; Rahi, Jugnoo S

    2015-02-01

    As visual impairment (VI) due to adverse drug reactions (ADR) is rare in adults and children, there is an incomplete evidence base to inform guidance for screening and for counseling patients on the potential risks of medications. We report on suspected drugs and the eye conditions found in a national study of incidence of diagnosis of visual impairment due to suspected ADR. Case ascertainment was via the British Ophthalmological Surveillance Unit (BOSU), between March 2010 and February 2012, with follow-up after 6 months. any child or adult with bilateral or unilateral visual impairment due to a suspected ADR, using distance acuity worse than Snellen 6/18 (logMAR 0.48) in the better eye (bilateral) or affected eye (unilateral). Anonymized patient information on potential cases was provided by managing ophthalmologists, comprising visual status before and after suspected ADR, ophthalmic condition attributable to the ADR, preexisting eye disease and prescribed medications at the time of the ADR. Permanency and causality of the visual impairment were confirmed by the managing clinician, after 6 months, using the WHO Uppsala Monitoring Committee criteria. Over 2 years, 36 eligible cases were reported of whom 23 had permanent VI. While most cases were due to drugs known to have adverse side-effects, some were unanticipated sporadic cases. Visual impairment due to ADRs is rare. However, with for example, increasing polypharmacy in the elderly, monitoring of ocular ADRs, although challenging, is necessary.

  14. Epidemiology of domestically acquired hepatitis E virus infection in Japan: assessment of the nationally reported surveillance data, 2007-2013.

    Science.gov (United States)

    Kanayama, Atsuhiro; Arima, Yuzo; Yamagishi, Takuya; Kinoshita, Hitomi; Sunagawa, Tomimasa; Yahata, Yuichiro; Matsui, Tamano; Ishii, Koji; Wakita, Takaji; Oishi, Kazunori

    2015-07-01

    In recent years, there has been an increase in the number of reported hepatitis E virus (HEV) infections from developed countries. To describe recent trends in notification and potential risk groups and risk factors in Japan, HEV infection cases and demographic, food consumption, clinical and laboratory data reported during 2007-2013 were analysed. In total, 530 HEV infections were reported during 2007-2013. Amongst 462 domestic cases, the mean age was 56.5 years (sd 13.9) and 80.1 % were male. Forty-three cases (9.3 %) were asymptomatic, amongst which 11 were detected from blood donations. Whilst ∼50 cases were reported annually during 2007-2011, the number of reported cases increased to 121 in 2012 and 126 in 2013. The increase was characterized by a rise in the number of domestic, symptomatic cases (P = 0.05) and cases confirmed by anti-HEV IgA detection (P National Health Insurance system in Japan in October 2011 and its acceptance for surveillance purposes. However, the increase was not associated with detection of asymptomatic cases. Moreover, males aged 50-69 years remained as the high-risk group, and pork and other meats continued to be the most suspected items. Our findings indicated that HEV infection is an emerging and important public health concern in Japan.

  15. Health environmental risks surveillance systems: toxicological surveillance

    OpenAIRE

    Ana Ferrer Dufol; Santiago Nogué Xarau; Francisco Vargas Marcos; Olivia Castillo Soria; Pilar Gascó Alberich; Ana de la Torre Reoyo; Eduardo de la Peña de Torres

    2004-01-01

    A study of the Clinical Toxicological Section, about the Epidemiological Surveillance in Emergency Services, in relation to chemical products intoxications during the 1999-2003 period, is presented. This work is a result of an agreement between the Spanish Toxicological Association (AETOX) and the Spanish Ministry of Health and Consumption, and was presented in the National Congress of Environment (CONAMA) within the “Health Environmental Risks Surveillance Systems” working group.

  16. Environmental surveillance master sampling schedule

    Energy Technology Data Exchange (ETDEWEB)

    Bisping, L.E.

    1996-02-01

    Environmental surveillance of the Hanford Site and surrounding areas is conducted by the Pacific Northwest National Laboratory (PNNL) for the US Department of Energy (DOE). This document contains the planned 1996 schedules for routine collection of samples for the Surface Environmental Surveillance Project (SESP), Drinking Water Project, and Ground-Water Surveillance Project.

  17. CT colonography and cost-effectiveness

    Energy Technology Data Exchange (ETDEWEB)

    Mavranezouli, Ifigeneia [University College London, National Collaborating Centre for Mental Health, Centre for Outcomes Research and Effectiveness, Sub-department of Clinical Health Psychology, London (United Kingdom); East, James E. [St Marks Hospital, Imperial College London, Wolfson Unit for Endoscopy, London (United Kingdom); Taylor, Stuart A. [University College Hospital, Specialist X-Ray, London (United Kingdom); University College Hospital, Department of Imaging, London (United Kingdom)

    2008-11-15

    CT colonography (CTC) is increasingly advocated as an effective initial screening tool for colorectal cancer. Nowadays, policy-makers are increasingly interested in cost-effectiveness issues. A number of studies assessing the cost-effectiveness of CTC have been published to date. The majority of findings indicate that CTC is probably not cost-effective when colonoscopy is available, but this conclusion is sensitive to a number of key parameters. This review discusses the findings of these studies, and considers those factors which most influence final conclusions, notably intervention costs, compliance rates, effectiveness of colonoscopy, and the assumed prevalence and natural history of diminutive advanced polyps. (orig.)

  18. Routine Pediatric Enterovirus 71 Vaccination in China: a Cost-Effectiveness Analysis.

    Directory of Open Access Journals (Sweden)

    Joseph T Wu

    2016-03-01

    Full Text Available China accounted for 87% (9.8 million/11.3 million of all hand, foot, and mouth disease (HFMD cases reported to WHO during 2010-2014. Enterovirus 71 (EV71 is responsible for most of the severe HFMD cases. Three EV71 vaccines recently demonstrated good efficacy in children aged 6-71 mo. Here we assessed the cost-effectiveness of routine pediatric EV71 vaccination in China.We characterized the economic and health burden of EV71-associated HFMD (EV71-HFMD in China using (i the national surveillance database, (ii virological surveillance records from all provinces, and (iii a caregiver survey on the household costs and health utility loss for 1,787 laboratory-confirmed pediatric cases. Using a static model parameterized with these data, we estimated the effective vaccine cost (EVC, defined as cost/efficacy or simply the cost of a 100% efficacious vaccine below which routine pediatric vaccination would be considered cost-effective. We performed the base-case analysis from the societal perspective with a willingness-to-pay threshold of one times the gross domestic product per capita (GDPpc and an annual discount rate of 3%. We performed uncertainty analysis by (i accounting for the uncertainty in the risk of EV71-HFMD due to missing laboratory data in the national database, (ii excluding productivity loss of parents and caregivers, (iii increasing the willingness-to-pay threshold to three times GDPpc, (iv increasing the discount rate to 6%, and (v accounting for the proportion of EV71-HFMD cases not registered by national surveillance. In each of these scenarios, we performed probabilistic sensitivity analysis to account for parametric uncertainty in our estimates of the risk of EV71-HFMD and the expected costs and health utility loss due to EV71-HFMD. Routine pediatric EV71 vaccination would be cost-saving if the all-inclusive EVC is below US$10.6 (95% CI US$9.7-US$11.5 and would remain cost-effective if EVC is below US$17.9 (95% CI US$16.9-US$18.8 in

  19. Green Infrastructure Siting and Cost Effectiveness Analysis

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Parcel scale green infrastructure siting and cost effectiveness analysis. You can find more details at the project's website.

  20. Cost-Effective Stress Management Training.

    Science.gov (United States)

    Shea, Gordon F.

    1980-01-01

    Stress management training can be a cost effective way to improve productivity and job performance. Among many relaxation techniques, the most effective in terms of teachability, participant motivation, and profitability are self-hypnosis, progressive relaxation, and transcendental meditation. (SK)

  1. Determining a cost effective intervention response to HIV/AIDS in Peru

    Directory of Open Access Journals (Sweden)

    Cáceres Carlos F

    2009-09-01

    Full Text Available Abstract Background The HIV epidemic in Peru is still regarded as concentrated - sentinel surveillance data shows greatest rates of infection in men who have sex with men, while much lower rates are found in female sex workers and still lower in the general population. Without an appropriate set of preventive interventions, continuing infections could present a challenge to the sustainability of the present programme of universal access to treatment. Determining how specific prevention and care strategies would impact on the health of Peruvians should be key in reshaping the national response. Methods HIV/AIDS prevalence levels for risk groups with sufficient sentinel survey data were estimated. Unit costs were calculated for a series of interventions against HIV/AIDS which were subsequently inputted into a model to assess their ability to reduce infection transmission rates. Interventions included: mass media, voluntary counselling and testing; peer counselling for female sex workers; peer counselling for men who have sex with men; peer education of youth in-school; condom provision; STI treatment; prevention of mother to child transmission; and highly active antiretroviral therapy. Impact was assessed by the ability to reduce rates of transmission and quantified in terms of cost per DALY averted. Results Results of the analysis show that in Peru, the highest levels of HIV prevalence are found in men who have sex with men. Cost effectiveness varied greatly between interventions ranging from peer education of female commercial sex workers at $US 55 up to $US 5,928 (per DALY averted for prevention of mother to child transmission. Conclusion The results of this work add evidence-based clarity as to which interventions warrant greatest consideration when planning an intervention response to HIV in Peru. Cost effectiveness analysis provides a necessary element of transparency when facing choices about priority setting, particularly when the country

  2. Acromioclavicular joint injuries in National Collegiate Athletic Association football: data from the 2004-2005 through 2008-2009 National Collegiate Athletic Association Injury Surveillance System.

    Science.gov (United States)

    Dragoo, Jason L; Braun, Hillary J; Bartlinski, Stephen E; Harris, Alex H S

    2012-09-01

    Injuries to the shoulder are common in collegiate football, and injuries to the acromioclavicular (AC) joint have previously accounted for up to 41% of all shoulder injuries. To determine the incidence and epidemiology of injury to the AC joint in National Collegiate Athletic Association (NCAA) football athletes. Descriptive epidemiology study. The NCAA Injury Surveillance System (ISS) men's football database was reviewed from the 2004-2009 playing seasons. The exposure data set from the same years was reviewed for the purposes of computing rates of injury per athlete exposure (AE). The injury rate (number of injuries divided by number of AEs) was computed per 10,000 AEs for competition and practice exposures. Ninety-five percent confidence intervals (95% CIs) for the incidence rates were calculated using assumptions of a Poisson distribution. According to the estimates made by the NCAA ISS, a total of 748 injuries to the AC joint occurred in NCAA football players during 2,222,155 AEs, accounting for 4.49% of all injuries sustained during this 5-year surveillance period. The overall rate of injury was 3.34 per 10,000 AEs (95% CI, 3.10-3.59). Players were 11.68 (95% CI, 10.11-13.49) times more likely to sustain an injury in games than practices. Partial sprains (types I or II) accounted for 96.4% of injuries, while complete sprains (≥type III) accounted for the remaining 3.6%. The average amount of time lost per injury was 11.61 days. Complete sprains resulted in a mean time loss of 31.9 days (95% CI, 24.4-39.6) while partial injuries resulted in 11.0 days lost (95% CI, 9.6-12.3). Overall, 2.41% of injuries underwent surgical intervention, with 22.2% of complete sprains and 1.7% of partial injuries resulting in surgery. Complete sprains of the AC joint were 13.5 (95% CI, 4.63-35.26) times more likely to result in surgical intervention than partial sprains. The majority of injuries (71.93%) resulted from contact with another player and 47.09% occurred while

  3. [Analysis on sports and recreation related injuries through data from the Chinese National Injury Surveillance System, 2009-2013].

    Science.gov (United States)

    Deng, Xiao; Jin, Ye; Ye, Pengpeng; Gao, Xin; Wang, Yuan; Ji, Cuirong; Er, Yuliang; Wang, Linhong; Duan, Leilei

    2015-04-01

    To understand the trend and characteristics of sports and recreation related injuries reported from National Injury Surveillance System (NISS) to provide basis for corresponding prevention strategies and decision-making. Descriptive analysis was applied to display the overall trend, general information, injury event and clinical characteristics of sports and recreation related injuries from 2009 to 2013. The proportion of sports and recreation related injuries among all injuries increased from 2009 to 2013, with an annual increase exceeding 45% (46.21%, 47.32%, 48.14%, 52.00%, 53.65%, respectively). Sports and recreation related injuries mainly involved males, with 15-29 age groups, particularly in summer and autumn. Sports and recreation related injuries mostly occurred at home, with annual rates of proportion as 33.07%, 34.16%, 32.98%, 34.57 and 36.22%, mostly caused by falls (41.19%, 41.64%, 44.70%, 47.41%, 47.96%). Contusion and abrasion were the leading types of injuries (43.49%, 44.56%, 45.14%, 45.02%, 45.62%) with the serious leading types as fracture, concussion/cerebral contusion or laceration, and sharp force injury/bite/open wounds. Head was the part mainly involved (31.30%, 32.48%, 31.89%, 30.88%, 29.44%) in injuries. Most sports and recreation related injuries were minor and most of the patients headed home after treatment. Sports and recreation related injury appeared a growing public health problem in China. Children and the elderly should be the target groups for intervention. Falls prevention in sports and the use of protection gears should be the focus countermeasures for prevention.

  4. Prevalence of the main food-borne pathogens in retail food under the national food surveillance system in Japan.

    Science.gov (United States)

    Hara-Kudo, Y; Konuma, H; Kamata, Y; Miyahara, M; Takatori, K; Onoue, Y; Sugita-Konishi, Y; Ohnishi, T

    2013-01-01

    The National Food Surveillance System in Japan was formed in 1998 to monitor the contamination of retail foods with bacterial pathogens. Approximately 2000-3000 samples were tested annually, and the data from food categories that had more than 400 samples collected during 1998-2008 were analysed. With regard to meat, the frequency of positive samples for Salmonella in chicken for raw consumption and ground chicken was 12.7% and 33.5%, respectively. Moreover, Shiga toxin-producing Escherichia coli (STEC) O157 was found in ground meat, organ meat and processed meat, although at a low frequency (0.1%). The prevalence of Campylobacter jejuni/coli was 13.3% and 20.9% in chicken for raw consumption and ground chicken, respectively. In vegetables and fruit, Salmonella was detected in cucumber, lettuce, sprout and tomato samples at a frequency of around 0.1-0.2%. With regard to seafood, Salmonella was found in 0.5% of oysters for raw consumption. Seafood was not contaminated with STEC O157 or Shigella. Serotype Infantis was the most frequently detected serotype of Salmonella in seafood, followed by the serotypes Typhimurium, Schwarzengrund and Manhattan. In ground chicken, 72.2% of the strains were identified as the serotype Infantis. E. coli, as an indicator of food hygiene, was detected in all food categories. The results show the prevalence of the above-mentioned pathogens in the retail food supplied in Japan; further, they indicate that consumption of raw food carries the risk of contracting food-borne infections.

  5. Using data from a nationally representative nutrition surveillance system to assess trends and influence nutrition programs and policy

    Directory of Open Access Journals (Sweden)

    Nasima Akhter

    2010-02-01

    Full Text Available The Nutritional Surveillance Project (NSP* of Helen Keller International (HKI, Bangladesh, implemented in partnership with the Government of Bangladesh’s (GOB Institute of Public Health Nutrition (IPHN from 1990 until 2006, is among the longest running surveillance systems; and was implemented with an overall goal to monitor nutrition and health status of children and mothers in Bangladesh. From 1990-1997, NSP data collection included rural and urban poor populations of disaster prone areas of Bangladesh. Since 1998, it evolved into a nationally representative nutrition surveillance system in rural Bangladesh and also continued assessing trends of malnutrition in urban poor areas. Over the 16 year period, the NSP produced plethora of information that was packaged and shared as bulletins, in peer reviewed journal articles, as presentations at conferences, seminars, workshops. The NSP had a flexible framework that allowed it to assess trends and underlying factors of malnutrition, monitor and evaluate selected programs and conduct special studies related to current and emerging issues. NSP findings were available to contribute to program development and supported policy discussions in-country and internationally. The NSP continuously highlighted the importance of monitoring, which is not only an indispensible element for a successful program, but also helps prioritization and decision making to maximize utilization of limited resources for developing countries burdened with numerous problems to address. The NSP provides an example of a technically sound surveillance system with rapid turnover of data and findings, which is imperative to successful program planning, policy formulation and tracking progress toward developmental goals.Le projet Nutritional Surveillance Project (NSP* de l’association Helen Keller International (HKI, mis en œuvre au Bangladesh en partenariat avec l’Institute of Public Health Nutrition (IPHN,

  6. Biosimilar medicines and cost-effectiveness

    Directory of Open Access Journals (Sweden)

    Steven Simoens

    2011-02-01

    Full Text Available Steven SimoensResearch Centre for Pharmaceutical Care and Pharmaco-economics, Faculty of Pharmaceutical Sciences, Katholieke Universiteit Leuven, Leuven, BelgiumAbstract: Given that biosimilars are agents that are similar but not identical to the reference biopharmaceutical, this study aims to introduce and describe specific issues related to the economic evaluation of biosimilars by focusing on the relative costs, relative effectiveness, and cost-effectiveness of biosimilars. Economic evaluation assesses the cost-effectiveness of a medicine by comparing the costs and outcomes of a medicine with those of a relevant comparator. The assessment of cost-effectiveness of a biosimilar is complicated by the fact that evidence needed to obtain marketing authorization from a registration authority does not always correspond to the data requirements of a reimbursement authority. In particular, this relates to the availability of adequately powered equivalence or noninferiority studies, the need for comparative data about the effectiveness in a real-world setting rather than the efficacy in a structured setting, and the use of health outcome measures instead of surrogate endpoints. As a biosimilar is likely to be less expensive than the comparator (eg, the reference biopharmaceutical, the assessment of the cost-effectiveness of a biosimilar depends on the relative effectiveness. If appropriately designed and powered clinical studies demonstrate equivalent effectiveness between a biosimilar and the comparator, then a cost-minimization analysis identifies the least expensive medicine. If there are differences in the effectiveness of a biosimilar and the comparator, other techniques of economic evaluation need to be employed, such as cost-effectiveness analysis or cost-utility analysis. Given that there may be uncertainty surrounding the long-term safety (ie, risk of immunogenicity and rare adverse events and effectiveness of a biosimilar, the cost-effectiveness

  7. Cost-effectiveness of malaria microscopy and rapid diagnostic tests versus presumptive diagnosis

    DEFF Research Database (Denmark)

    Batwala, Vincent; Magnussen, Pascal; Hansen, Kristian Schultz

    2011-01-01

    ABSTRACT: BACKGROUND: Current Uganda National Malaria treatment guidelines recommend parasitological confirmation either by microscopy or rapid diagnostic test (RDT) before treatment with artemether-lumefantrine (AL). However, the cost-effectiveness of these strategies has not been assessed...

  8. Trends and risk factors of hyperglycemia and diabetes among Kuwaiti adults: National Nutrition Surveillance Data from 2002 to 2009

    Directory of Open Access Journals (Sweden)

    Ahmed Faruk

    2013-02-01

    Full Text Available Abstract Background Current prevalence estimates for diabetes in Arabian Gulf countries are some of the world’s highest, yet regional trends and contributing factors are poorly documented. The present study was designed to determine temporal changes in the prevalence of impaired fasting glucose (IFG and diabetes and associated factors in Kuwaiti adults. Methods Data analysis from the nationally representative cross-sectional Kuwait National Nutrition Surveillance System. 2745 males and 3611 females, aged 20–69 years, attending registration for employment or pensions and Hajj Pilgrimage health check-ups or accompanying children for immunizations from 2002 through 2009 were participated. Socio-demographic and lifestyle information, height and weight, and blood samples were collected. Results During the 8 years (2002–09, prevalences of IFG in males and females decreased by 7.4% and 6.8% and of diabetes by 9.8% and 8.9% in males and females, respectively. Linear regression for blood glucose level with time, adjusted for age, BMI, blood cholesterol and education level, showed a greater decrease in males than females (1.12 vs 0.93 mmol/L; males also showed an increase in 2002–2003 followed by a marked decrease in 2006–2007 while females showed a significant decrease in 2008–2009. Both males and females showed the largest decrease in the 2nd half of the study accounting for the majority of the overall decrease (1.13 mmol/L for males and 0.87 mmol/l for females for the 4 years. Compared with 2002–03, the OR for IFG in males decreased with time, and becoming significantly lower (OR=0.32; 95% CI: 0.21-0.49 for 2008–09. In females, the OR for IFG decreased significantly with time, except in 2006–07. Similarly, the OR for diabetes in males decreased to 0.34 (95% CI: 0.24-0.49 and in females to 0.33 (95% CI: 0.22-0.50 in 2008–09. For both genders, age and BMI were independently positively associated with IFG and diabetes, while education

  9. Trends and risk factors of hyperglycemia and diabetes among Kuwaiti adults: National Nutrition Surveillance Data from 2002 to 2009

    Science.gov (United States)

    2013-01-01

    Background Current prevalence estimates for diabetes in Arabian Gulf countries are some of the world’s highest, yet regional trends and contributing factors are poorly documented. The present study was designed to determine temporal changes in the prevalence of impaired fasting glucose (IFG) and diabetes and associated factors in Kuwaiti adults. Methods Data analysis from the nationally representative cross-sectional Kuwait National Nutrition Surveillance System. 2745 males and 3611 females, aged 20–69 years, attending registration for employment or pensions and Hajj Pilgrimage health check-ups or accompanying children for immunizations from 2002 through 2009 were participated. Socio-demographic and lifestyle information, height and weight, and blood samples were collected. Results During the 8 years (2002–09), prevalences of IFG in males and females decreased by 7.4% and 6.8% and of diabetes by 9.8% and 8.9% in males and females, respectively. Linear regression for blood glucose level with time, adjusted for age, BMI, blood cholesterol and education level, showed a greater decrease in males than females (1.12 vs 0.93 mmol/L); males also showed an increase in 2002–2003 followed by a marked decrease in 2006–2007 while females showed a significant decrease in 2008–2009. Both males and females showed the largest decrease in the 2nd half of the study accounting for the majority of the overall decrease (1.13 mmol/L for males and 0.87 mmol/l for females for the 4 years). Compared with 2002–03, the OR for IFG in males decreased with time, and becoming significantly lower (OR=0.32; 95% CI: 0.21-0.49) for 2008–09. In females, the OR for IFG decreased significantly with time, except in 2006–07. Similarly, the OR for diabetes in males decreased to 0.34 (95% CI: 0.24-0.49) and in females to 0.33 (95% CI: 0.22-0.50) in 2008–09. For both genders, age and BMI were independently positively associated with IFG and diabetes, while education levels and smoking

  10. Automatic Dependent Surveillance - Broadcast Verification and Validation Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Automatic Dependent Surveillance ? Broadcast (ADS-B) is an emerging Communications, Navigation, and Surveillance (CNS) technology that will vastly expand the state...

  11. A long-term experimental case study of the ecological effectiveness and cost effectiveness of invasive plant management in achieving conservation goals: bitou bush control in booderee national park in eastern australia.

    Directory of Open Access Journals (Sweden)

    David B Lindenmayer

    Full Text Available Invasive plant management is often justified in terms of conservation goals, yet progress is rarely assessed against these broader goals, instead focussing on short-term reductions of the invader as a measure of success. Key questions commonly remain unanswered including whether invader removal reverses invader impacts and whether management itself has negative ecosystem impacts. We addressed these knowledge gaps using a seven year experimental investigation of Bitou Bush, Chrysanthemoides monilifera subsp. rotundata. Our case study took advantage of the realities of applied management interventions for Bitou Bush to assess whether it is a driver or passenger of environmental change, and quantified conservation benefits relative to management costs of different treatment regimes. Among treatments examined, spraying with herbicide followed by burning and subsequent re-spraying (spray-fire-spray proved the most effective for reducing the number of individuals and cover of Bitou Bush. Other treatment regimes (e.g. fire followed by spraying, or two fires in succession were less effective or even exacerbated Bitou Bush invasion. The spray-fire-spray regime did not increase susceptibility of treated areas to re-invasion by Bitou Bush or other exotic species. This regime significantly reduced plant species richness and cover, but these effects were short-lived. The spray-fire-spray regime was the most cost-effective approach to controlling a highly invasive species and facilitating restoration of native plant species richness to levels characteristic of uninvaded sites. We provide a decision tree to guide management, where recommended actions depend on the outcome of post-treatment monitoring and performance against objectives. Critical to success is avoiding partial treatments and treatment sequences that may exacerbate invasive species impacts. We also show the value of taking advantage of unplanned events, such as wildfires, to achieve management

  12. Streptococcus pneumoniae Serotypes and Mortality in Adults and Adolescents in South Africa: Analysis of National Surveillance Data, 2003 - 2008.

    Directory of Open Access Journals (Sweden)

    Cheryl Cohen

    Full Text Available An association between pneumococcal serotypes and mortality has been suggested. We aimed to investigate this among individuals aged ≥15 years with invasive pneumococcal disease (IPD in South Africa.IPD cases were identified through national laboratory-based surveillance at 25 sites, pre-pneumococcal conjugate vaccine (PCV introduction, from 2003-2008. We assessed the association between the 20 commonest serotypes and in-hospital mortality using logistic regression with serotype 4 (the third commonest serotype with intermediate case-fatality ratio (CFR as referent.Among 3953 IPD cases, CFR was 55% (641/1166 for meningitis and 23% (576/2484 for bacteremia (p<0.001. Serotype 19F had the highest CFR (48%, 100/207, followed by serotype 23F (39%, 99/252 and serotype 1 (38%, 246/651. On multivariable analysis, factors independently associated with mortality included serotype 1 (OR 1.9, 95%CI 1.1-3.5 and 19F (OR 2.9, 95%CI 1.4-6.1 vs. serotype 4; increasing age (25-44 years, OR 1.8, 95%CI 1.0-3.0; 45-64 years, OR 3.6, 95%CI 2.0-6.4; ≥65 years, OR 5.2, 95%CI 1.9-14.1; vs. 15-24 years; meningitis (OR 4.1, 95%CI 3.0-5.6 vs. bacteremic pneumonia; and HIV infection (OR1.7, 95%CI 1.0-2.8. On stratified multivariate analysis, serotype 19F was associated with increased mortality amongst bacteremic pneumococcal pneumonia cases, while no serotype was associated with increased mortality in meningitis cases.Mortality was increased in HIV-infected individuals, which may be reduced by increased antiretroviral therapy availability. Serotypes associated with increased mortality are included in the 10-and-13-valent PCV and may become less common in adults due to indirect effects following routine infant immunization.

  13. Making choices in health: WHO guide to cost effectiveness analysis

    National Research Council Canada - National Science Library

    Tan Torres Edejer, Tessa

    2003-01-01

    ... . . . . . . . . . . . . . . . . . . . . . . . XXI PART ONE: METHODS COST-EFFECTIVENESS FOR GENERALIZED ANALYSIS 1. 2. What is Generalized Cost-Effectiveness Analysis? . . . . . . . . . . . . 3 Undertaking...

  14. Electrochemical Journals, AIP's Scitation, Cost-Effectiveness

    OpenAIRE

    Roth, Dana L

    2004-01-01

    A review of the relative subscription costs, page & article counts of Electrochemical Society journals compared with commercial counterparts. A description of the AIP's Scitation database. The relative cost-effectiveness (normalized cost/article/Impact Factor) of society and commercial journals related to electrochemistry.

  15. Cost-effectiveness in reproductive medicine

    NARCIS (Netherlands)

    L.M. Moolenaar

    2013-01-01

    This thesis reports on cost-effectiveness in reproductive medicine. Firstly, we evaluated the methodologic quality of studies in reproductive medicine. Insight into the quality of economical analysis in reproductive medicine is important for valuing the performed studies and to assess whether these

  16. Cost-effectiveness analysis and innovation.

    Science.gov (United States)

    Jena, Anupam B; Philipson, Tomas J

    2008-09-01

    While cost-effectiveness (CE) analysis has provided a guide to allocating often scarce resources spent on medical technologies, less emphasis has been placed on the effect of such criteria on the behavior of innovators who make health care technologies available in the first place. A better understanding of the link between innovation and cost-effectiveness analysis is particularly important given the large role of technological change in the growth in health care spending and the growing interest of explicit use of CE thresholds in leading technology adoption in several Westernized countries. We analyze CE analysis in a standard market context, and stress that a technology's cost-effectiveness is closely related to the consumer surplus it generates. Improved CE therefore often clashes with interventions to stimulate producer surplus, such as patents. We derive the inconsistency between technology adoption based on CE analysis and economic efficiency. Indeed, static efficiency, dynamic efficiency, and improved patient health may all be induced by the cost-effectiveness of the technology being at its worst level. As producer appropriation of the social surplus of an innovation is central to the dynamic efficiency that should guide CE adoption criteria, we exemplify how appropriation can be inferred from existing CE estimates. For an illustrative sample of technologies considered, we find that the median technology has an appropriation of about 15%. To the extent that such incentives are deemed either too low or too high compared to dynamically efficient levels, CE thresholds may be appropriately raised or lowered to improve dynamic efficiency.

  17. Cost-effectiveness analysis of a statewide media campaign to promote adolescent physical activity.

    Science.gov (United States)

    Peterson, Michael; Chandlee, Margaret; Abraham, Avron

    2008-10-01

    A cost-effectiveness analysis of a statewide social marketing campaign was performed using a statewide surveillance survey distributed to 6th through 12th graders, media production and placement costs, and 2000 census data. Exposure to all three advertisements had the highest impact on both intent and behavior with 65.6% of the respondents considering becoming more active and 58.3% reporting becoming more active. Average cost of the entire campaign was $4.01 per person to see an ad, $7.35 per person to consider being more active, and $8.87 per person to actually become more active, with billboards yielding the most positive cost-effectiveness. Findings highlight market research as an essential part of social marketing campaigns and the importance of using multiple marketing modalities to enhance cost-effectiveness and impact.

  18. Cost-effectiveness of integrated collaborative care for comorbid major depression in patients with cancer☆

    Science.gov (United States)

    Duarte, A.; Walker, J.; Walker, S.; Richardson, G.; Holm Hansen, C.; Martin, P.; Murray, G.; Sculpher, M.; Sharpe, M.

    2015-01-01

    Objectives Comorbid major depression is associated with reduced quality of life and greater use of healthcare resources. A recent randomised trial (SMaRT, Symptom Management Research Trials, Oncology-2) found that a collaborative care treatment programme (Depression Care for People with Cancer, DCPC) was highly effective in treating depression in patients with cancer. This study aims to estimate the cost-effectiveness of DCPC compared with usual care from a health service perspective. Methods Costs were estimated using UK national unit cost estimates and health outcomes measured using quality-adjusted life-years (QALYs). Incremental cost-effectiveness of DCPC compared with usual care was calculated and scenario analyses performed to test alternative assumptions on costs and missing data. Uncertainty was characterised using cost-effectiveness acceptability curves. The probability of DCPC being cost-effective was determined using the UK National Institute for Health and Care Excellence's (NICE) cost-effectiveness threshold range of £20,000 to £30,000 per QALY gained. Results DCPC cost on average £631 more than usual care per patient, and resulted in a mean gain of 0.066 QALYs, yielding an incremental cost-effectiveness ratio of £9549 per QALY. The probability of DCPC being cost-effective was 0.9 or greater at cost-effectiveness thresholds above £20,000 per QALY for the base case and scenario analyses. Conclusions Compared with usual care, DCPC is likely to be cost-effective at the current thresholds used by NICE. This study adds to the weight of evidence that collaborative care treatment models are cost-effective for depression, and provides new evidence regarding their use in specialist medical settings. PMID:26652589

  19. The use of rapid assessment methodology to compliment existing national assessment and surveillance data: a study among injecting drug users in Penang, Malaysia.

    Science.gov (United States)

    Vicknasingam, B; Navaratnam, V

    2008-02-01

    The study explores how data collated from rapid assessment can enhance those produced by national level surveillance systems, in this case the national drug information (NADI) system in Malaysia. Qualitative data were collected in keeping with internationally accepted guidance on rapid assessment methods in the field of substance use. An inductive research strategy was employed. The rapid assessment produced multiple data on local drug use practices and how these were influenced by the contexts of use. The assessment points to the importance of collecting data not only on patterns of drug use but also on the health and social consequences of drug use. We suggest that the current national drug information system places greater emphasis on behavioural and health-related variables in order to better understand the potential relationships between drug use and health-related risk, including HIV/AIDS.

  20. The Spanish national health care-associated infection surveillance network (INCLIMECC): data summary January 1997 through December 2006 adapted to the new National Healthcare Safety Network Procedure-associated module codes.

    Science.gov (United States)

    Pérez, Cristina Díaz-Agero; Rodela, Ana Robustillo; Monge Jodrá, Vincente

    2009-12-01

    In 1997, a national standardized surveillance system (designated INCLIMECC [Indicadores Clínicos de Mejora Continua de la Calidad]) was established in Spain for health care-associated infection (HAI) in surgery patients, based on the National Nosocomial Infection Surveillance (NNIS) system. In 2005, in its procedure-associated module, the National Healthcare Safety Network (NHSN) inherited the NNIS program for surveillance of HAI in surgery patients and reorganized all surgical procedures. INCLIMECC actively monitors all patients referred to the surgical ward of each participating hospital. We present a summary of the data collected from January 1997 to December 2006 adapted to the new NHSN procedures. Surgical site infection (SSI) rates are provided by operative procedure and NNIS risk index category. Further quality indicators reported are surgical complications, length of stay, antimicrobial prophylaxis, mortality, readmission because of infection or other complication, and revision surgery. Because the ICD-9-CM surgery procedure code is included in each patient's record, we were able to reorganize our database avoiding the loss of extensive information, as has occurred with other systems.

  1. Cost-effectiveness of the Norwegian breast cancer screening program.

    Science.gov (United States)

    van Luijt, P A; Heijnsdijk, E A M; de Koning, H J

    2017-02-15

    The Norwegian Breast Cancer Screening Programme (NBCSP) has a nation-wide coverage since 2005. All women aged 50-69 years are invited biennially for mammography screening. We evaluated breast cancer mortality reduction and performed a cost-effectiveness analysis, using our microsimulation model, calibrated to most recent data. The microsimulation model allows for the comparison of mortality and costs between a (hypothetical) situation without screening and a situation with screening. Breast cancer incidence in Norway had a steep increase in the early 1990s. We calibrated the model to simulate this increase and included recent costs for screening, diagnosis and treatment of breast cancer and travel and productivity loss. We estimate a 16% breast cancer mortality reduction for a cohort of women, invited to screening, followed over their complete lifetime. Cost-effectiveness is estimated at NOK 112,162 per QALY gained, when taking only direct medical costs into account (the cost of the buses, examinations, and invitations). We used a 3.5% annual discount rate. Cost-effectiveness estimates are substantially below the threshold of NOK 1,926,366 as recommended by the WHO guidelines. For the Norwegian population, which has been gradually exposed to screening, breast cancer mortality reduction for women exposed to screening is increasing and is estimated to rise to ∼30% in 2020 for women aged 55-80 years. The NBCSP is a highly cost-effective measure to reduce breast cancer specific mortality. We estimate a breast cancer specific mortality reduction of 16-30%, at the cost of 112,162 NOK per QALY gained. © 2016 UICC.

  2. Cost-effectiveness analysis of rotavirus vaccination in Argentina.

    Science.gov (United States)

    Urueña, Analía; Pippo, Tomás; Betelu, María Sol; Virgilio, Federico; Hernández, Laura; Giglio, Norberto; Gentile, Ángela; Diosque, Máximo; Vizzotti, Carla

    2015-05-07

    Rotavirus is a leading cause of severe diarrhea in children under 5. In Argentina, the most affected regions are the Northeast and Northwest, where hospitalizations and deaths are more frequent. This study estimated the cost-effectiveness of adding either of the two licensed rotavirus vaccines to the routine immunization schedule. The integrated TRIVAC vaccine cost-effectiveness model from the Pan American Health Organization's ProVac Initiative (Version 2.0) was used to assess health benefits, costs savings, life-years gained (LYGs), DALYs averted, and cost/DALY averted of vaccinating 10 successive cohorts, from the health care system and societal perspectives. Two doses of monovalent (RV1) rotavirus vaccine and three doses of pentavalent (RV5) rotavirus vaccine were each compared to a scenario assuming no vaccination. The price/dose was US$ 7.50 and US$ 5.15 for RV1 and RV5, respectively. We ran both a national and sub-national analysis, discounting all costs and benefits 3% annually. Our base case results were compared to a range of alternative univariate and multivariate scenarios. The number of LYGs was 5962 and 6440 for RV1 and RV5, respectively. The cost/DALY averted when compared to no vaccination from the health care system and societal perspective was: US$ 3870 and US$ 1802 for RV1, and US$ 2414 and US$ 358 for RV5, respectively. Equivalent figures for the Northeast were US$ 1470 and US$ 636 for RV1, and US$ 913 and US$ 80 for RV5. Therefore, rotavirus vaccination was more cost-effective in the Northeast compared to the whole country; and, in the Northwest, health service's costs saved outweighed the cost of introducing the vaccine. Vaccination with either vaccine compared to no vaccination was highly cost-effective based on WHO guidelines and Argentina's 2011 per capita GDP of US$ 9090. Key variables influencing results were vaccine efficacy, annual loss of efficacy, relative coverage of deaths, vaccine price, and discount rate. Compared to no

  3. Cost-effectiveness of HPV vaccination in Belize.

    Science.gov (United States)

    Walwyn, Leslie; Janusz, Cara Bess; Clark, Andrew David; Prieto, Elise; Waight, Eufemia; Largaespada, Natalia

    2015-05-07

    Among women in Belize, cervical cancer is both the leading cancer and the leading cause of cancer deaths. Both the quadrivalent and bivalent human papillomavirus (HPV) vaccines are licensed in Belize. The Ministry of Health of Belize convened a multidisciplinary team to estimate the costs, health benefits, and cost-effectiveness of adding an HPV vaccine to the national immunization schedule. The CERVIVAC cost-effectiveness model (Version 1.123) was used to assess the lifetime health and economic outcomes of vaccinating one cohort of girls aged 10 years against HPV. The comparator was no HPV vaccination. The PAHO Revolving Fund negotiated price of US$ 13.79 per dose was used (for the quadrivalent vaccine) and national data sources were used to define demography, cervical cancer incidence and mortality, cervical cancer treatment costs, and vaccine delivery costs. Estimates from international agencies were used in scenario analysis. In a cohort of ∼4000 Belizean girls tracked over a lifetime, HPV vaccination is estimated to prevent 69 new cases of cervical cancer (undiscounted), and 51 cervical cancer deaths (undiscounted). Considering the potential cervical cancer treatment costs and lost wages avoided by households (societal perspective), the cost per disability-adjusted life year (DALY) averted was estimated to be US$ 429. This increased to US$ 1320 when cervical cancer treatment costs and lost wages were excluded from the analysis. Both estimates are far below the gross domestic product (GDP) per capita of Belize (US$ 4795). The lifetime health care costs saved by the women and their families represent more than 60% of the investment cost needed by the Government for the vaccine. Routine HPV vaccination would be highly cost-effective in Belize. If affordable, efforts should be made to expedite the introduction of this vaccine into the Belizean national immunization program. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. 贵州省2010年土源性线虫病监测点监测结果分析%Analysis of surveillance results of soil transmitted nematode infection at a national surveillance site in Guizhou of 2010

    Institute of Scientific and Technical Information of China (English)

    朱爱娅; 李安梅; 林广初; 耿燕; 徐建军; 孙良先

    2012-01-01

    OBJECTIVE To understand the status of infection of soil transmitted nematodes at the national surveillance site in Guizhou Province. METHODS Surveillance site and target populations were selected based on China's National soil transmitted nematode infection surveillance program. Eggs of intestinal nematodes were examined by the Kato-Katz technique. A transparent adhesive tape test was used to look for Enterobius vermicularis in children under 12 years of age. A modified floatation test with saturated sodium nit rate was used for egg detection in soil samples. RESULTS 1 000 residents were investigated, the total rate of infection with soil transmitted nematodes was 34.3%. The infection rates of Ascaris lumbricoides, hookworms and whipworm were 26.3%, 0.3% and 16.0%, respectively. No positive infection of Enterobius vermicularis was found in children from 3 to 12 years old. 40 soil samples from vegetable gardens, around toilets, courtyards and kitchens of 10 households were detected, and positive detection rate of Ascaris lumbricoides eggs were 60%, 80%, 20% and 10%, respectively. CONCLUSION The status of infection of soil transmitted nematodes at the national surveillance site in Guizhou Province is still severe, and it has great importance of improving people' s health by decreasing the infection rate with comprehensive measures.%目的 了解贵州省土源性线虫病监测点居民土源性线虫感染现状.方法 根据《全国土源性线虫病监测方案》要求选点,确定监测人群,采用改良加藤厚涂片法查粪便虫卵,透明胶纸肛拭法查12岁以下儿童蛲虫卵.改良饱和硝酸钠漂浮法检查土样中的虫卵.结果 共调查1 000人,土源性线虫总感染率为34.3%,其中,蛔虫、钩虫、鞭虫感染率分别为26.3%、0.3%和16.0%,3~12岁儿童蛲虫卵的监测中未发现感染者.对10户居民菜园、厕所周边、庭院、厨房的40份土样进行检查,蛔虫卵阳性率分别为60%、80%、20

  5. Dynamic modeling of cost-effectiveness of rotavirus vaccination, Kazakhstan.

    Science.gov (United States)

    Freiesleben de Blasio, Birgitte; Flem, Elmira; Latipov, Renat; Kuatbaeva, Ajnagul; Kristiansen, Ivar Sønbø

    2014-01-01

    The government of Kazakhstan, a middle-income country in Central Asia, is considering the introduction of rotavirus vaccination into its national immunization program. We performed a cost-effectiveness analysis of rotavirus vaccination spanning 20 years by using a synthesis of dynamic transmission models accounting for herd protection. We found that a vaccination program with 90% coverage would prevent ≈880 rotavirus deaths and save an average of 54,784 life-years for children vaccine cost at vaccination program costs would be entirely offset. To further evaluate efficacy of a vaccine program, benefits of indirect protection conferred by vaccination warrant further study.

  6. Operating Dedicated Data Centers - Is It Cost-Effective?

    Science.gov (United States)

    Ernst, M.; Hogue, R.; Hollowell, C.; Strecker-Kellog, W.; Wong, A.; Zaytsev, A.

    2014-06-01

    The advent of cloud computing centres such as Amazon's EC2 and Google's Computing Engine has elicited comparisons with dedicated computing clusters. Discussions on appropriate usage of cloud resources (both academic and commercial) and costs have ensued. This presentation discusses a detailed analysis of the costs of operating and maintaining the RACF (RHIC and ATLAS Computing Facility) compute cluster at Brookhaven National Lab and compares them with the cost of cloud computing resources under various usage scenarios. An extrapolation of likely future cost effectiveness of dedicated computing resources is also presented.

  7. Guidelines for a national epidemiological surveillance system of thyroid cancer in France; Recommandations pour la mise en place d'un dispositif de surveillance epidemiologique nationale des cancers thyroidiens

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2002-10-01

    At the request of the French Department of Health, a multidisciplinary Thyroid Cancer Committee, coordinated by the French Public Health Agency analysed the observed increase of thyroid cancer incidence in France and outlined the limits of the present case registration system. This Committee set up guidelines to improve the national surveillance system of thyroid cancer. The Committee analysed 4 models for the incidence survey, 3 of which have been excluded: a poor cost-benefit ratio precludes the constitution of a national registry dedicated to thyroid cancer; however, the Committee has recommended this model that still exists for thyroid cancer of the youth(under 19 years old), a national system base exclusively on pathological data would only be relevant after significant improvement of data collection, obligatory of all cases of thyroid cancer is inappropriate considering the fit prognosis of this cancer. A two level system is proposed with continuous registration of incident caes through the National Hospital Discharge survey, specific focused analysis of clinical and pathological data in case of a cluster alert in any given area. Whatever the system, it seems necessary to in general: propose a unique health registration number per patient, improve access to medical data, organize a national standardised collection of pathological findings, follow up the diagnosis practices related to thyroid cancer that have an impact on incidence rates. In conclusion, a reliable incidence survey and a follow up of diagnostic practices and of risk factors may provide a relevant model of epidemiological survey of thyroid cancers in France but such a system requires a long lasting strategic and financial involvement. (author)

  8. ST-analysis in electronic foetal monitoring is cost-effective from both the maternal and neonatal perspective

    NARCIS (Netherlands)

    van ’t Hooft, Janneke; Vink, Maarten; Opmeer, Brent C.; Ensing, Sabine; Kwee, Anneke; Mol, Ben Willem J

    2016-01-01

    Objective: Electronic foetal monitoring (EFM) together with non-invasive ST-analysis (STAN) has been suggested as a superior technique to EFM alone for foetal surveillance to prevent metabolic acidosis. This study aims to compare the cost-effectiveness of these two techniques from both maternal (sho

  9. Cost effectiveness of rural development programme instruments in denmark

    DEFF Research Database (Denmark)

    Jensen, Jørgen Dejgård; Jacobsen, Lars Bo; Madsen, Bjarne

    2011-01-01

    support (e.g. 10 million €/year) for the respective instruments, and in turn assess the geographically distributed effects on farm income and employment, on production, value-added and employment in related upstream and downstream industries, on income and employment in the municipalities, and on a number......The objective of this study is to investigate the cost-effectiveness of selected instruments of the Danish Rural Development Programme 2007-2013, which constitutes the Danish implementation of the EU Rural Development Programme under Pillar Two of the Common Agricultural Policy. The Programme aims...... (micro-based “National Accounts” for municipalities, municipality economic model) and national level (national economic model), which enables analysis at a fairly detailed geographical level and hence to evaluate the spatially distributed effects of the considered policy instruments, while at the same...

  10. Cost effectiveness of rural development programme instruments in denmark

    DEFF Research Database (Denmark)

    Jensen, Jørgen Dejgård; Jacobsen, Lars Bo; Madsen, Bjarne

    2011-01-01

    The objective of this study is to investigate the cost-effectiveness of selected instruments of the Danish Rural Development Programme 2007-2013, which constitutes the Danish implementation of the EU Rural Development Programme under Pillar Two of the Common Agricultural Policy. The Programme aims...... (micro-based “National Accounts” for municipalities, municipality economic model) and national level (national economic model), which enables analysis at a fairly detailed geographical level and hence to evaluate the spatially distributed effects of the considered policy instruments, while at the same...... time incorporating economic interactions between different geographical areas, via inter-regional trade, commuting and influences via prices and wages. In order to make results for different policy instruments comparable, we use the simulation models to assess the effects of a given amount of public...

  11. Acceptance of health technology assessment submissions with incremental cost-effectiveness ratios above the cost-effectiveness threshold

    Directory of Open Access Journals (Sweden)

    Griffiths EA

    2015-08-01

    Full Text Available Elizabeth A Griffiths, Janek K Hendrich, Samuel DR Stoddart, Sean CM Walsh HERON™ Commercialization, PAREXEL International, London, UK Objectives: In health technology assessment (HTA agencies where cost-effectiveness plays a role in decision-making, an incremental cost-effectiveness ratio (ICER threshold is often used to inform reimbursement decisions. The acceptance of submissions with ICERs higher than the threshold was assessed across different agencies and across indications, in order to inform future reimbursement submissions. Methods: All HTA appraisals from May 2000 to May 2014 from National Institute for Health and Care Excellence (NICE, Scottish Medicines Consortium (SMC, Pharmaceutical Benefits Advisory Committee (PBAC, and Canadian Agency for Drugs and Technologies in Health (CADTH were assessed. Multiple technology appraisals, resubmissions, vaccination programs, and requests for advice were excluded. Submissions not reporting an ICER, or for which an ICER could not be determined were also excluded. The remaining appraisals were reviewed, and the submitted ICER, recommendation, and reasoning behind the recommendation were extracted. Results: NICE recommended the highest proportion of submissions with ICERs higher than the threshold (34% accepted without restrictions; 20% with restrictions, followed by PBAC (16% accepted without restrictions; 4% with restrictions, SMC (11% accepted without restrictions; 14% accepted with restrictions, and CADTH (0% accepted without restrictions; 26% with restrictions. Overall, the majority of higher-than-threshold ICER submissions were classified into the "malignant disease and immunosuppression" therapeutic category; however, there was no notable variation in acceptance rates by disease area. Reasons for accepting submissions reporting ICERs above the threshold included high clinical benefit over the standard of care, and addressing an unmet therapeutic need. Conclusion: Acceptance of submissions

  12. Cost effectiveness of a medical digital library.

    Science.gov (United States)

    Roussel, F; Darmoni, S J; Thirion, B

    2001-01-01

    The rapid increase in the price of electronic journals has made the optimization of collection management an urgent task. As there is currently no standard procedure for the evaluation of this problem, we applied the Reading Factor (RF), an electronically computed indicator used for consultation of individual articles. The aim of our study was to assess the cost effective impact of modifications in our digital library (i.e. change of access from the Intranet to the Internet or change in editorial policy). The digital OVID library at Rouen University Hospital continues to be cost-effective in comparison with the interlibrary loan costs. Moreover, when electronic versions are offered alongside a limited amount of interlibrary loans, a reduction in library costs was observed.

  13. Sampling: Making Electronic Discovery More Cost Effective

    Directory of Open Access Journals (Sweden)

    Milton Luoma

    2011-06-01

    Full Text Available With the huge volumes of electronic data subject to discovery in virtually every instance of litigation, time and costs of conducting discovery have become exceedingly important when litigants plan their discovery strategies.  Rather than incurring the costs of having lawyers review every document produced in response to a discovery request in search of relevant evidence, a cost effective strategy for document review planning is to use statistical sampling of the database of documents to determine the likelihood of finding relevant evidence by reviewing additional documents.  This paper reviews and discusses how sampling can be used to make document review more cost effective by considering issues such as an appropriate sample size, how to develop a sampling strategy, and taking into account the potential value of the litigation in relation to the costs of additional discovery efforts. 

  14. Hip Fracture Prevention: Cost-Effective Strategies

    OpenAIRE

    Peter Vestergaard; Lars Rejnmark; Leif Mosekilde

    2001-01-01

    The available literature on cost benefit, cost effectiveness and cost utility of different drug and non-drug regimens in preventing hip fractures was reviewed. The cost of a hip fracture and of the different treatment regimens varied considerably from one country to another. In primary prevention, potential savings only exceeded costs in women over the age of 70 years treated with hormonal replacement therapy (HRT). In the case of HRT, treating those with low bone mineral density levels (seco...

  15. [Cost effectiveness and health sector reform].

    Science.gov (United States)

    Musgrove, P

    1995-01-01

    The cost-effectiveness of a health intervention is an estimate of the relation between what it costs to be provided, and the improvement in health which results from such intervention. Health may improve because the incidence of illness or injury is reduced, because death is avoided or delayed, or because the duration or severity of disability is limited. The calculation of this health benefit combines objective factors, such as the age at incidence and whether or not the outcome is death, with subjective factors such as the severity of disability, the judgement as to the value of life lived at different ages, and the rate at which the future is discounted. The construction and interpretation of the estimate are explained. Also, the paper examines whether the concept of cost-effectiveness is consistent with ethical norms such as equity, and concludes that they are not in conflict. Finally, it addresses the question of how to incorporate cost-effectiveness into a health sector reform, and possible ways to implement it.

  16. Cost effectiveness of new roadway lighting systems

    Directory of Open Access Journals (Sweden)

    Yi Jiang

    2015-06-01

    Full Text Available Appropriate and adequate lighting at select locations on roadways is essential for roadway safety. As the lighting technologies advance, many types of new lighting devices have been developed for roadway lightings. The most promising new lighting technologies for roadway lighting include light emitting diode, induction, plasma, and metal halide lighting systems. A study was conducted to compare the new systems with the conventional high pressure sodium systems that are currently used on the Indiana roadway systems. In this study, the engineering issues, were analyzed such as illuminance, color rendering, power usage, cost effectiveness, and approval procedures for new roadway lighting systems. This paper, however, presents only the study findings related to cost effectiveness of the evaluated roadway lighting systems. Illustrated in this paper are the main features of the roadway lighting systems under evaluations, installations of the new lighting systems, measurements of power consumptions, and life cycle cost analyses of the lighting systems. Through this study, experience and knowledge have been obtained on the installations, power measurements, and cost effectiveness of the new types of the roadway lighting devices. The actual power values of various luminaires were obtained by measuring the electric current with a multi-meter. It was found that the differences between the rated and measured power values could be significant. The results of the life cycle cost analysis indicate that the lower life cycle costs of some of the alternative lighting devices are attributed to their relatively lower electricity usages and longer lamp/emitter replacement cycles.

  17. Surveillance issues in inflammatory bowel disease: ulcerative colitis.

    Science.gov (United States)

    Provenzale, D; Onken, J

    2001-02-01

    This review article on the surveillance of patients with ulcerative colitis provides an overview of the criteria for evaluating screening and surveillance programs and applies the criteria to the available evidence to determine the effectiveness of the surveillance of patients with ulcerative colitis. We examine the clinical outcomes associated with surveillance, the additional clinical time required to confirm the diagnosis of dysplasia and cancer, compliance with surveillance and follow-up, and the effectiveness of the individual components of a surveillance program, including colonoscopy and pathologist's interpretation. The disability associated with colectomy is considered, as are the cost and acceptability of surveillance programs. Patients with long-standing ulcerative colitis are at risk for developing colorectal cancer. Recommended surveillance colonoscopy should be supported. New endoscopic and histopathologic techniques to improve the identification of high-risk patients may enhance the effectiveness and cost-effectiveness of surveillance practices.

  18. Introduction to surveillance studies

    CERN Document Server

    Petersen, JK

    2012-01-01

    Introduction & OverviewIntroduction Brief History of Surveillance Technologies & TechniquesOptical SurveillanceAerial Surveillance Audio Surveillance Radio-Wave SurveillanceGlobal Positioning Systems Sensors Computers & the Internet Data Cards Biochemical Surveillance Animal Surveillance Biometrics Genetics Practical ConsiderationsPrevalence of Surveillance Effectiveness of Surveillance Freedom & Privacy IssuesConstitutional Freedoms Privacy Safeguards & Intrusions ResourcesReferences Glossary Index

  19. Regional distribution of nosocomial infections due to ESBL-positive Enterobacteriaceae in Germany: data from the German National Reference Center for the Surveillance of Nosocomial Infections (KISS).

    Science.gov (United States)

    Leistner, R; Schröder, C; Geffers, C; Breier, A-C; Gastmeier, P; Behnke, M

    2015-03-01

    Surveillance systems for hospital infections are reporting increasing rates of extended-spectrum β-lactamase (ESBL)-positive Enterobacteriaceae in Europe. We aimed to perform a national survey on this trend and on the regional distribution of nosocomial infections due to ESBL-positive Enterobacteriaceae in German hospitals. Data from 2007 to 2012 from two components of the German national nosocomial infection surveillance system were used for this analysis. The data derive from intensive care units and surgical departments. Independent factors determining the proportion of ESBL-positive Enterobacteriaceae among nosocomial infections due to Enterobacteriaceae and changes in its regional distribution (broken down into German federal states) were calculated by regression analysis. From 2007 to 2012, the data showed a significantly increasing proportion of ESBL-positive Enterobacteriaceae in surgical site infections (from 11.46 to 15.38, 134%, p 0.003), urinary tract infections (9.36 to 16.56, 177%, p infections (11.91 to 14.70, 123%, p nosocomial infections has significantly increased in Germany over the last 6 years. Hospitals in Central Germany and surgical departments in all of Germany are especially affected by this development.

  20. Surveillance Pleasures

    DEFF Research Database (Denmark)

    Albrechtslund, Anders

    and leisure have not been studied with the same intensity as e.g. policing, civil liberties and social sorting. This paper offers a study of trends in surveillance pleasures, i.e. watching and eavesdropping in popular culture. My focus is the existential aspects and ethical dilemmas of surveillance...

  1. Analysis of the cost-effectiveness of varicella vaccine programmes based on an observational survey in the Latium region of Italy.

    Science.gov (United States)

    Gialloreti, Leonardo Emberti; Divizia, Maurizio; Pica, Francesca; Volpi, Antonio

    2005-10-01

    Varicella is the most widespread childhood disease in Italy. However, as in many parts of the world, the country does not yet have a unified approach to the management of the disease. A cost-effectiveness analysis of varicella vaccination strategies, using the Latium region in Italy as a case study, was undertaken. Mass vaccination is only recommended if the immunization programme can achieve coverage of over 85% in a short time. However, experience in Italy with non-compulsory vaccinations has shown this is difficult to achieve. Consequently, eradication of the disease is not seen as an attainable short-term goal. For mass varicella vaccination to be successful, it must be run at a national as well as regional level in combination with education programmes, and a reliable surveillance system. The interaction between varicella and herpes zoster must also be taken into account when considering vaccination strategies, as zoster vaccination strategies may have an impact on varicella coverage.

  2. Surveillance and Maintenance Plan for the ORNL Decontamination and Decommissioning Program FY 1993--2002

    Energy Technology Data Exchange (ETDEWEB)

    Ford, M.K.; Holder, L. Jr.

    1992-07-01

    The Decontamination and Decommissioning (D D) Program at the Oak Ridge National Laboratory (ORNL) is part of the Department of Energy (DOE) Environmental Restoration D D program. The purpose and objectivesof this program include: (1) surveillance and maintenance (S M) of facilities awaiting decommissioning; (2) planning for the orderly decommissioning of these facilities; and (3) implementation of a program to accomplish facility disposition in a safe, cost-effective, and timely manner. Participating D D contractors are required to prepare formal plans that document the S M programs established for each site. This report has been prepared to provide this documentation for those facilities included in the ORNL D D Program.

  3. The cost-effectiveness of pentavalent rotavirus vaccination in England and Wales.

    Science.gov (United States)

    Atkins, Katherine E; Shim, Eunha; Carroll, Stuart; Quilici, Sibilia; Galvani, Alison P

    2012-11-01

    Rotavirus vaccines have shown great potential for reducing the disease burden of the major cause of severe childhood gastroenteritis. The decision regarding whether rotavirus vaccination will be introduced into the national immunization program is currently being reviewed. The conclusions of previous evaluations of rotavirus vaccination cost-effectiveness contradict each other. This is the first analysis to incorporate a dynamic transmission model to assess the cost-effectiveness of rotavirus vaccination in England and Wales. Most previously reported models do not include herd protection, and thus may underestimate the cost-effectiveness of vaccination against rotavirus. We incorporate a dynamic model of rotavirus transmission in England and Wales into a cost-effectiveness analysis to determine the probability that the pentavalent rotavirus vaccination will be cost-effective over a range of full-course vaccine prices. This novel approach allows the cost-effectiveness analysis to include a feasible level of herd protection provided by a vaccination program. Our base case model predicts that pentavalent rotavirus vaccination is likely to be cost-effective in England and Wales at £ 60 per course. In some scenarios the vaccination is predicted to be not only cost-effective but also cost-saving. These savings could be generated within ten years after vaccine introduction. Our budget impact analysis demonstrates that for the realistic base case scenarios, 58-96% of the cost outlay for vaccination will be recouped within the first four years of a program. Our results indicate that rotavirus vaccination would be beneficial to public health and could be economically sound. Since rotavirus vaccination is not presently on the immunization schedule for England and Wales but is currently under review, this study can inform policymakers of the cost-effectiveness and budget impact of implementing a mass rotavirus vaccine strategy.

  4. Comprehensive overview: efficacy, tolerability, and cost-effectiveness of irbesartan

    Directory of Open Access Journals (Sweden)

    Gialama F

    2013-10-01

    Full Text Available Fotini Gialama, Nikos ManiadakisHealth Services Organisation and Management, National School of Public Health, Athens, GreeceBackground: Hypertension represents a major health problem, affecting more than one billion adults worldwide. Irbesartan, an angiotensin II receptor blocker, is considered to be a highly effective treatment in the management of hypertension. The purpose of this review is to evaluate the efficacy, safety and tolerability profile, and cost-effectiveness of treatment with irbesartan in hypertension.Methods: A review of the literature was conducted using the electronic PubMed and Cochrane Library databases and the Health Economic Evaluations Database of search terms relating to irbesartan efficacy, tolerability, and cost-effectiveness, and the results were utilized.Results: Findings from the present analysis show that irbesartan either as monotherapy or in combination with other antihypertensive agents can achieve significant reductions in blood pressure, both systolic and diastolic, compared with alternative treatment options. Irbesartan was also found to have a renoprotective effect independent of its blood pressure-lowering in patients with type 2 diabetes and nephropathy. Furthermore, irbesartan demonstrated an excellent safety and tolerability profile, with either lower or equal adverse events compared with placebo and other alternative treatments. In terms of economic analyses, compared with other antihypertensive therapy alternatives, irbesartan was found to be a preferred option, that is less costly and more effective.Conclusion: The evidence indicates that treating patients with hypertension alone or with type 2 diabetes and nephropathy using irbesartan can control hypertension, prolong life, and reduce costs in relation to existing alternatives.Keywords: irbesartan, tolerability, safety, efficacy, cost-effectiveness, economic evaluation

  5. Cost effectiveness analysis of hemiarthroplasty and total shoulder arthroplasty.

    Science.gov (United States)

    Mather, Richard C; Watters, Tyler S; Orlando, Lori A; Bolognesi, Michael P; Moorman, Claude T

    2010-04-01

    Total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) are two viable surgical treatment options for glenohumeral osteoarthritis. Recent systematic reviews and randomized trials suggest that TSA, while more costly initially, may have superior outcomes with regard to pain, function and quality of life with lower revision rates. This study compared the cost-effectiveness of TSA with HA. A Markov decision model was constructed for a cost-utility analysis of TSA compared to HA in a cohort of 64-year-old patients. Outcome probabilities and effectiveness were derived from the literature. Costs were estimated from the societal perspective using the national average Medicare reimbursement for the procedures in 2008 US dollars. Effectiveness was expressed in quality-adjusted life years (QALYs) gained. Principal outcome measures were average incremental costs, incremental effectiveness, incremental QALYs, and net health benefits. In the base case, HA resulted in a lower number of average QALYs gained at a higher average cost to society and was, therefore, dominated by the TSA strategy for the treatment of glenohumeral osteoarthritis. The cost effectiveness ratio for TSA and HA were $957/QALY and $1,194/QALY respectively. Sensitivity analysis revealed that if the utility of TSA is equal to, or revision rate lower than HA, TSA continues to be a dominant strategy. Total shoulder arthroplasty with a cemented glenoid is a cost-effective procedure, resulting in greater utility for the patient at a lower overall cost to the payer. These findings suggest that TSA is the preferred treatment for certain populations from both a patient and payer perspective. 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  6. Data sharing report characterization of the surveillance and maintenance project miscellaneous process inventory waste items Oak Ridge National Laboratory, Oak Ridge, TN

    Energy Technology Data Exchange (ETDEWEB)

    Weaver, Phyllis C. [Oak Ridge Inst. for Science and Education (ORISE), Oak Ridge, TN (United States)

    2013-12-12

    The U.S. Department of Energy (DOE) Oak Ridge Office of Environmental Management (EM-OR) requested Oak Ridge Associated Universities (ORAU), working under the Oak Ridge Institute for Science and Education (ORISE) contract, to provide technical and independent waste management planning support under the American Recovery and Reinvestment Act (ARRA). Specifically, DOE EM-OR requested ORAU to plan and implement a sampling and analysis campaign to target certain items associated with URS|CH2M Oak Ridge, LLC (UCOR) surveillance and maintenance (S&M) process inventory waste. Eight populations of historical and reoccurring S&M waste at the Oak Ridge National Laboratory (ORNL) have been identified in the Waste Handling Plan for Surveillance and Maintenance Activities at the Oak Ridge National Laboratory, DOE/OR/01-2565&D2 (WHP) (DOE 2012) for evaluation and processing for final disposal. This waste was generated during processing, surveillance, and maintenance activities associated with the facilities identified in the process knowledge (PK) provided in Appendix A. A list of items for sampling and analysis were generated from a subset of materials identified in the WHP populations (POPs) 4, 5, 6, 7, and 8, plus a small number of items not explicitly addressed by the WHP. Specifically, UCOR S&M project personnel identified 62 miscellaneous waste items that would require some level of evaluation to identify the appropriate pathway for disposal. These items are highly diverse, relative to origin; composition; physical description; contamination level; data requirements; and the presumed treatment, storage, and disposal facility (TSDF). Because of this diversity, ORAU developed a structured approach to address item-specific data requirements necessary for acceptance in a presumed TSDF that includes the Environmental Management Waste Management Facility (EMWMF)—using the approved Waste Lot (WL) 108.1 profile—the Y-12 Sanitary Landfill (SLF) if appropriate; Energy

  7. DATA SHARING REPORT CHARACTERIZATION OF THE SURVEILLANCE AND MAINTENANCE PROJECT MISCELLANEOUS PROCESS INVENTORY WASTE ITEMS OAK RIDGE NATIONAL LABORATORY, Oak Ridge TN

    Energy Technology Data Exchange (ETDEWEB)

    Weaver, Phyllis C

    2013-12-12

    The U.S. Department of Energy (DOE) Oak Ridge Office of Environmental Management (EM-OR) requested Oak Ridge Associated Universities (ORAU), working under the Oak Ridge Institute for Science and Education (ORISE) contract, to provide technical and independent waste management planning support under the American Recovery and Reinvestment Act (ARRA). Specifically, DOE EM-OR requested ORAU to plan and implement a sampling and analysis campaign to target certain items associated with URS|CH2M Oak Ridge, LLC (UCOR) surveillance and maintenance (S&M) process inventory waste. Eight populations of historical and reoccurring S&M waste at the Oak Ridge National Laboratory (ORNL) have been identified in the Waste Handling Plan for Surveillance and Maintenance Activities at the Oak Ridge National Laboratory, DOE/OR/01-2565&D2 (WHP) (DOE 2012) for evaluation and processing for final disposal. This waste was generated during processing, surveillance, and maintenance activities associated with the facilities identified in the process knowledge (PK) provided in Appendix A. A list of items for sampling and analysis were generated from a subset of materials identified in the WHP populations (POPs) 4, 5, 6, 7, and 8, plus a small number of items not explicitly addressed by the WHP. Specifically, UCOR S&M project personnel identified 62 miscellaneous waste items that would require some level of evaluation to identify the appropriate pathway for disposal. These items are highly diverse, relative to origin; composition; physical description; contamination level; data requirements; and the presumed treatment, storage, and disposal facility (TSDF). Because of this diversity, ORAU developed a structured approach to address item-specific data requirements necessary for acceptance in a presumed TSDF that includes the Environmental Management Waste Management Facility (EMWMF)—using the approved Waste Lot (WL) 108.1 profile—the Y-12 Sanitary Landfill (SLF) if appropriate; Energy

  8. A cost effective CO2 strategy

    DEFF Research Database (Denmark)

    by the Ministry of Transport, with the Technical University of Denmark as one of the main contributors. The CO2-strategy was to be based on the principle of cost-effectiveness. A model was set up to assist in the assessment. The model consists of a projection of CO2-emissions from road and rail modes from 2020...... are evaluated according to CO2 reduction potential and according to the ‘shadow price’ on a reduction of one ton CO2. The shadow price reflects the costs (and benefits) of the different measures. Comparing the measures it is possible to identify cost effective measures, but these measures are not necessarily......, a scenario-part and a cost-benefit part. Air and sea modes are not analyzed. The model adopts a bottom-up approach to allow a detailed assessment of transport policy measures. Four generic areas of intervention were identified and the likely effect on CO2 emissions, socioeconomic efficiency and other...

  9. OPCAB Surgery is cost-effective for elderly patients

    DEFF Research Database (Denmark)

    Holme, Susanne Juel; Jensen Beck, Søren; Houlind, Kim;

    2013-01-01

    To determine the cost-effective operative strategy for coronary artery bypass surgery in patients above 70 years.......To determine the cost-effective operative strategy for coronary artery bypass surgery in patients above 70 years....

  10. National Bloodstream Infection Surveillance in Switzerland 2008-2014: Different Patterns and Trends for University and Community Hospitals.

    Science.gov (United States)

    Buetti, Niccolò; Marschall, Jonas; Atkinson, Andrew; Kronenberg, Andreas

    2016-09-01

    OBJECTIVE To characterize the epidemiology of bloodstream infections in Switzerland, comparing selected pathogens in community and university hospitals. DESIGN Observational, retrospective, multicenter laboratory surveillance study. METHODS Data on bloodstream infections from 2008 through 2014 were obtained from the Swiss infection surveillance system, which is part of the Swiss Centre for Antibiotic Resistance (ANRESIS). We compared pathogen prevalences across 26 acute care hospitals. A subanalysis for community-acquired and hospital-acquired bloodstream infections in community and university hospitals was performed. RESULTS A total of 42,802 bloodstream infection episodes were analyzed. The most common etiologies were Escherichia coli (28.3%), Staphylococcus aureus (12.4%), and polymicrobial bloodstream infections (11.4%). The proportion of E. coli increased from 27.5% in 2008 to 29.6% in 2014 (P = .04). E. coli and S. aureus were more commonly reported in community than university hospitals (34.3% vs 22.7%, P<.001 and 13.9% vs 11.1%, P<.001, respectively). Fifty percent of episodes were community-acquired, with E. coli again being more common in community hospitals (41.0% vs 32.4%, P<.001). The proportion of E. coli in community-acquired bloodstream infections increased in community hospitals only. Community-acquired polymicrobial infections (9.9% vs 5.6%, P<.001) and community-acquired coagulase-negative staphylococci (6.7% vs 3.4%, P<0.001) were more prevalent in university hospitals. CONCLUSIONS The role of E. coli as predominant pathogen in bloodstream infections has become more pronounced. There are distinct patterns in community and university hospitals, potentially influencing empirical antibiotic treatment. Infect Control Hosp Epidemiol 2016;37:1060-1067.

  11. The burden of extrapulmonary and meningitis tuberculosis: an investigation of national surveillance data, Germany, 2002 to 2009.

    Science.gov (United States)

    Ducomble, T; Tolksdorf, K; Karagiannis, I; Hauer, B; Brodhun, B; Haas, W; Fiebig, L

    2013-03-21

    Tuberculosis (TB) surveillance commonly focuses on pulmonary (PTB) where the main organ affected is the lung. This might lead to underestimate extrapulmonary TB (EPTB) forms, where in addition to the lung other sites are affected by TB. In Germany, TB notification data provide the main site and the secondary site of disease. To gain an overview of all the different EPTB forms, we analysed German TB notification data between 2002 and 2009 using information on both main and secondary disease site to describe all individual EPTB forms. Further, we assessed factors associated with meningitis using multivariable logistic regression. Solely analysing the main site of disease, lead to one third of EPTB manifestations being overlooked. Case characteristics varied substantially across individual extrapulmonary forms. Of 46,349 TB patients, 422 (0.9%) had meningitis as main or secondary site. Of those, 105 (25%) of the 415 with available information had died. Multivariable analysis showed that meningitis was more likely in children younger than five years and between five and nine years-old (odds ratio (OR): 4.90; 95% confidence interval (CI): 3.40–7.07 and OR: 2.65; 95% CI: 1.40–5.00), in females (OR: 1.42; 95% CI: 1.17–1.73), and in those born in the World Health Organization (WHO) regions of south-east Asia (OR: 2.38; 95% CI: 1.66–3.43) and eastern Mediterranean (OR: 1.51; 95% CI: 1.02–2.23). Overall, EPTB manifestations, including meningitis, which is often fatal, were underestimated by routine analysis. We thus recommend using all information on disease manifestation generated by surveillance to monitor severe forms and to transfer the gained knowledge to TB case management where awareness of EPTB is most important.

  12. Cost-effectiveness of a ROPS retrofit education campaign.

    Science.gov (United States)

    Myers, M L; Cole, H P; Westneat, S C

    2004-05-01

    A community educational campaign implemented in two Kentucky counties was effective in influencing farmers to retrofit their tractors with rollover protective structures (ROPS) to protect tractor operators from injury in the event of an overturn. This article reports on the cost-effectiveness of this program in the two counties when compared to no program in a control county. A decision analysis indicated that it would be effective at averting 0.27 fatal and 1.53 nonfatal injuries over a 20-year period, and when this analysis was extended statewide, 7.0 fatal and 40 nonfatal injuries would be averted in Kentucky. Over the 20-year period, the cost-per-injury averted was calculated to be $172,657 at a 4% annual discount rate. This cost compared favorably with a national cost of $489,373 per injury averted despite the additional program cost in Kentucky. The principle reason for the increased cost-effectiveness of the Kentucky program was the three-fold higher propensity for tractors to overturn in Kentucky. The cost-per-injury averted in one of the two counties was $112,535. This lower cost was attributed principally to incentive awards financed locally for farmers to retrofit their tractors with ROPS.

  13. Cost-Effective Fuel Treatment Planning

    Science.gov (United States)

    Kreitler, J.; Thompson, M.; Vaillant, N.

    2014-12-01

    The cost of fighting large wildland fires in the western United States has grown dramatically over the past decade. This trend will likely continue with growth of the WUI into fire prone ecosystems, dangerous fuel conditions from decades of fire suppression, and a potentially increasing effect from prolonged drought and climate change. Fuel treatments are often considered the primary pre-fire mechanism to reduce the exposure of values at risk to wildland fire, and a growing suite of fire models and tools are employed to prioritize where treatments could mitigate wildland fire damages. Assessments using the likelihood and consequence of fire are critical because funds are insufficient to reduce risk on all lands needing treatment, therefore prioritization is required to maximize the effectiveness of fuel treatment budgets. Cost-effectiveness, doing the most good per dollar, would seem to be an important fuel treatment metric, yet studies or plans that prioritize fuel treatments using costs or cost-effectiveness measures are absent from the literature. Therefore, to explore the effect of using costs in fuel treatment planning we test four prioritization algorithms designed to reduce risk in a case study examining fuel treatments on the Sisters Ranger District of central Oregon. For benefits we model sediment retention and standing biomass, and measure the effectiveness of each algorithm by comparing the differences among treatment and no treat alternative scenarios. Our objective is to maximize the averted loss of net benefits subject to a representative fuel treatment budget. We model costs across the study landscape using the My Fuel Treatment Planner software, tree list data, local mill prices, and GIS-measured site characteristics. We use fire simulations to generate burn probabilities, and estimate fire intensity as conditional flame length at each pixel. Two prioritization algorithms target treatments based on cost-effectiveness and show improvements over those

  14. National Status and Trends, Benthic Surveillance Project Aryl Hydrocarbon Hydrolase (AHH) Data, 1988-1992, National Centers for Coastal Ocean Science

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — In order to determine the current status of and detect any long-term trends in the environmental quality of U.S. nearshore waters, NOAA initiated the National Status...

  15. National Status and Trends, Benthic Surveillance Project Aryl Hydrocarbon Hydrolase (AHH) Data, 1988-1992, National Centers for Coastal Ocean Science

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — In order to determine the current status of and detect any long-term trends in the environmental quality of U.S. nearshore waters, NOAA initiated the National...

  16. The role of state public health agencies in national efforts to track workplace hazards and the relevance of state experiences to nanomaterial worker surveillance.

    Science.gov (United States)

    Roisman, Rachel; Materna, Barbara; Beckman, Stella; Katz, Elizabeth; Shusterman, Dennis; Harrison, Robert

    2011-06-01

    This essay examines the role state public health agencies could play in the surveillance of emerging workplace hazards including nanotechnology. This essay describes existing state occupational health surveillance programs in order to demonstrate their potential applicability, and limitations, in regards to nanomaterial worker surveillance. State public health agencies have access to information and an ability to put surveillance information to use in ways that complement those of industry, academia, regulatory agencies, and federal partners. Some state public health agencies have significant experience with occupational health surveillance and are therefore valuable partners in the development and implementation of nanotechnology worker surveillance programs. Including states in emerging hazard surveillance enhances surveillance activities and builds state capacity to help workers.

  17. DATA SHARING REPORT CHARACTERIZATION OF POPULATION 7: PERSONAL PROTECTIVE EQUIPMENT, DRY ACTIVE WASTE, AND MISCELLANEOUS DEBRIS, SURVEILLANCE AND MAINTENANCE PROJECT OAK RIDGE NATIONAL LABORATORY OAK RIDGE, TENNESSEE

    Energy Technology Data Exchange (ETDEWEB)

    Harpenau, Evan M

    2013-10-10

    The U.S. Department of Energy (DOE) Oak Ridge Office of Environmental Management (EM-OR) requested that Oak Ridge Associated Universities (ORAU), working under the Oak Ridge Institute for Science and Education (ORISE) contract, provide technical and independent waste management planning support under the American Recovery and Reinvestment Act (ARRA). Specifically, DOE EM-OR requested that ORAU plan and implement a sampling and analysis campaign targeting certain URS|CH2M Oak Ridge, LLC (UCOR) surveillance and maintenance (S&M) process inventory waste. Eight populations of historical and reoccurring S&M waste at the Oak Ridge National Laboratory (ORNL) have been identified in the Waste Handling Plan for Surveillance and Maintenance Activities at the Oak Ridge National Laboratory, DOE/OR/01-2565&D2 (WHP) (DOE 2012) for evaluation and processing to determine a final pathway for disposal. Population 7 (POP 7) consists of 56 containers of aged, low-level and potentially mixed S&M waste that has been staged in various locations around ORNL. Several of these POP 7 containers primarily contain personal protective equipment (PPE) and dry active waste (DAW), but may contain other miscellaneous debris. This data sharing report addresses the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA) specified waste in a 13-container subpopulation (including eight steel boxes, three 55-gal drums, one sealand, and one intermodal) that lacked sufficient characterization data for possible disposal at the Environmental Management Waste Management Facility (EMWMF) using the approved Waste Lot (WL) 108.1 profile.

  18. Data sharing report characterization of population 7: Personal protective equipment, dry active waste, and miscellaneous debris, surveillance and maintenance project Oak Ridge National Laboratory Oak Ridge, Tennessee

    Energy Technology Data Exchange (ETDEWEB)

    Harpenau, Evan M. [Oak Ridge Inst. for Science and Education (ORISE), Oak Ridge, TN (United States)

    2013-10-10

    The U.S. Department of Energy (DOE) Oak Ridge Office of Environmental Management (EM-OR) requested that Oak Ridge Associated Universities (ORAU), working under the Oak Ridge Institute for Science and Education (ORISE) contract, provide technical and independent waste management planning support under the American Recovery and Reinvestment Act (ARRA). Specifically, DOE EM-OR requested that ORAU plan and implement a sampling and analysis campaign targeting certain URS|CH2M Oak Ridge, LLC (UCOR) surveillance and maintenance (S&M) process inventory waste. Eight populations of historical and reoccurring S&M waste at the Oak Ridge National Laboratory (ORNL) have been identified in the Waste Handling Plan for Surveillance and Maintenance Activities at the Oak Ridge National Laboratory, DOE/OR/01-2565&D2 (WHP) (DOE 2012) for evaluation and processing to determine a final pathway for disposal. Population 7 (POP 7) consists of 56 containers of aged, low-level and potentially mixed S&M waste that has been staged in various locations around ORNL. Several of these POP 7 containers primarily contain personal protective equipment (PPE) and dry active waste (DAW), but may contain other miscellaneous debris. This data sharing report addresses the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA) specified waste in a 13-container subpopulation (including eight steel boxes, three 55-gal drums, one sealand, and one intermodal) that lacked sufficient characterization data for possible disposal at the Environmental Management Waste Management Facility (EMWMF) using the approved Waste Lot (WL) 108.1 profile.

  19. [Intensified insulin treatment is cost-effective].

    Science.gov (United States)

    Reichard, P; Alm, C; Andersson, E; Wärn, I; Rosenqvist, U

    1999-01-20

    Both the Diabetes Control and Complications Trial (DCCT) in USA/Canada, and Stockholm Diabetes Intervention Study (SDIS) showed intensified insulin treatment and reduced glycaemia to prevent complications in patients with insulin-dependent (type I) diabetes mellitus. In the DCCT, the intensified treatment was considered cost-effective. In the SDIS, investigation of the direct increase in costs due to the intensified insulin treatment showed the saving in direct costs due to the reduction in photocoagulation requirements, and in the prevalence of renal insufficiency and of amputation, to correspond to 10 years' intensive insulin treatment. Thus, as intensified insulin treatment in type I diabetes reduces direct suffering at a low cost, it may be regarded as 'evidence-based' and mandatory.

  20. Custom LSI plus hybrid equals cost effectiveness

    Science.gov (United States)

    Friedman, S. N.

    The possibility to combine various technologies, such as Bi-Polar linear and CMOS/Digital makes it feasible to create systems with a tailored performance not available on a single monolithic circuit. The custom LSI 'BLOCK', especially if it is universal in nature, is proving to be a cost effective way for the developer to improve his product. The custom LSI represents a low price part in contrast to the discrete components it will replace. In addition, the hybrid assembly can realize a savings in labor as a result of the reduced parts handling and associated wire bonds. The possibility of the use of automated system manufacturing techniques leads to greater reliability as the human factor is partly eliminated. Attention is given to reliability predictions, cost considerations, and a product comparison study.

  1. Cost-effective ultrasound PACS solution

    Science.gov (United States)

    Honeyman-Buck, Janice C.; Frost, Meryll M.; Staab, Edward V.

    1995-05-01

    Picture archiving and communication systems (PACS) have been quite successful at the University of Florida in the areas of CT, MR, and nuclear medicine. In each case, although we have not always been able to provide the optimal level of performance, we have been able to solve a problem and the systems are used extensively. Ultrasound images are required in a number of locations and the multiformat camera print capability was no longer adequate for the growing volume in the ultrasound section. Although we were certain we could successfully implement PACS for ultrasound, new forces in health care dictate that we justify our system in terms of cost. We analyzed the feasibility of a PACS solution for ultrasound and designed a system that meets our needs and is cost effective. We evaluated the ultrasound operation in terms of image acquisition patterns and throughput requirements. An inventory of existing and PACS equipment was made to determine the feasibility of interfacing the two systems. Commercial systems were evaluated for functionality and cost and a system was designed to meet our needs. The only way to achieve our goal of installing a cost effective ultrasound PACS was to eliminate film and use the cost savings to offset the cost of new equipment and development. We designed a system that could be produced using inexpensive components and existing hardware and software to meet our needs. A commercial vendor was chosen to provide the ultrasound acquisition. The Radiology Information System interface used at the University provides the necessary data to build a DICOM header, and an existing DICOM server routes the images to the appropriate workstations, archives, and printers. Additional storage is added to an existing archive to accommodate the ultrasound images and two existing workstations are evaluated for use in ultrasound.

  2. Using Cost-Effectiveness Tests to Design CHP Incentive Programs

    Energy Technology Data Exchange (ETDEWEB)

    Tidball, Rick [ICF International, Fairfax, VA (United States)

    2014-11-01

    This paper examines the structure of cost-effectiveness tests to illustrate how they can accurately reflect the costs and benefits of CHP systems. This paper begins with a general background discussion on cost-effectiveness analysis of DER and then describes how cost-effectiveness tests can be applied to CHP. Cost-effectiveness results are then calculated and analyzed for CHP projects in five states: Arkansas, Colorado, Iowa, Maryland, and North Carolina. Based on the results obtained for these five states, this paper offers four considerations to inform regulators in the application of cost-effectiveness tests in developing CHP programs.

  3. Economic Analysis of Classical Swine Fever Surveillance in the Netherlands.

    Science.gov (United States)

    Guo, X; Claassen, G D H; Oude Lansink, A G J M; Loeffen, W; Saatkamp, H W

    2016-06-01

    Classical swine fever (CSF) is a highly contagious pig disease that causes economic losses and impaired animal welfare. Improving the surveillance system for CSF can help to ensure early detection of the virus, thereby providing a better initial situation for controlling the disease. Economic analysis is required to compare the benefits of improved surveillance with the costs of implementing a more intensive system. This study presents a comprehensive economic analysis of CSF surveillance in the Netherlands, taking into account the specialized structure of Dutch pig production, differences in virulence of CSF strains and a complete list of possible surveillance activities. The starting point of the analysis is the current Dutch surveillance system (i.e. the default surveillance-setup scenario), including the surveillance activities 'daily clinical observation by the farmer', 'veterinarian inspection after a call', 'routine veterinarian inspection', 'pathology in AHS', 'PCR on tonsil in AHS', 'PCR on grouped animals in CVI' and 'confirmatory PCR by NVWA'. Alternative surveillance-setup scenarios were proposed by adding 'routine serology in slaughterhouses', 'routine serology on sow farms' and 'PCR on rendered animals'. The costs and benefits for applying the alternative surveillance-setup scenarios were evaluated by comparing the annual mitigated economic losses because of intensified CSF surveillance with the annual additional surveillance costs. The results of the cost-effectiveness analysis show that the alternative surveillance-setup scenarios with 'PCR on rendered animals' are effective for the moderately virulent CSF strain, whereas the scenarios with 'routine serology in slaughterhouses' or 'routine serology on sow farms' are effective for the low virulent strain. Moreover, the current CSF surveillance system in the Netherlands is cost-effective for both moderately virulent and low virulent CSF strains. The results of the cost-benefit analysis for the

  4. Sonoma Persistent Surveillance System

    Energy Technology Data Exchange (ETDEWEB)

    Pennington, D M

    2006-03-24

    Sonoma offers the first cost-effective, broad-area, high-resolution, real-time motion imagery system for surveillance applications. Sonoma is unique in its ability to provide continuous, real-time video imagery of an area the size of a small city with resolutions sufficient to track 8,000 moving objects in the field of view. At higher resolutions and over smaller areas, Sonoma can even track the movement of individual people. The visual impact of the data available from Sonoma is already causing a paradigm shift in the architecture and operation of other surveillance systems. Sonoma is expected to cost just one-tenth the price of comparably sized sensor systems. Cameras mounted on an airborne platform constantly monitor an area, feeding data to the ground for real-time analysis. Sonoma was designed to provide real-time data for actionable intelligence in situations such as monitoring traffic, special events, border security, and harbors. If a Sonoma system had been available in the aftermath of the Katrina and Rita hurricanes, emergency responders would have had real-time information on roads, water levels, and traffic conditions, perhaps saving many lives.

  5. Descriptive Epidemiology of Collegiate Men's Football Injuries: National Collegiate Athletic Association Injury Surveillance System, 1988–1989 Through 2003–2004

    Science.gov (United States)

    Dick, Randall; Ferrara, Michael S; Agel, Julie; Courson, Ron; Marshall, Stephen W; Hanley, Michael J; Reifsteck, Fred

    2007-01-01

    Objective: To review 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for men's football and identify potential areas for injury prevention initiatives. Background: Football is a high-velocity collision sport in which injuries are expected. Football tends to have one of the highest injury rates in sports. Epidemiologic data helps certified athletic trainers and other clinicians identify injury trends and patterns to appropriately design and institute injury prevention protocols and then measure their effects. Main Results: During the 16-year reporting period, about 19% of the Division I, II, and III NCAA institutions sponsoring football participated in the Injury Surveillance System. The results from the 16-year study period show little variation in the injury rates over time: games averaged 36 injuries per 1000 athlete-exposures (A-Es); fall practice, approximately 4 injuries per 1000 A-Es; and spring practice, about 10 injuries per 1000 A-Es. The game injury rate was more than 9 times higher than the in-season practice injury rate (35.90 versus 3.80 injuries per 1000 A-Es, rate ratio = 9.1, 95% confidence interval = 9.0, 9.2), and the spring practice injury rate was more than 2 times higher than the fall practice injury rate (9.62 versus 3.80 injuries per 1000 A-Es, rate ratio = 2.5, 95% confidence interval = 2.5, 2.6). The rate ratio for games versus fall practices was greatest for upper leg contusions (18.1 per 1000 A-Es), acromioclavicular joint sprains (14.0 per 1000 A-Es), knee internal derangements (13.4 per 1000 A-Es), ankle ligament sprains (12.0 per 1000 A-Es), and concussions (11.1 per 1000 A-Es). Recommendations: Football is a complex sport that requires a range of skills performed by athletes with a wide variety of body shapes and types. Injury risks are greatest during games. Thus, injury prevention measures should focus on position-specific activities to reduce the injury rate. As equipment technology improves for

  6. Descriptive epidemiology of collegiate men's football injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004.

    Science.gov (United States)

    Dick, Randall; Ferrara, Michael S; Agel, Julie; Courson, Ron; Marshall, Stephen W; Hanley, Michael J; Reifsteck, Fred

    2007-01-01

    To review 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for men's football and identify potential areas for injury prevention initiatives. Football is a high-velocity collision sport in which injuries are expected. Football tends to have one of the highest injury rates in sports. Epidemiologic data helps certified athletic trainers and other clinicians identify injury trends and patterns to appropriately design and institute injury prevention protocols and then measure their effects. During the 16-year reporting period, about 19% of the Division I, II, and III NCAA institutions sponsoring football participated in the Injury Surveillance System. The results from the 16-year study period show little variation in the injury rates over time: games averaged 36 injuries per 1000 athlete-exposures (A-Es); fall practice, approximately 4 injuries per 1000 A-Es; and spring practice, about 10 injuries per 1000 A-Es. The game injury rate was more than 9 times higher than the in-season practice injury rate (35.90 versus 3.80 injuries per 1000 A-Es, rate ratio = 9.1, 95% confidence interval = 9.0, 9.2), and the spring practice injury rate was more than 2 times higher than the fall practice injury rate (9.62 versus 3.80 injuries per 1000 A-Es, rate ratio = 2.5, 95% confidence interval = 2.5, 2.6). The rate ratio for games versus fall practices was greatest for upper leg contusions (18.1 per 1000 A-Es), acromioclavicular joint sprains (14.0 per 1000 A-Es), knee internal derangements (13.4 per 1000 A-Es), ankle ligament sprains (12.0 per 1000 A-Es), and concussions (11.1 per 1000 A-Es). Football is a complex sport that requires a range of skills performed by athletes with a wide variety of body shapes and types. Injury risks are greatest during games. Thus, injury prevention measures should focus on position-specific activities to reduce the injury rate. As equipment technology improves for the helmet, shoulder pads, and other protective

  7. Potential use of telephone surveys for non-communicable disease surveillance in developing countries: evidence from a national household survey in Lebanon

    Directory of Open Access Journals (Sweden)

    Abla M. Sibai

    2016-05-01

    Full Text Available Abstract Background Given the worldwide proliferation of cellphones, this paper examines their potential use for the surveillance of non-communicable disease (NCD risk factors in a Middle Eastern country. Methods Data were derived from a national household survey of 2,656 adults (aged 18 years or older in Lebanon in 2009. Responses to questions on phone ownership yielded two subsamples, the ‘cell phone sample’ (n = 1,404 and the ‘any phone sample’ (n = 2,158. Prevalence estimates of various socio-demographics and 11 key NCD risk factors and comorbidities were compared between each subsample and the overall household sample. Results Adjusting for baseline age and sex distribution, no differences were observed for all NCD indicators when comparing either of subsamples to the overall household sample, except for binge drinking [(OR = 1.55, 95 % CI: 1.33–1.81 and (OR = 1.48, 95 % CI: 1.18–1.85 for ‘cell phone subsample’ and ‘any phone subsample’, respectively] and self-rated health (OR = 1.23, 95 % CI: 1.10–1.36 and (OR = 1.16, 95 % CI: 1.02–1.32, respectively. Differences in the odds of hyperlipidemia (OR = 1.27, 95 % CI: 1.06–1.51 was also found in the subsample of ‘any phone’ carriers. Conclusions Multi-mode telephone surveillance techniques provide viable alternative to face-to-face surveys in developing countries. Cell phones may also be useful for personalized public health and medical care interventions in young populations.

  8. Unintentional childhood injury patterns, odds, and outcomes in Kampala City: an analysis of surveillance data from the National Pediatric Emergency Unit

    Science.gov (United States)

    Mutto, Milton; Lawoko, Stephen; Nansamba, Catherine; Ovuga, Emilio; Svanstrom, Leif

    2011-01-01

    Abstract: Background: Unintentional Childhood Injuries pose a major public health challenge in Africa and Uganda. Previous estimates of the problem may have underestimated the childhood problem. We set to determine unintentional childhood injury pattern, odds, and outcomes at the National Paediatric Emergency unit in Kampala city using surveillance data. Methods: Incident proportions, odds and proportional rates were calculated and used to determine unintentional injury patterns across childhood (1-12 years). Results: A total of 556 cases recorded between January and May 2008 were analyzed: majority had been transported to hospital by mothers using mini-buses, private cars, and motorcycles. Median distance from injury location to hospital was 5 km. Homes, roads, and schools were leading injury locations. Males constituted 60% of the cases. Play and daily living activities were commonest injury time activities. Falls, burns and traffic accounted for 70.5% of unintentional childhood injuries. Burns, open wounds, fractures were commonest injury types. Motorcycles, buses and passenger-cars caused most crashes. Play grounds, furniture, stairs and trees were commonest source of falls. Most burn injuries were caused by liquids, fires and hot objects. 43.8% of cases were admitted. 30% were discharged without disability; 10%, were disabled; 1%, died. Injury odds and proportional incidence rates varied with age, place and cause. Poisoning and drowning were rare. Local pediatric injury priorities should include home, road and school safety. Conclusions: Unintentional injuries are common causes of hospital visit by children under 13 years especially boys. Homes, roads and educational facilities are commonest unintentional injury sites. Significant age and gender differences exist in intentional injury causation, characteristics and outcomes. In its current form, our surveillance system seems inefficient in capturing poisoning and drowning. The local prevention priorities could

  9. Unintentional Childhood Injury Patterns, Odds, and Outcomes in Kampala City: an analysis of surveillance data from the National Pediatric Emergency Unit

    Directory of Open Access Journals (Sweden)

    Emilio Ovuga

    2011-01-01

    Full Text Available BACKGROUND: Unintentional Childhood Injuries pose a major public health challenge in Africa and Uganda. Previous estimates of the problem may have underestimated the childhood problem. We set to determine unintentional childhood injury pattern, odds, and outcomes at the National Paediatric Emergency unit in Kampala city using surveillance data. METHODS: Incident proportions, odds and proportional rates were calculated and used to determine unintentional injury patterns across childhood (1-12 years. RESULTS: A total of 556 cases recorded between January and May 2008 were analyzed: majority had been transported to hospital by mothers using mini-buses, private cars, and motorcycles. Median distance from injury location to hospital was 5 km. Homes, roads, and schools were leading injury locations. Males constituted 60% of the cases. Play and daily living activities were commonest injury time activities. Falls, burns and traffic accounted for 70.5% of unintentional childhood injuries. Burns, open wounds, fractures were commonest injury types. Motorcycles, buses and passenger-cars caused most crashes. Play grounds, furniture, stairs and trees were commonest source of falls. Most burn injuries were caused by liquids, fires and hot objects. 43.8% of cases were admitted. 30% were discharged without disability; 10%, were disabled; 1%, died. Injury odds and proportional incidence rates varied with age, place and cause. Poisoning and drowning were rare. Local pediatric injury priorities should include home, road and school safety. CONCLUSIONS: Unintentional injuries are common causes of hospital visit by children under 13 years especially boys. Homes, roads and educational facilities are commonest unintentional injury sites. Significant age and gender differences exist in intentional injury causation, characteristics and outcomes. In its current form, our surveillance system seems inefficient in capturing poisoning and drowning. The local prevention

  10. Geocoding capacity of birth defects surveillance programs: results from the National Birth Defects Prevention Network Geocoding Survey.

    Science.gov (United States)

    Wang, Ying; O'Leary, Leslie A; Rickard, Russel S; Mason, Craig A

    2010-01-01

    A Web-based survey focusing on geocoding of birth defects data was developed and administrated to gain an understanding of the capacity of state birth defects programs to geocode maternal residence and to identify barriers to geocoding birth defects data. The survey consisted of 21 questions related to geocoding of maternal residence, type of software used, barriers to geocoding, and data linkage. In August 2007, an e-mail with a Web link to the survey was sent to all state birth defects program contacts in the United States, including the District of Columbia, Puerto Rico, and the Centers for Disease Control and Prevention (CDC) requesting they complete the online survey. By October 2007, 39 (74%) out of 53 birth defects program contacts completed the survey. Although nearly all birth defects programs collect maternal residential data, many are not currently geocoding that data. Results indicated that 97% of the programs that completed the survey reported they collected data on maternal residence, 53% of which reported that the birth defects surveillance data were geocoded to the street address level using maternal residential address at delivery. Twenty six percent of the programs that do not currently geocode the data identified "Software and address reference file are not available" as the most significant barrier to geocoding; another 16% chose "Lack of funding" as the most significant barrier to geocoding. Since geocoding is an important component of spatial analyses used to detect potential clusters of birth defects, leveraging resources to overcome the barriers that prevent programs from geocoding is important.

  11. The University of the National Football League: How Technology, Injury Surveillance, and Health Care Have Improved the Safety of America's Game.

    Science.gov (United States)

    Matava, Matthew J; Görtz, Simon

    2016-07-01

    American football has become one of the most popular sports in the United States. Despite the millions of players at all levels of competition who gain the physical, social, and psychological rewards that football provides, many interested stakeholders continue to ask, "Is football safe?" Although there are only approximately 1,700 players on National Football League (NFL) rosters, the injuries they sustain have garnered the most attention-and criticism-from the national media. Increased public awareness of the injury potential football possesses has led to an open debate and a major shift in public sentiment over the past 5 years. Although no sport is perfectly safe, the question is whether it can be made relatively safe and if the long-term consequences are worth the risk. This article reviews the methods by which one sports league-the NFL-has used advances in medical technology and injury surveillance to improve the health and safety of its players. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  12. An analysis of sprain and strain injury data for the New Zealand meat processing industry from national and industry injury surveillance databases.

    Science.gov (United States)

    Tappin, D C; Bentley, T A; Vitalis, A; Macky, K

    2008-11-01

    Data on musculoskeletal disorders (MSD) in meat processing and the tasks in which they occur is limited in the literature. This paper provides a summary of such data from the New Zealand industry. Despite the high incidence of MSD in meat processing in New Zealand, little research has been undertaken to identify and assess high-risk tasks and develop interventions to address them. This paper reports on the initial stages of a 2-year government funded project to address these issues. Findings are presented from the analysis of data from two injury surveillance databases. Accident Compensation Corporation national data claims assisted in defining the industry and indicated factors for further assessment, including consideration of claimants' gender, ethnicity and geographical region. National Injury Database industry data claims helped to identify specific tasks in which MSD are more likely to occur by departments and for the two main animal species processed. These factors have helped shape the assessment of high-risk tasks currently undertaken in the meat processing industry.

  13. Cost effectiveness of robotic mitral valve surgery

    Science.gov (United States)

    2017-01-01

    Significant technological advances have led to an impressive evolution in mitral valve surgery over the last two decades, allowing surgeons to safely perform less invasive operations through the right chest. Most new technology comes with an increased upfront cost that must be measured against postoperative savings and other advantages such as decreased perioperative complications, faster recovery, and earlier return to preoperative level of functioning. The Da Vinci robot is an example of such a technology, combining the significant benefits of minimally invasive surgery with a “gold standard” valve repair. Although some have reported that robotic surgery is associated with increased overall costs, there is literature suggesting that efficient perioperative care and shorter lengths of stay can offset the increased capital and intraoperative expenses. While data on current cost is important to consider, one must also take into account future potential value resulting from technological advancement when evaluating cost-effectiveness. Future refinements that will facilitate more effective surgery, coupled with declining cost of technology will further increase the value of robotic surgery compared to traditional approaches. PMID:28203539

  14. Regional Disease Surveillance Meeting - Final Paper

    Energy Technology Data Exchange (ETDEWEB)

    Lesperance, Ann M.; Mahy, Heidi A.

    2006-08-08

    On June 1, 2006, public health officials working in surveillance, epidemiological modeling, and information technology communities from the Seattle/Tacoma area and State of Washington met with members of the Pacific Northwest National Laboratory (PNNL) to discuss the current state of disease surveillance and gaps and needs to improve the current systems. The meeting also included a discussion of PNNL initiatives that might be appropriate to enhance disease surveillance and the current tools being used for disease surveillance. Participants broke out into two groups to identify critical gaps and needs for improving a surveillance system, and discuss the requirements for developing improved surveillance. Each group developed a list of key priorities summarizing the requirements for improved surveillance. The objective of this meeting was to work towards the development of an improved disease surveillance system.

  15. Cost-effectiveness of universal vaccination ag ainst varicella in the Netherlands

    NARCIS (Netherlands)

    De Boer, P.T.; Postma, M.J.

    2013-01-01

    Objectives: The Netherlands has no varicella vaccination in its National Immunization Program (NIP). Although varicella is regarded as a mild disease, implementation of varicella vaccination in the immunization schedule of several countries has shown to be cost-effective. Dutch children are infected

  16. Cost-effectiveness of universal vaccination ag ainst varicella in the Netherlands

    NARCIS (Netherlands)

    De Boer, P.T.; Postma, M.J.

    2013-01-01

    Objectives: The Netherlands has no varicella vaccination in its National Immunization Program (NIP). Although varicella is regarded as a mild disease, implementation of varicella vaccination in the immunization schedule of several countries has shown to be cost-effective. Dutch children are infected

  17. Updating the cost-effectiveness of rotavirus vaccination in The Netherlands

    NARCIS (Netherlands)

    Rozenbaum, M.H.; Hak, E.; Wilschut, J.C.; Postma, M.J.

    2010-01-01

    OBJECTIVES: To investigated the most important factors responsible for the large differences in previously estimated cost-effectiveness ratios and to update the costeffectiveness of rotavirus vaccination in the The Netherlands applying assumptions resulting from 2 consensus meetings with national an

  18. Pneumonia Mortality among Children under 5 in China from 1996 to 2013: An Analysis from National Surveillance System.

    Directory of Open Access Journals (Sweden)

    Chunhua He

    Full Text Available We investigated the mortality rate of pneumonia (PMR among children under 5 and its time trend from 1996 to 2013 to determine the priorities for ending preventable deaths from pneumonia in children under 5, and share China's successful experience in reducing PMR with other developing countries.We used data from China's Under 5 Child Mortality Surveillance System (U5CMSS to calculate the PMR and the proportion of pneumonia deaths to total deaths of children under 5. The data were grouped by urban and rural areas with Cochran-Mantel-Haensel (CMH test and Chi-square test to examine the differences of PMR and proportion. The time trend was tested by Cochran-Armitage trend test.The overall PMR of children under 5 was reduced by 85.5% (from 1053.2 to 153.2 per 100,000 live births from 1996 to 2013, with the urban and rural areas reduced by 69.1% (from 188.4 to 58.2 per 100,000 live births and 84.7% (from 1252.8 to 191.9 per 100,000 live births, respectively. The overall proportion of pneumonia deaths to total deaths was also declined from 23.4% in 1996 to 12.8% in 2013, with the rural areas decreased from 24.4% to 13.2% and the urban areas decreased from 11.1% to 9.7%. The PMRs in neonates (0-27 days, post-neonates (1-11 months, and childhood (12-59 months were reduced by 80.7%, 77.4%, and 80.1%, respectively in rural areas, and 71.7%, 69.6%, and 39.0%, respectively in urban areas. During 1996-2013, the PMR in children under 5 years was 4.9 fold higher in rural areas relative to that in urban areas, with relative risk (RR of 3.6 and 6.4 in neonates and 1- to 59-month-old children, respectively.PMR in children under 5 significantly declined in China from 1996 to 2013, especially in rural areas. However, huge disparities still existed between rural and urban areas. Infants had the highest PMR, which indicated that interventions aiming at prevention and control of infant pneumonia should be the priority for further reducing PMR in China.

  19. Costs and cost- effectiveness of alternative tuberculosis ...

    African Journals Online (AJOL)

    alternative strategies (the Hlabisa strategy prior to 1991 based on hospitalisation, the ... important national implications, supporting the goals of the new tuberculosis ... Through a simplified approach to tuberculosis management,S which entails ...

  20. Surveillance of Autism.

    Science.gov (United States)

    Boyle, Coleen A.; Bertrand, Jacquelyn; Yeargin-Allsopp, Marshalyn

    1999-01-01

    This article describes the autism surveillance activities of the Center for Disease Control and Prevention. It considers why surveillance to track prevalence of autistic disorders is needed, how such surveillance is conducted, and the special challenges of autism surveillance. (DB)

  1. Migration, settlement change and health in post-apartheid South Africa: Triangulating health and demographic surveillance with national census data1

    Science.gov (United States)

    COLLINSON, MARK A.; TOLLMAN, STEPHEN M.; KAHN, KATHLEEN

    2010-01-01

    Background World population growth will be increasingly concentrated in the urban areas of the developing world; however, some scholars caution against the oversimplification of African urbanization noting that there may be “counter-urbanization” and a prevailing pattern of circular rural–urban migration. The aim of the paper is to examine the ongoing urban transition in South Africa in the post-apartheid period, and to consider the health and social policy implications of prevailing migration patterns. Methods Two data sets were analysed, namely the South African national census of 2001 and the Agincourt health and demographic surveillance system. A settlement-type transition matrix was constructed on the national data to show how patterns of settlement have changed in a five-year period. Using the sub-district data, permanent and temporary migration was characterized, providing migration rates by age and sex, and showing the distribution of origins and destinations. Findings The comparison of national and sub-district data highlight the following features: urban population growth, particularly in metropolitan areas, resulting from permanent and temporary migration; prevailing patterns of temporary, circular migration, and a changing gender balance in this form of migration; stepwise urbanization; and return migration from urban to rural areas. Conclusions Policy concerns include: rural poverty exacerbated by labour migration; explosive conditions for the transmission of HIV; labour migrants returning to die in rural areas; and the challenges for health information created by chronically ill migrants returning to rural areas to convalesce. Lastly, suggestions are made on how to address the dearth of relevant population information for policy-making in the fields of migration, settlement change and health. PMID:17676507

  2. Surveillance Angels

    NARCIS (Netherlands)

    Rothkrantz, L.J.M.

    2014-01-01

    The use of sensor networks has been proposed for military surveillance and environmental monitoring applications. Those systems are composed of a heterogeneous set of sensors to observe the environment. In centralised systems the observed data will be conveyed to the control room to process the

  3. Surveillance Angels

    NARCIS (Netherlands)

    Rothkrantz, L.J.M.

    2014-01-01

    The use of sensor networks has been proposed for military surveillance and environmental monitoring applications. Those systems are composed of a heterogeneous set of sensors to observe the environment. In centralised systems the observed data will be conveyed to the control room to process the data

  4. Cost-effectiveness of Total Knee Arthroplasty in the United States

    Science.gov (United States)

    Losina, Elena; Walensky, Rochelle P.; Kessler, Courtenay L.; Emrani, Parastu S.; Reichmann, William M.; Wright, Elizabeth A.; Holt, Holly L.; Solomon, Daniel H.; Yelin, Edward; Paltiel, A. David; Katz, Jeffrey N.

    2009-01-01

    Background Total knee arthroplasty (TKA) relieves pain and improves quality of life for persons with advanced knee osteoarthritis. However, to our knowledge, the cost-effectiveness of TKA and the influences of hospital volume and patient risk on TKA cost-effectiveness have not been investigated in the United States. Methods We developed a Markov, state-transition, computer simulation model and populated it with Medicare claims data and cost and outcomes data from national and multinational sources. We projected lifetime costs and quality-adjusted life expectancy (QALE) for different risk populations and varied TKA intervention and hospital volume. Cost-effectiveness of TKA was estimated across all patient risk and hospital volume permutations. Finally, we conducted sensitivity analyses to determine various parameters’ influences on cost-effectiveness. Results Overall, TKA increased QALE from 6.822 to 7.957 quality-adjusted life years (QALYs). Lifetime costs rose from $37 100 (no TKA) to $57 900 after TKA, resulting in an incremental cost-effectiveness ratio of $18 300 per QALY. For high-risk patients, TKA increased QALE from 5.713 to 6.594 QALY, yielding a cost-effectiveness ratio of $28 100 per QALY. At all risk levels, TKA was more costly and less effective in low-volume centers than in high-volume centers. Results were insensitive to variations of key input parameters within policy-relevant, clinically plausible ranges. The greatest variations were seen for the quality of life gain after TKA and the cost of TKA. Conclusions Total knee arthroplasty appears to be cost-effective in the US Medicare-aged population, as currently practiced across all risk groups. Policy decisions should be made on the basis of available local options for TKA. However, when a high-volume hospital is available, TKAs performed in a high-volume hospital confer even greater value per dollar spent than TKAs performed in low-volume centers. PMID:19546411

  5. Antihypertensive drugs: a perspective on pharmaceutical price erosion and its impact on cost-effectiveness.

    Science.gov (United States)

    Refoios Camejo, Rodrigo; McGrath, Clare; Herings, Ron; Meerding, Willem-Jan; Rutten, Frans

    2012-01-01

    When comparators' prices decrease due to market competition and loss of exclusivity, the incremental clinical effectiveness required for a new technology to be cost-effective is expected to increase; and/or the minimum price at which it will be funded will tend to decrease. This may be, however, either unattainable physiologically or financially unviable for drug development. The objective of this study is to provide an empirical basis for this discussion by estimating the potential for price decreases to impact on the cost-effectiveness of new therapies in hypertension. Cost-effectiveness at launch was estimated for all antihypertensive drugs launched between 1998 and 2008 in the United Kingdom using hypothetical degrees of incremental clinical effectiveness within the methodologic framework applied by the UK National Institute for Health and Clinical Excellence. Incremental cost-effectiveness ratios were computed and compared with funding thresholds. In addition, the levels of incremental clinical effectiveness required to achieve specific cost-effectiveness thresholds at given prices were estimated. Significant price decreases were observed for existing drugs. This was shown to markedly affect cost-effectiveness of technologies entering the market. The required incremental clinical effectiveness was in many cases greater than physiologically possible so, as a consequence, a number of products might not be available today if current methods of economic appraisal had been applied. We conclude that the definition of cost-effectiveness thresholds is fundamental in promoting efficient innovation. Our findings demonstrate that comparator price attrition has the potential to put pressure in the pharmaceutical research model and presents a challenge to new therapies being accepted for funding. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  6. Cost-effectiveness of diagnostic for malaria in Extra-Amazon Region, Brazil

    Directory of Open Access Journals (Sweden)

    de Oliveira Maria Regina F

    2012-11-01

    Full Text Available Abstract Background Rapid diagnostic tests (RDT for malaria have been demonstrated to be effective and they should replace microscopy in certain areas. Method The cost-effectiveness of five RDT and thick smear microscopy was estimated and compared. Data were collected on Brazilian Extra-Amazon Region. Data sources included the National Malaria Control Programme of the Ministry of Health, the National Healthcare System reimbursement table, laboratory suppliers and scientific literature. The perspective was that of the Brazilian public health system, the analytical horizon was from the start of fever until the diagnostic results provided to patient and the temporal reference was that of year 2010. Two costing methods were produced, based on exclusive-use microscopy or shared-use microscopy. The results were expressed in costs per adequately diagnosed cases in 2010 U.S. dollars. One-way sensitivity analysis was performed considering key model parameters. Results In the cost-effectiveness analysis with exclusive-use microscopy, the RDT CareStart™ was the most cost-effective diagnostic strategy. Microscopy was the most expensive and most effective, with an additional case adequately diagnosed by microscopy costing US$ 35,550.00 in relation to CareStart™. In opposite, in the cost-effectiveness analysis with shared-use microscopy, the thick smear was extremely cost-effective. Introducing into the analytic model with shared-use microscopy a probability for individual access to the diagnosis, assuming a probability of 100% of access for a public health system user to any RDT and, hypothetically, of 85% of access to microscopy, this test saw its effectiveness reduced and was dominated by the RDT CareStart™. Conclusion The analysis of cost-effectiveness of malaria diagnosis technologies in the Brazilian Extra-Amazon Region depends on the exclusive or shared use of the microscopy. Following the assumptions of this study, shared-use microscopy would be

  7. Cost-effective nursing practice: cost-awareness and empowerment.

    Science.gov (United States)

    Fisher, P

    1993-12-01

    Cost-effective nursing practice is essential to succeed today as resources allocated to health care are declining. Realizing that any change poses a threat to our security, it is imperative that stakeholders be permitted to participate in decision-making processes affecting their work. An honest, open exchange of ideas towards cost-effective practices should be encouraged. Cost-effective behaviours are influenced significantly by negative attitudes with regard to loss of human resources, increased workload, and potential pay cuts. This article describes innovative strategies which could promote successful cost-effective nursing practice, including working smarter, not working harder. Topics addressed are attitude, awareness and empowerment.

  8. Cost-effectiveness of bedaquiline in MDR and XDR tuberculosis in Italy

    Science.gov (United States)

    Codecasa, Luigi R.; Toumi, Mondher; D’Ausilio, Anna; Aiello, Andrea; Damele, Francesco; Termini, Roberta; Uglietti, Alessia; Hettle, Robert; Graziano, Giorgio; De Lorenzo, Saverio

    2017-01-01

    ABSTRACT Objective: To evaluate the cost-effectiveness of bedaquiline plus background drug regimens (BR) for multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) in Italy. Methods: A Markov model was adapted to the Italian setting to estimate the incremental cost-effectiveness ratio (ICER) of bedaquiline plus BR (BBR) versus BR in the treatment of MDR-TB and XDR-TB over 10 years, from both the National Health Service (NHS) and societal perspective. Cost-effectiveness was evaluated in terms of life-years gained (LYG). Clinical data were sourced from trials; resource consumption for compared treatments was modelled according to advice from an expert clinicians panel. NHS tariffs for inpatient and outpatient resource consumption were retrieved from published Italian sources. Drug costs were provided by reference centres for disease treatment in Italy. A 3% annual discount was applied to both cost and effectiveness. Deterministic and probabilistic sensitivity analyses were conducted. Results: Over 10 years, BBR vs. BR alone is cost-effective, with ICERs of €16,639/LYG and €4081/LYG for the NHS and society, respectively. The sensitivity analyses confirmed the robustness of the results from both considered perspectives. Conclusion: In Italy, BBR vs. BR alone has proven to be cost-effective in the treatment of MDR-TB and XDR-TB under a range of scenarios. PMID:28265350

  9. Risk factors for nasopharyngeal carriage of drug-resistant Streptococcus pneumoniae: data from a nation-wide surveillance study in Greece

    Directory of Open Access Journals (Sweden)

    Samonis Georgios

    2009-07-01

    Full Text Available Abstract Background A nation-wide surveillance study was conducted in Greece in order to provide a representative depiction of pneumococcal carriage in the pre-vaccination era and to evaluate potential risk factors for carriage of resistant strains in healthy preschool children attending daycare centers. Methods A study group was organized with the responsibility to collect nasopharyngeal samples from children. Questionnaires provided demographic data, data on antibiotic consumption, family and household data, and medical history data. Pneumococcal isolates were tested for their susceptibility to various antimicrobial agents and resistant strains were serotyped. Results Between February and May 2004, from a total population of 2536 healthy children, a yield of 746 pneumococci was isolated (carriage rate 29.41%. Resistance rates differed among geographic regions. Recent antibiotic use in the last month was strongly associated with the isolation of resistant pneumococci to a single or multiple antibiotics. Serotypes 19F, 14, 9V, 23F and 6B formed 70.6% of the total number of resistant strains serotyped. Conclusion Recent antibiotic use is a significant risk factor for the colonization of otherwise healthy children's nasopharynx by resistant strains of S pneumoniae. The heptavalent pneumococcal conjugate vaccine could provide coverage for a significant proportion of resistant strains in the Greek community. A combined strategy of vaccination and prudent antibiotic use could provide a means for combating pneumococcal resistance.

  10. Descriptive Epidemiology of Collegiate Women's Gymnastics Injuries: National Collegiate Athletic Association Injury Surveillance System, 1988–1989 Through 2003–2004

    Science.gov (United States)

    Marshall, Stephen W; Covassin, Tracey; Dick, Randall; Nassar, Lawrence G; Agel, Julie

    2007-01-01

    Objective: To review 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for women's gymnastics and identify potential areas for injury prevention initiatives. Background: In the 1988–1989 academic year, 112 schools were sponsoring varsity women's gymnastics teams, with approximately 1550 participants. By 2003–2004, the number of varsity teams had decreased 23% to 86, involving 1380 participants. Significant participation reductions during this time were particularly apparent in Divisions II and III. Main Results: A significant annual average decrease was noted in competition (−4.0%, P Gymnasts with a previous history of ankle sprain should either wear an ankle brace or use prophylactic tape on their ankles to decrease the risk of recurrent injury. Preventive efforts may incorporate more neuromuscular training and core stability programs in the off-season and preseason conditioning to enhance proper landing and skill mechanics. Equipment manufacturers are encouraged to reevaluate the design of the landing mats to allow for better absorption of forces. PMID:17710171

  11. Epidemiology of syndesmosis injuries in intercollegiate football: incidence and risk factors from National Collegiate Athletic Association injury surveillance system data from 2004-2005 to 2008-2009.

    Science.gov (United States)

    Hunt, Kenneth J; George, Elizabeth; Harris, Alex H S; Dragoo, Jason L

    2013-07-01

    To describe the incidence and risk factors for high ankle sprains (ie, syndesmosis injuries) among National Collegiate Athletic Association (NCAA) football players. Descriptive epidemiologic study. Data were examined from the NCAA's Injury Surveillance System (ISS) for 5 football seasons (from 2004-2005 to 2008-2009). All NCAA men's football programs participating in the ISS. No additional risk factors were introduced as a result of this analysis. For partial and complete syndesmosis injuries, outcome measures included incidence, time lost from participation, and requirement for surgical repair. The overall incidence of high ankle sprains in NCAA football players was 0.24 per 1000 athlete exposures, accounting for 24.6% of all ankle sprains. Athletes were nearly 14 times more likely to sustain the injury during games compared with practice; complete syndesmosis injuries resulted in significantly greater time lost compared with partial injuries (31.3 vs 15.8 days). Less than 3% of syndesmosis injuries required surgical intervention. There was a significantly higher injury incidence on artificial surfaces compared with natural grass. The majority of injuries (75.2%) occurred during contact with another player. Our data suggest a significantly higher incidence of syndesmosis injuries during games, during running plays, and to running backs and interior defensive linemen. The wide range in time lost from participation for complete syndesmosis injuries underscores the need for improved understanding of injury mechanism and classification of injury severity such that prevention, safe return to play protocols, and outcomes can be further improved.

  12. Potential Misclassification of Urinary Tract-Related Bacteremia Upon Applying the 2015 Catheter-Associated Urinary Tract Infection Surveillance Definition From the National Healthcare Safety Network.

    Science.gov (United States)

    Greene, M Todd; Ratz, David; Meddings, Jennifer; Fakih, Mohamad G; Saint, Sanjay

    2016-04-01

    The Centers for Disease Control and Prevention recently updated the surveillance definition of catheter-associated urinary tract infection to include only urine culture bacteria of at least 1 × 10(5) colony-forming units/mL. Our findings suggest that the new surveillance definition may fail to capture clinically meaningful catheter-associated urinary tract infections.

  13. Routine HIV screening in Portugal: clinical impact and cost-effectiveness.

    Directory of Open Access Journals (Sweden)

    Yazdan Yazdanpanah

    Full Text Available OBJECTIVE: To compare the clinical outcomes and cost-effectiveness of routine HIV screening in Portugal to the current practice of targeted and on-demand screening. DESIGN: We used Portuguese national clinical and economic data to conduct a model-based assessment. METHODS: We compared current HIV detection practices to strategies of increasingly frequent routine HIV screening in Portuguese adults aged 18-69. We considered several subpopulations and geographic regions with varying levels of undetected HIV prevalence and incidence. Baseline inputs for the national case included undiagnosed HIV prevalence 0.16%, annual incidence 0.03%, mean population age 43 years, mean CD4 count at care initiation 292 cells/μL, 63% HIV test acceptance, 78% linkage to care, and HIV rapid test cost €6 under the proposed routine screening program. Outcomes included quality-adjusted survival, secondary HIV transmission, cost, and incremental cost-effectiveness. RESULTS: One-time national HIV screening increased HIV-infected survival from 164.09 quality-adjusted life months (QALMs to 166.83 QALMs compared to current practice and had an incremental cost-effectiveness ratio (ICER of €28,000 per quality-adjusted life year (QALY. Screening more frequently in higher-risk groups was cost-effective: for example screening annually in men who have sex with men or screening every three years in regions with higher incidence and prevalence produced ICERs of €21,000/QALY and €34,000/QALY, respectively. CONCLUSIONS: One-time HIV screening in the Portuguese national population will increase survival and is cost-effective by international standards. More frequent screening in higher-risk regions and subpopulations is also justified. Given Portugal's challenging economic priorities, we recommend prioritizing screening in higher-risk populations and geographic settings.

  14. Air surveillance

    Energy Technology Data Exchange (ETDEWEB)

    Patton, G.W.

    1995-06-01

    This section of the 1994 Hanford Site Environmental Report summarizes the air surveillance and monitoring programs currently in operation at that Hanford Site. Atmospheric releases of pollutants from Hanford to the surrounding region are a potential source of human exposure. For that reason, both radioactive and nonradioactive materials in air are monitored at a number of locations. The influence of Hanford emissions on local radionuclide concentrations was evaluated by comparing concentrations measured at distant locations within the region to concentrations measured at the Site perimeter. This section discusses sample collection, analytical methods, and the results of the Hanford air surveillance program. A complete listing of all analytical results summarized in this section is reported separately by Bisping (1995).

  15. Descriptive Epidemiology of Collegiate Men's Soccer Injuries: National Collegiate Athletic Association Injury Surveillance System, 1988–1989 Through 2002–2003

    Science.gov (United States)

    Agel, Julie; Evans, Todd A; Dick, Randall; Putukian, Margot; Marshall, Stephen W

    2007-01-01

    Objective: To review 15 years of National Collegiate Athletic Association (NCAA) injury surveillance data for men's soccer and to identify potential areas for injury prevention initiatives. Background: The NCAA sanctioned its first men's soccer championship in 1959. Since then, the sport has grown to include more than 18 000 annual participants across 3 NCAA divisions. During the 15 years from 1988–1989 to 2002–2003, the NCAA Injury Surveillance System accumulated game and practice injury data for men's soccer across all 3 NCAA divisions. Main Results: The injury rate was 4 times higher in games compared with practices (18.75 versus 4.34 injuries per 1000 athlete-exposures, rate ratio = 4.3, 95% confidence interval = 4.2, 4.5), and preseason practices had a higher injury rate than in-season practices (7.98 versus 2.43 injuries per 1000 athlete-exposures, rate ratio = 3.3, 95% confidence interval = 3.1, 3.5). In both games and practices, more than two thirds of men's soccer injuries occurred to the lower extremities, followed by the head and neck in games and the trunk and back in practices. Although player-to-player contact was the primary cause of injury during games, most practice injuries occurred without direct contact to the injured body part. Ankle ligament sprains represented the most common injury during practices and games, whereas knee internal derangements were the most common type of severe injury (defined as 10+ days of time loss). Recommendations: Sprains, contusions, and strains of the lower extremities were the most common injuries in men's collegiate soccer, with player-to-player contact the primary injury mechanism during games. Preventive efforts should focus on the player-to-player contact that often leads to these injuries and greater enforcement of the rules that are in place to limit their frequency and severity. Emphasis also should be placed on addressing the high rate of first-time and recurrent ankle ligament sprains. PMID:17710176

  16. Descriptive Epidemiology of Collegiate Women's Basketball Injuries: National Collegiate Athletic Association Injury Surveillance System, 1988–1989 Through 2003–2004

    Science.gov (United States)

    Agel, Julie; Olson, David E; Dick, Randall; Arendt, Elizabeth A; Marshall, Stephen W; Sikka, Robby S

    2007-01-01

    Objective: To review 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for women's basketball and to identify potential areas for injury prevention initiatives. Background: The number of colleges participating in women's college basketball has grown over the past 25 years. The Injury Surveillance System (ISS) has enabled the NCAA to collect and report injury trends over an extended period of time. This has allowed certified athletic trainers and coaches to be more informed regarding injuries and to adjust training regimens to reduce the risk of injury. It also has encouraged administrators to make rule changes that attempt to reduce the risk of injury. Main Results: From 1988–1989 through 2003–2004, 12.4% of schools across Divisions I, II, and III that sponsor varsity women's basketball programs participated in annual ISS data collection. Game and practice injury rates exhibited significant decreases over the study period. The rate of injury in a game situation was almost 2 times higher than in a practice (7.68 versus 3.99 injuries per 1000 athlete-exposures, rate ratio = 1.9, 95% confidence interval = 1.9, 2.0). Preseason-practice injury rates were more than twice as high as regular-season practice injury rates (6.75 versus 2.84 injuries per 1000 athlete-exposures, rate ratio = 2.4, 95% confidence interval = 2.2, 2.4). More than 60% of all game and practice injuries were to the lower extremity, with the most common game injuries being ankle ligament sprains, knee injuries (internal derangements and patellar conditions), and concussions. In practices, ankle ligament sprains, knee injuries (internal derangements and patellar conditions), upper leg muscle-tendon strains, and concussions were the most common injuries. Recommendations: Appropriate preseason conditioning and an emphasis on proper training may reduce the risk of injury and can optimize performance. As both player size and the speed of the women's game continue to

  17. Cost-effectiveness of vaccination against herpes zoster.

    Science.gov (United States)

    de Boer, Pieter T; Wilschut, Jan C; Postma, Maarten J

    2014-01-01

    Herpes zoster (HZ) is a common disease among elderly, which may develop into a severe pain syndrome labeled postherpetic neuralgia (PHN). A live-attenuated varicella zoster virus vaccine has been shown to be effective in reducing the incidence and burden of illness of HZ and PHN, providing the opportunity to prevent significant health-related and financial consequences of HZ. In this review, we summarize the available literature on cost-effectiveness of HZ vaccination and discuss critical parameters for cost-effectiveness results. A search in PubMed and EMBASE was performed to identify full cost-effectiveness studies published before April 2013. Fourteen cost-effectiveness studies were included, all performed in western countries. All studies evaluated cost-effectiveness among elderly above 50 years and used costs per quality-adjusted life year (QALY) gained as primary outcome. The vast majority of studies showed vaccination of 60- to 75-year-old individuals to be cost-effective, when duration of vaccine efficacy was longer than 10 years. Duration of vaccine efficacy, vaccine price, HZ incidence, HZ incidence and discount rates were influential to the incremental cost-effectiveness ratio (ICER). HZ vaccination may be a worthwhile intervention from a cost-effectiveness point of view. More extensive reporting on methodology and more detailed results of sensitivity analyses would be desirable to address uncertainty and to guarantee optimal comparability between studies, for example regarding model structure, discounting, vaccine characteristics and loss of quality of life due to HZ and PHN.

  18. Cost-effectiveness of online positive psychology: Randomized controlled trial

    NARCIS (Netherlands)

    Bolier, Linda; Majo, Cristina; Smit, Filip; Westerhof, Gerben Johan; Haverman, Merel; Walburg, J.A.; Riper, Heleen; Bohlmeijer, Ernst Thomas

    2014-01-01

    As yet, no evidence is available about the cost-effectiveness of positive psychological interventions. When offered via the Internet, these interventions may be particularly cost-effective, because they are highly scalable and do not rely on scant resources such as therapists’ time. Alongside a rand

  19. Standardized rendering from IR surveillance motion imagery

    Science.gov (United States)

    Prokoski, F. J.

    2014-06-01

    Government agencies, including defense and law enforcement, increasingly make use of video from surveillance systems and camera phones owned by non-government entities.Making advanced and standardized motion imaging technology available to private and commercial users at cost-effective prices would benefit all parties. In particular, incorporating thermal infrared into commercial surveillance systems offers substantial benefits beyond night vision capability. Face rendering is a process to facilitate exploitation of thermal infrared surveillance imagery from the general area of a crime scene, to assist investigations with and without cooperating eyewitnesses. Face rendering automatically generates greyscale representations similar to police artist sketches for faces in surveillance imagery collected from proximate locations and times to a crime under investigation. Near-realtime generation of face renderings can provide law enforcement with an investigation tool to assess witness memory and credibility, and integrate reports from multiple eyewitnesses, Renderings can be quickly disseminated through social media to warn of a person who may pose an immediate threat, and to solicit the public's help in identifying possible suspects and witnesses. Renderings are pose-standardized so as to not divulge the presence and location of eyewitnesses and surveillance cameras. Incorporation of thermal infrared imaging into commercial surveillance systems will significantly improve system performance, and reduce manual review times, at an incremental cost that will continue to decrease. Benefits to criminal justice would include improved reliability of eyewitness testimony and improved accuracy of distinguishing among minority groups in eyewitness and surveillance identifications.

  20. The clinical and cost effectiveness of group art therapy for people with non-psychotic mental health disorders: a systematic review and cost-effectiveness analysis.

    Science.gov (United States)

    Uttley, Lesley; Stevenson, Matt; Scope, Alison; Rawdin, Andrew; Sutton, Anthea

    2015-07-07

    The majority of mental health problems are non-psychotic (e.g., depression, anxiety, and phobias). For some people, art therapy may be a more acceptable alternative form of psychological therapy than standard forms of treatment, such as talking therapies. This study was part of a health technology assessment commissioned by the National Institute for Health Research, UK and aimed to systematically appraise the clinical and cost-effective evidence for art therapy for people with non-psychotic mental health disorders. Comprehensive literature searches for studies examining art therapy in populations with non-psychotic mental health disorders were performed in May 2013. A quantitative systematic review of clinical effectiveness and a systematic review of studies evaluating the cost-effectiveness of group art therapy were conducted. Eleven randomised controlled trials were included (533 patients). Meta-analysis was not possible due to clinical heterogeneity and insufficient comparable data on outcome measures across studies. The control groups varied between studies but included: no treatment/wait-list, attention placebo controls and psychological therapy comparators. Art therapy was associated with significant positive changes relative to the control group in mental health symptoms in 7 of the 11 studies. A de novo model was constructed and populated with data identified from the clinical review. Scenario analyses were conducted allowing comparisons of group art therapy with wait-list control and group art therapy with group verbal therapy. Group art-therapy appeared cost-effective compared with wait-list control with high certainty although generalisability to the target population was unclear; group verbal therapy appeared more cost-effective than art therapy but there was considerable uncertainty and a sizeable probability that art therapy was more cost effective. From the limited available evidence art therapy was associated with positive effects compared with

  1. Intensity of human prion disease surveillance predicts observed disease incidence

    NARCIS (Netherlands)

    G.M. Klug (Genevieve); H. Wand (Handan); M. Simpson (Marion); A. Boyd (Alison); M. Law (Matthew); C. Masters (Colin); R. Mateǰ (Radoslav); R. Howley (Rachel); M. Farrell (Michael); M. Breithaupt; I. Zerr (Inga); C.M. van Duijn (Cock); C.A. Ibrahim-Verbaas (Carla); J. Mackenzie; R.G. Will (Robert); J-P. Brandel (Jean-Philippe); A. Alperovitch (Annick); H. Budka (Herbert); G.G. Kovacs (Gabor); G.H. Jansen (Gerard); M. Coulthard (Michael); S.J. Collins (Steven)

    2013-01-01

    textabstractBackground: Prospective national screening and surveillance programmes serve a range of public health functions. Objectively determining their adequacy and impact on disease may be problematic for rare disorders. We undertook to assess whether objective measures of disease surveillance

  2. Surgical site infection after valvular or coronary artery bypass surgery: 2008-2011 French SSI national ISO-RAISIN surveillance.

    Science.gov (United States)

    Cossin, S; Malavaud, S; Jarno, P; Giard, M; L'Hériteau, F; Simon, L; Bieler, L; Molinier, L; Marcheix, B; Venier, A-G

    2015-11-01

    Multisite information regarding surgical site infection (SSI) rates for cardiac surgery programmes is not widely available. Ward characteristics that may affect outcomes have not been analysed previously. To determine individual- and ward-level factors associated with SSI occurrence after coronary artery bypass grafting (CABG) and valvular surgery. A dataset from the French national SSI database ISO-RAISIN 2008-2011 was used. Only adult patients were included. A standardized questionnaire was completed for each patient who underwent surgery, and patients with and without SSI were characterized. Patients and ward risk factors for SSI were analysed using a multilevel logistic regression model with SSI as binary outcome (two levels: patient and ward). Out of 8569 patients from 39 wards, the SSI rate was 2.2%. Micro-organisms were isolated in 144 patients (74%): 35% coagulase-negative staphylococci (N = 51), 23% Staphylococcus aureus (N = 33), 6% Escherichia coli (N = 8). Higher probability of SSI was associated with the duration of preoperative hospitalization, the duration of follow-up, the duration of surgery >75th percentile and the SSI rate in the surgery ward. The residual heterogeneity between wards (median odds ratio: 1.53) was as relevant as duration of preoperative hospitalization (odds ratio: 1.57). Although patient risk factors were more strongly associated with SSI occurrence, this study provided evidence for the existence of a ward-level effect. This should be taken into account when considering possible corrective interventions. Copyright © 2015. Published by Elsevier Ltd.

  3. The Case for Adolescent HIV Vaccination in South Africa: A Cost-Effectiveness Analysis.

    Science.gov (United States)

    Moodley, Nishila; Gray, Glenda; Bertram, Melanie

    2016-01-01

    Despite comprising 0.7% of the world population, South Africa is home to 18% of the global human immunodeficiency virus (HIV) prevalence. Unyielding HIV subepidemics among adolescents threaten national attempts to curtail the disease burden. Should an HIV vaccine become available, establishing its point of entry into the health system becomes a priority. This study assesses the impact of school-based HIV vaccination and explores how variations in vaccine characteristics affect cost-effectiveness. The cost per quality adjusted life year (QALY) gained associated with school-based adolescent HIV vaccination services was assessed using Markov modeling that simulated annual cycles based on national costing data. The estimation was based on a life expectancy of 70 years and employs the health care provider perspective. The simultaneous implementation of HIV vaccination services with current HIV management programs would be cost-effective, even at relatively higher vaccine cost. At base vaccine cost of US$ 12, the incremental cost effectiveness ratio (ICER) was US$ 43 per QALY gained, with improved ICER values yielded at lower vaccine costs. The ICER was sensitive to duration of vaccine mediated protection and variations in vaccine efficacy. Data from this work demonstrate that vaccines offering longer duration of protection and at lower cost would result in improved ICER values. School-based HIV vaccine services of adolescents, in addition to current HIV prevention and treatment health services delivered, would be cost-effective.

  4. Cost-effectiveness of cardiotocography plus ST analysis of the fetal electrocardiogram compared with cardiotocography only.

    Science.gov (United States)

    Vijgen, Sylvia M C; Westerhuis, Michelle E M H; Opmeer, Brent C; Visser, Gerard H A; Moons, Karl G M; Porath, Martina M; Oei, Guid S; Van Geijn, Herman P; Bolte, Antoinette C; Willekes, Christine; Nijhuis, Jan G; Van Beek, Erik; Graziosi, Giuseppe C M; Schuitemaker, Nico W E; Van Lith, Jan M M; Van Den Akker, Eline S A; Drogtrop, Addy P; Van Dessel, Hendrikus J H M; Rijnders, Robbert J P; Oosterbaan, Herman P; Mol, Ben Willem J; Kwee, Anneke

    2011-07-01

    To assess the cost-effectiveness of addition of ST analysis of the fetal electrocardiogram (ECG; STAN) to cardiotocography (CTG) for fetal surveillance during labor compared with CTG only. Cost-effectiveness analysis based on a randomized clinical trial on ST analysis of the fetal ECG. Obstetric departments of three academic and six general hospitals in The Netherlands. Population. Laboring women with a singleton high-risk pregnancy, a fetus in cephalic presentation, a gestational age >36 weeks and an indication for internal electronic fetal monitoring. A trial-based cost-effectiveness analysis was performed from a health-care provider perspective. Primary health outcome was the incidence of metabolic acidosis measured in the umbilical artery. Direct medical costs were estimated from start of labor to childbirth. Cost-effectiveness was expressed as costs to prevent one case of metabolic acidosis. The incidence of metabolic acidosis was 0.7% in the ST-analysis group and 1.0% in the CTG-only group (relative risk 0.70; 95% confidence interval 0.38-1.28). Per delivery, the mean costs per patient of CTG plus ST analysis (n= 2 827) were €1,345 vs. €1,316 for CTG only (n= 2 840), with a mean difference of €29 (95% confidence interval -€9 to €77) until childbirth. The incremental costs of ST analysis to prevent one case of metabolic acidosis were €9 667. The additional costs of monitoring by ST analysis of the fetal ECG are very limited when compared with monitoring by CTG only and very low compared with the total costs of delivery. © 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.

  5. Cost-effectiveness of a smokeless tobacco control mass media campaign in India.

    Science.gov (United States)

    Murukutla, Nandita; Yan, Hongjin; Wang, Shuo; Negi, Nalin Singh; Kotov, Alexey; Mullin, Sandra; Goodchild, Mark

    2017-08-10

    Tobacco control mass media campaigns are cost-effective in reducing tobacco consumption in high-income countries, but similar evidence from low-income countries is limited. An evaluation of a 2009 smokeless tobacco control mass media campaign in India provided an opportunity to test its cost-effectiveness. Campaign evaluation data from a nationally representative household survey of 2898 smokeless tobacco users were compared with campaign costs in a standard cost-effectiveness methodology. Costs and effects of the Surgeon campaign were compared with the status quo to calculate the cost per campaign-attributable benefit, including quit attempts, permanent quits and tobacco-related deaths averted. Sensitivity analyses at varied CIs and tobacco-related mortality risk were conducted. The Surgeon campaign was found to be highly cost-effective. It successfully generated 17 259 148 additional quit attempts, 431 479 permanent quits and 120 814 deaths averted. The cost per benefit was US$0.06 per quit attempt, US$2.6 per permanent quit and US$9.2 per death averted. The campaign continued to be cost-effective in sensitivity analyses. This study suggests that tobacco control mass media campaigns can be cost-effective and economically justified in low-income and middle-income countries. It holds significant policy implications, calling for sustained investment in evidence-based mass media campaigns as part of a comprehensive tobacco control strategy. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  6. Cost-effectiveness analysis of diagnostic options for pneumocystis pneumonia (PCP.

    Directory of Open Access Journals (Sweden)

    Julie R Harris

    Full Text Available BACKGROUND: Diagnosis of Pneumocystis jirovecii pneumonia (PCP is challenging, particularly in developing countries. Highly sensitive diagnostic methods are costly, while less expensive methods often lack sensitivity or specificity. Cost-effectiveness comparisons of the various diagnostic options have not been presented. METHODS AND FINDINGS: We compared cost-effectiveness, as measured by cost per life-years gained and proportion of patients successfully diagnosed and treated, of 33 PCP diagnostic options, involving combinations of specimen collection methods [oral washes, induced and expectorated sputum, and bronchoalveolar lavage (BAL] and laboratory diagnostic procedures [various staining procedures or polymerase chain reactions (PCR], or clinical diagnosis with chest x-ray alone. Our analyses were conducted from the perspective of the government payer among ambulatory, HIV-infected patients with symptoms of pneumonia presenting to HIV clinics and hospitals in South Africa. Costing data were obtained from the National Institutes of Communicable Diseases in South Africa. At 50% disease prevalence, diagnostic procedures involving expectorated sputum with any PCR method, or induced sputum with nested or real-time PCR, were all highly cost-effective, successfully treating 77-90% of patients at $26-51 per life-year gained. Procedures using BAL specimens were significantly more expensive without added benefit, successfully treating 68-90% of patients at costs of $189-232 per life-year gained. A relatively cost-effective diagnostic procedure that did not require PCR was Toluidine Blue O staining of induced sputum ($25 per life-year gained, successfully treating 68% of patients. Diagnosis using chest x-rays alone resulted in successful treatment of 77% of patients, though cost-effectiveness was reduced ($109 per life-year gained compared with several molecular diagnostic options. CONCLUSIONS: For diagnosis of PCP, use of PCR technologies, when

  7. Cost-effectiveness of introducing a rotavirus vaccine in developing countries: The case of Mexico

    Directory of Open Access Journals (Sweden)

    Gutierrez Juan-Pablo

    2008-07-01

    Full Text Available Abstract Background In developing countries rotavirus is the leading cause of severe diarrhoea and diarrhoeal deaths in children under 5. Vaccination could greatly alleviate that burden, but in Mexico as in most low- and middle-income countries the decision to add rotavirus vaccine to the national immunisation program will depend heavily on its cost-effectiveness and affordability. The objective of this study was to assess the cost-effectiveness of including the pentavalent rotavirus vaccine in Mexico's national immunisation program. Methods A cost-effectiveness model was developed from the perspective of the health system, modelling the vaccination of a hypothetical birth cohort of 2 million children monitored from birth through 60 months of age. It compares the cost and disease burden of rotavirus in an unvaccinated cohort of children with one vaccinated as recommended at 2, 4, and 6 months. Results Including the pentavalent vaccine in the national immunisation program could prevent 71,464 medical visits (59%, 5,040 hospital admissions (66%, and 612 deaths from rotavirus gastroenteritis (70%. At US$10 per dose and a cost of administration of US$13.70 per 3-dose regimen, vaccination would cost US$122,058 per death prevented, US$4,383 per discounted life-year saved, at a total net cost of US$74.7 million dollars to the health care system. Key variables influencing the results were, in order of importance, case fatality, vaccine price, vaccine efficacy, serotype prevalence, and annual loss of efficacy. The results are also very sensitive to the discount rate assumed when calculated per life-year saved. Conclusion At prices below US $15 per dose, the cost per life-year saved is estimated to be lower than one GNP per capita and hence highly cost effective by the WHO Commission on Macroeconomics and Health criteria. The cost-effectiveness estimates are highly dependent upon the mortality in the absence of the vaccine, which suggests that the vaccine

  8. Cost-effectiveness of introducing a rotavirus vaccine in developing countries: the case of Mexico.

    Science.gov (United States)

    Valencia-Mendoza, Atanacio; Bertozzi, Stefano M; Gutierrez, Juan-Pablo; Itzler, Robbin

    2008-07-29

    In developing countries rotavirus is the leading cause of severe diarrhoea and diarrhoeal deaths in children under 5. Vaccination could greatly alleviate that burden, but in Mexico as in most low- and middle-income countries the decision to add rotavirus vaccine to the national immunisation program will depend heavily on its cost-effectiveness and affordability. The objective of this study was to assess the cost-effectiveness of including the pentavalent rotavirus vaccine in Mexico's national immunisation program. A cost-effectiveness model was developed from the perspective of the health system, modelling the vaccination of a hypothetical birth cohort of 2 million children monitored from birth through 60 months of age. It compares the cost and disease burden of rotavirus in an unvaccinated cohort of children with one vaccinated as recommended at 2, 4, and 6 months. Including the pentavalent vaccine in the national immunisation program could prevent 71,464 medical visits (59%), 5,040 hospital admissions (66%), and 612 deaths from rotavirus gastroenteritis (70%). At US$10 per dose and a cost of administration of US$13.70 per 3-dose regimen, vaccination would cost US$122,058 per death prevented, US$4,383 per discounted life-year saved, at a total net cost of US$74.7 million dollars to the health care system. Key variables influencing the results were, in order of importance, case fatality, vaccine price, vaccine efficacy, serotype prevalence, and annual loss of efficacy. The results are also very sensitive to the discount rate assumed when calculated per life-year saved. At prices below US $15 per dose, the cost per life-year saved is estimated to be lower than one GNP per capita and hence highly cost effective by the WHO Commission on Macroeconomics and Health criteria. The cost-effectiveness estimates are highly dependent upon the mortality in the absence of the vaccine, which suggests that the vaccine is likely to be significantly more cost-effective among poorer

  9. Cost-effectiveness of introducing a rotavirus vaccine in developing countries: The case of Mexico

    Science.gov (United States)

    Valencia-Mendoza, Atanacio; Bertozzi, Stefano M; Gutierrez, Juan-Pablo; Itzler, Robbin

    2008-01-01

    Background In developing countries rotavirus is the leading cause of severe diarrhoea and diarrhoeal deaths in children under 5. Vaccination could greatly alleviate that burden, but in Mexico as in most low- and middle-income countries the decision to add rotavirus vaccine to the national immunisation program will depend heavily on its cost-effectiveness and affordability. The objective of this study was to assess the cost-effectiveness of including the pentavalent rotavirus vaccine in Mexico's national immunisation program. Methods A cost-effectiveness model was developed from the perspective of the health system, modelling the vaccination of a hypothetical birth cohort of 2 million children monitored from birth through 60 months of age. It compares the cost and disease burden of rotavirus in an unvaccinated cohort of children with one vaccinated as recommended at 2, 4, and 6 months. Results Including the pentavalent vaccine in the national immunisation program could prevent 71,464 medical visits (59%), 5,040 hospital admissions (66%), and 612 deaths from rotavirus gastroenteritis (70%). At US$10 per dose and a cost of administration of US$13.70 per 3-dose regimen, vaccination would cost US$122,058 per death prevented, US$4,383 per discounted life-year saved, at a total net cost of US$74.7 million dollars to the health care system. Key variables influencing the results were, in order of importance, case fatality, vaccine price, vaccine efficacy, serotype prevalence, and annual loss of efficacy. The results are also very sensitive to the discount rate assumed when calculated per life-year saved. Conclusion At prices below US $15 per dose, the cost per life-year saved is estimated to be lower than one GNP per capita and hence highly cost effective by the WHO Commission on Macroeconomics and Health criteria. The cost-effectiveness estimates are highly dependent upon the mortality in the absence of the vaccine, which suggests that the vaccine is likely to be

  10. Data Sharing Report for the Quantification of Removable Activity in Various Surveillance and Maintenance Facilities at the Oak Ridge National Laboratory Oak Ridge TN

    Energy Technology Data Exchange (ETDEWEB)

    King, David A. [Oak Ridge Inst. for Science and Education (ORISE), Oak Ridge, TN (United States)

    2013-12-12

    The U.S. Department of Energy (DOE) Oak Ridge Office of Environmental Management (OR-EM) requested that Oak Ridge Associated Universities (ORAU), working under the Oak Ridge Institute for Science and Education (ORISE) contract, provide technical and independent waste management planning support using American Recovery and Reinvestment Act (ARRA) funds. Specifically, DOE OR-EM requested that ORAU plan and implement a sampling and analysis campaign targeting potential removable radiological contamination that may be transferrable to future personal protective equipment (PPE) and contamination control materials—collectively referred to as PPE throughout the remainder of this report—used in certain URS|CH2M Oak Ridge, LLC (UCOR) Surveillance and Maintenance (S&M) Project facilities at the Oak Ridge National Laboratory (ORNL). Routine surveys in Bldgs. 3001, 3005, 3010, 3028, 3029, 3038, 3042, 3517, 4507, and 7500 continuously generate PPE. The waste is comprised of Tyvek coveralls, gloves, booties, Herculite, and other materials used to prevent worker exposure or the spread of contamination during routine maintenance and monitoring activities. This report describes the effort to collect and quantify removable activity that may be used by the ORNL S&M Project team to develop radiation instrumentation “screening criteria.” Material potentially containing removable activity was collected on smears, including both masselin large-area wipes (LAWs) and standard paper smears, and analyzed for site-related constituents (SRCs) in an analytical laboratory. The screening criteria, if approved, may be used to expedite waste disposition of relatively clean PPE. The ultimate objectives of this effort were to: 1) determine whether screening criteria can be developed for these facilities, and 2) provide process knowledge information for future site planners. The screening criteria, if calculated, must be formally approved by Federal Facility Agreement parties prior to use for

  11. Contribution of job-exposure matrices for exposure assessment in occupational safety and health monitoring systems: application from the French national occupational disease surveillance and prevention network.

    Science.gov (United States)

    Florentin, Arnaud; Zmirou-Navier, Denis; Paris, Christophe

    2017-08-01

    To detect new hazards ("signals"), occupational health monitoring systems mostly rest on the description of exposures in the jobs held and on reports by medical doctors; these are subject to declarative bias. Our study aims to assess whether job-exposure matrices (JEMs) could be useful tools for signal detection by improving exposure reporting. Using the French national occupational disease surveillance and prevention network (RNV3P) data from 2001 to 2011, we explored the associations between disease and exposure prevalence for 3 well-known pathology/exposure couples and for one debatable couple. We compared the associations measured when using physicians' reports or applying the JEMs, respectively, for these selected diseases and across non-selected RNV3P population or for cases with musculoskeletal disorders, used as two reference groups; the ratio of exposure prevalences according to the two sources of information were computed for each disease category. Our population contained 58,188 subjects referred with pathologies related to work. Mean age at diagnosis was 45.8 years (95% CI 45.7; 45.9), and 57.2% were men. For experts, exposure ratios increase with knowledge on exposure causality. As expected, JEMs retrieved more exposed cases than experts (exposure ratios between 12 and 194), except for the couple silica/silicosis, but not for the MSD control group (ratio between 0.2 and 0.8). JEMs enhanced the number of exposures possibly linked with some conditions, compared to experts' assessment, relative to the whole database or to a reference group; they are less likely to suffer from declarative bias than reports by occupational health professionals.

  12. National surveillance study on carbapenem non-susceptible Klebsiella pneumoniae in Taiwan: the emergence and rapid dissemination of KPC-2 carbapenemase.

    Directory of Open Access Journals (Sweden)

    Sheng-Kang Chiu

    Full Text Available OBJECTIVES: The global spread and increasing incidence of carbapenem non-susceptible Klebsiella pneumoniae (CnSKP has made its treatment difficult, increasing the mortality. To establish nationwide data on CnSKP spread and carbapenem-resistance mechanisms, we conducted a national surveillance study in Taiwanese hospitals. METHODS: We collected 100 and 247 CnSKP isolates in 2010 and 2012, respectively. The tests performed included antibiotic susceptibility tests; detection of carbapenemase, extended-spectrum β-lactamases (ESBL, and AmpC β-lactamases genes; outer membrane porin profiles; and genetic relationship with pulsed-field gel electrophoresis and multilocus sequence type. RESULTS: The resistance rate of CnSKP isolates to cefazolin, cefotaxime, cefoxitin, ceftazidime, and ciprofloxacin was over 90%. Susceptibility rate to tigecycline and colistin in 2010 was 91.0% and 83.0%, respectively; in 2012, it was 91.9% and 87.9%, respectively. In 2010, carbapenemase genes were detected in only 6.0% of isolates (4 bla IMP-8 and 2 bla VIM-1. In 2012, carbapenemase genes were detected in 22.3% of isolates (41 bla KPC-2, 7 bla VIM-1, 6 bla IMP-8, and 1 bla NDM-1. More than 95% of isolates exhibited either OmpK35 or OmpK36 porin loss or both. Impermeability due to porin mutation coupled with AmpC β-lactamases or ESBLs were major carbapenem-resistance mechanisms. Among 41 KPC-2-producing K. pneumoniae isolates, all were ST11 with 1 major pulsotype. CONCLUSIONS: In 2010 and 2012, the major mechanisms of CnSKP in Taiwan were the concomitance of AmpC with OmpK35/36 loss. KPC-2-KP dissemination with the same ST11 were observed in 2012. The emergence and rapid spread of KPC-2-KP is becoming an endemic problem in Taiwan. The identification of NDM-1 K. pneumoniae case is alarming.

  13. Implementation of a protocol proposed by the Brazilian National Health Surveillance Agency for antibiotic use in very low birth weight infants.

    Science.gov (United States)

    Pinto, Maria Cristina F Guedes; Bueno, Arnaldo C; Vieira, Alan A

    2013-01-01

    To analyze the implementation of a protocol proposed by the Brazilian National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária - ANVISA) to improve sepsis diagnosis in very low birth weight newborns. This was a prospective study that evaluated the implementation of a protocol involving clinical and laboratory criteria (hematologic scoring system of Rodwell and C-reactive protein serial measurements), recommended by ANVISA, to improve the diagnosis of neonatal sepsis in very low birth weight newborns. The study included all patients who were born and remained in the neonatal intensive care unit until discharge or death, and excluded those with congenital diseases. The main outcomes measured in newborns before (2006-2007) and after implementation of the protocol (2008) were the rates of early and late-onset sepsis, use of antibiotics, and mortality. Means were compared by Student's t-test and categorical variables were compared by the chi-squared test; the significance level for all tests was set at 95%. The study included 136 newborns with very low birth weight. There was no difference between groups regarding general clinical characteristics in the studied periods. There was, however, a decrease in the number of diagnoses of probable early-onset sepsis (p<0.001), use of antimicrobial regimens (p<0.001), and overall mortality and infection-related mortality (p=0.009 and p=0.049, respectively). The implementation of the protocol allowed improvement of sepsis diagnosis by reducing the diagnosis of probable early-onset sepsis, thus promoting efficient antimicrobial use in this population. Copyright © 2013 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  14. Performance and Cost-Effectiveness of Computed Tomography Lung Cancer Screening Scenarios in a Population-Based Setting: A Microsimulation Modeling Analysis in Ontario, Canada

    NARCIS (Netherlands)

    K. ten Haaf (Kevin); M.C. Tammemagi (Martin); Bondy, S.J. (Susan J.); C.M. van der Aalst (Carlijn); Gu, S. (Sumei); McGregor, S.E. (S. Elizabeth); Nicholas, G. (Garth); H.J. de Koning (Harry); L.F. Paszat (Lawrence F.)

    2017-01-01

    textabstractBackground: The National Lung Screening Trial (NLST) results indicate that computed tomography (CT) lung cancer screening for current and former smokers with three annual screens can be cost-effective in a trial setting. However, the cost-effectiveness in a population-based setting with

  15. Systems approaches to animal disease surveillance and resource allocation: methodological frameworks for behavioral analysis.

    Science.gov (United States)

    Rich, Karl M; Denwood, Matthew J; Stott, Alistair W; Mellor, Dominic J; Reid, Stuart W J; Gunn, George J

    2013-01-01

    While demands for animal disease surveillance systems are growing, there has been little applied research that has examined the interactions between resource allocation, cost-effectiveness, and behavioral considerations of actors throughout the livestock supply chain in a surveillance system context. These interactions are important as feedbacks between surveillance decisions and disease evolution may be modulated by their contextual drivers, influencing the cost-effectiveness of a given surveillance system. This paper identifies a number of key behavioral aspects involved in animal health surveillance systems and reviews some novel methodologies for their analysis. A generic framework for analysis is discussed, with exemplar results provided to demonstrate the utility of such an approach in guiding better disease control and surveillance decisions.

  16. Cost-Effectiveness and Quality of Care of a Comprehensive ART Program in Malawi.

    Science.gov (United States)

    Orlando, Stefano; Diamond, Samantha; Palombi, Leonardo; Sundaram, Maaya; Shear Zimmer, Lauren; Marazzi, Maria Cristina; Mancinelli, Sandro; Liotta, Giuseppe

    2016-05-01

    The aim of this study is to assess the cost-effectiveness of a holistic, comprehensive human immunodeficiency virus (HIV) treatment Program in Malawi.Comprehensive cost data for the year 2010 have been collected at 30 facilities from the public network of health centers providing antiretroviral treatment (ART) throughout the country; two of these facilities were operated by the Disease Relief through Excellent and Advanced Means (DREAM) program.The outcomes analysis was carried out over five years comparing two cohorts of patients on treatment: 1) 2387 patients who started ART in the two DREAM centers during 2008, 2) patients who started ART in Malawi in the same year under the Ministry of Health program.Assuming the 2010 cost as constant over the five years the cost-effective analysis was undertaken from a health sector and national perspective; a sensitivity analysis included two hypothesis of ART impact on patients' income.The total cost per patient per year (PPPY) was $314.5 for the DREAM protocol and $188.8 for the other Malawi ART sites, with 737 disability adjusted life years (DALY) saved among the DREAM program patients compared with the others. The Incremental Cost-Effectiveness Ratio was $1640 per DALY saved; it ranged between $896-1268 for national and health sector perspective respectively. The cost per DALY saved remained under $2154 that is the AFR-E-WHO regional gross domestic product per capita threshold for a program to be considered very cost-effective.HIV/acquired immune deficiency syndrome comprehensive treatment program that joins ART with laboratory monitoring, treatment adherence reinforcing and Malnutrition control can be very cost-effective in the sub-Saharan African setting.

  17. Cost-effectiveness of chemotherapy for sputum smear-positive pulmonary tuberculosis in Malawi, Mozambique and Tanzania.

    Science.gov (United States)

    de Jonghe, E; Murray, C J; Chum, H J; Nyangulu, D S; Salomao, A; Styblo, K

    1994-01-01

    The cost-effectiveness of chemotherapy for pulmonary sputum smear-positive tuberculosis was examined in the national tuberculosis control programmes of Malawi, Mozambique and Tanzania. In these three programmes, routine cure rates have exceeded 80 per cent. Average, average incremental and marginal unit costs for standard, short-course and retreatment regimens with and without hospitalization have been measured. The average incremental cost per year of life saved through chemotherapy ranged from US $0.90-3.10. In all conditions, short-course chemotherapy is preferable to standard 12-month chemotherapy. When hospitalization during the intensive phase of chemotherapy increases the cure rate by 10-15 percentage points, it can be relatively cost-effective. Analysing the cost-effectiveness of short-course and standard chemotherapy, where the depth of the margin of benefit is different, illustrates some of the dangers of simplistic use of cost-effectiveness ratios.

  18. Rare disease surveillance: An international perspective

    NARCIS (Netherlands)

    Elliott, E.J.; Nicoll, A.; Lynn, R.; Marchessault, V.; Hirasing, R.A.; Ridley, G.

    2001-01-01

    Background: The International Network of Paediatric Surveillance Units (INoPSU) was established in 1998 and met formally for the first time in Ottawa, Ontario in June 2000. Objectives: To document the methodology and activities of existing national paediatric surveillance units; the formation of

  19. Rare disease surveillance: An international perspective

    NARCIS (Netherlands)

    Elliott, E.J.; Nicoll, A.; Lynn, R.; Marchessault, V.; Hirasing, R.A.; Ridley, G.

    2001-01-01

    Background: The International Network of Paediatric Surveillance Units (INoPSU) was established in 1998 and met formally for the first time in Ottawa, Ontario in June 2000. Objectives: To document the methodology and activities of existing national paediatric surveillance units; the formation of INo

  20. Clinical value, cost-effectiveness, and safety of myocardial perfusion scintigraphy: a position statement

    DEFF Research Database (Denmark)

    Marcassa, C.; Bax, J.J.; Bengel, F.

    2008-01-01

    Mortality rates due to coronary artery disease (CAD) have declined in recent years as result of improved prevention, diagnosis, and management. Nonetheless, CAD remains the leading cause of death worldwide with most casualties expected to occur in developing nations. Myocardial perfusion...... scintigraphy (MPS) provides a highly cost-effective tool for the early detection of obstructive CAD in symptomatic individuals and contributes substantially to stratification of patients according to their risk of cardiac death or nonfatal myocardial infarction. MPS also provides valuable information...

  1. Cost-Effective, Ultra-Sensitive Groundwater Monitoring for Site Remediation and Management

    Science.gov (United States)

    2015-08-01

    research stage, the IS2 is similar in 12 price to other practices and can be expected to improve in cost-effectiveness if brought to market . 13 1.0...M., & Puls, R. W. (1993). Passive sampling of groundwater monitoring wells without purging: multilevel well chemistry and tracer disappearance...sgrp/GWRep10/start.htm. USEPA. (2004). Cleaning Up the Nation’s Waste Sites: Markets and Technology Trends. Washington, DC. Verreydt, G., Bronders

  2. Clinical sentinel surveillance of equine West Nile fever, Spain

    DEFF Research Database (Denmark)

    Saegerman, C.; Alba-Casals, A.; García-Bocanegra, I.;

    2016-01-01

    West Nile fever (WNF) is a viral zoonotic infection caused by a mosquito-borne flavivirus of the Flaviviridae family. According to a comparative study, the passive surveillance of horses by equine veterinarians appeared to be the most cost-effective system in the European context of WNF. Clinical...

  3. The clinical utility and cost effectiveness of routine thyroid screening ...

    African Journals Online (AJOL)

    depression, cognitive impairment, and psychosis, while ... the utility and cost effectiveness of the current protocol used in thyroid testing in adult psychiatric patients presenting at .... Antidepressants were prescribed to 302 (28%) of patients,.

  4. Cost-effectiveness analysis of Mectizan treatment Programmes for ...

    African Journals Online (AJOL)

    Cost-effectiveness analysis of Mectizan treatment Programmes for Onchocerciasis Control: Operational Experiences in two districts of Southwestern Nigeria. ... Vol 8, No 1 (2009) >. Log in or Register to get access to full text downloads.

  5. Exploring cost-effective maize integrated weed management ...

    African Journals Online (AJOL)

    Exploring cost-effective maize integrated weed management approaches under intensive farming systems. ... Log in or Register to get access to full text downloads. ... Kamuliand Iganga districts with one hand-hoe weeding (1hh) as the control.

  6. Improving cost-effectiveness of hypertension management at a ...

    African Journals Online (AJOL)

    Improving cost-effectiveness of hypertension management at a community health centre. ... Log in or Register to get access to full text downloads. ... drugs on prescribing patterns, costs of drug treatment and blood pressure (BP) control. Design ...

  7. Cost-effectiveness of screening for HIV in primary care: a health economics modelling analysis.

    Science.gov (United States)

    Baggaley, Rebecca F; Irvine, Michael A; Leber, Werner; Cambiano, Valentina; Figueroa, Jose; McMullen, Heather; Anderson, Jane; Santos, Andreia C; Terris-Prestholt, Fern; Miners, Alec; Hollingsworth, T Déirdre; Griffiths, Chris J

    2017-07-28

    Early HIV diagnosis reduces morbidity, mortality, the probability of onward transmission, and their associated costs, but might increase cost because of earlier initiation of antiretroviral treatment (ART). We investigated this trade-off by estimating the cost-effectiveness of HIV screening in primary care. We modelled the effect of the four-times higher diagnosis rate observed in the intervention arm of the RHIVA2 randomised controlled trial done in Hackney, London (UK), a borough with high HIV prevalence (≥0·2% adult prevalence). We constructed a dynamic, compartmental model representing incidence of infection and the effect of screening for HIV in general practices in Hackney. We assessed cost-effectiveness of the RHIVA2 trial by fitting model diagnosis rates to the trial data, parameterising with epidemiological and behavioural data from the literature when required, using trial testing costs and projecting future costs of treatment. Over a 40 year time horizon, incremental cost-effectiveness ratios were £22 201 (95% credible interval 12 662-132 452) per quality-adjusted life-year (QALY) gained, £372 207 (268 162-1 903 385) per death averted, and £628 874 (434 902-4 740 724) per HIV transmission averted. Under this model scenario, with UK cost data, RHIVA2 would reach the upper National Institute for Health and Care Excellence cost-effectiveness threshold (about £30 000 per QALY gained) after 33 years. Scenarios using cost data from Canada (which indicate prolonged and even higher health-care costs for patients diagnosed late) suggest this threshold could be reached in as little as 13 years. Screening for HIV in primary care has important public health benefits as well as clinical benefits. We predict it to be cost-effective in the UK in the medium term. However, this intervention might be cost-effective far sooner, and even cost-saving, in settings where long-term health-care costs of late-diagnosed patients in high

  8. Surveillance and Critical Theory

    Directory of Open Access Journals (Sweden)

    Christian Fuchs

    2015-09-01

    Full Text Available In this comment, the author reflects on surveillance from a critical theory approach, his involvement in surveillance research and projects, and the status of the study of surveillance. The comment ascertains a lack of critical thinking about surveillance, questions the existence of something called “surveillance studies” as opposed to a critical theory of society, and reflects on issues such as Edward Snowden’s revelations, and Foucault and Marx in the context of surveillance.

  9. Cost-effectiveness of home visits in the outpatient treatment of patients with alcohol dependence.

    Science.gov (United States)

    Moraes, Edilaine; Campos, Geraldo M; Figlie, Neliana B; Laranjeira, Ronaldo; Ferraz, Marcos B

    2010-01-01

    The purpose of this study was to compare the cost-effectiveness of conventional outpatient treatment for alcoholic patients (CT) with this same conventional treatment plus home visits (HV), a new proposal for intervention within the Brazilian outpatient treatment system. A cost-effectiveness evaluation alongside a 12-week randomized clinical trial was performed. We identified the resources utilized by each intervention, as well as the cost according to National Health System (SUS), Brazilian Medical Association (AMB) tables of fees, and others based on 2005 data. The incremental cost-effectiveness ratio (ICER) was estimated as the main outcome measure - abstinent cases at the end of treatment. There were 51.8% abstinent cases for HV and 43.1% for CT, a clinically relevant finding. Other outcome measures, such as quality of life, also showed significant improvements that favored HV. The baseline scenario presented an ICER of USD 1,852. Sensitivity analysis showed an ICER of USD 689 (scenario favoring HV) and USD 2,334 (scenario favoring CT). The HV treatment was found to be cost-effective according to the WHO Commission on Macroeconomics and Health. 2009 S. Karger AG, Basel.

  10. Cost-effectiveness of skin-barrier-enhancing emollients among preterm infants in Bangladesh

    Science.gov (United States)

    LeFevre, Amnesty; Shillcutt, Samuel D; Saha, Samir K; Ahmed, ASM Nawshad Uddin; Ahmed, Saifuddin; Chowdhury, MAK Azad; Law, Paul A; Black, Robert; Santosham, Mathuram

    2010-01-01

    Abstract Objective To evaluate the cost-effectiveness of topical emollients, sunflower seed oil (SSO) and synthetic Aquaphor, versus no treatment, in preventing mortality among hospitalized preterm infants (effective if they fell below a ceiling ratio based on the per capita gross national income of Bangladesh (United States dollars, US$ 470). Findings Aquaphor and SSO were both highly cost-effective relative to control, reducing neonatal mortality by 26% and 32%, respectively. SSO cost US$ 61 per death averted and US$ 2.15 per YLL averted (I$ 6.39, international dollars, per YLL averted). Aquaphor cost US$ 162 per death averted and US$ 5.74 per YLL averted (I$ 17.09 per YLL averted). Results were robust to sensitivity analysis. Aquaphor was cost-effective relative to SSO with 77% certainty: it cost an incremental US$ 26 more per patient treated, but averted 1.25 YLLs (US$ 20.74 per YLL averted). Conclusion Topical therapy with SSO or Aquaphor was highly cost-effective in reducing deaths from infection among the preterm neonates studied. The choice of emollient should be made taking into account budgetary limitations and ease of supply. Further research is warranted on additional locally available emollients, use of emollients in community-based settings and generalizability to other geographic regions. PMID:20428367

  11. [Cost-effectiveness of an organized breast cancer screening program in Southern Brazil].

    Science.gov (United States)

    Ribeiro, Rodrigo Antonini; Caleffi, Maira; Polanczyk, Carisi Anne

    2013-11-01

    The aim of this study was to evaluate the cost-effectiveness of an organized breast cancer mammographic screening program implemented in Porto Alegre (Núcleo Mama Porto Alegre - NMPOA), Rio Grande do Sul State, Brazil. A Markov model was constructed to estimate the incremental cost-effectiveness ratio of NMPOA compared to current BC diagnosis and care in the Brazilian public health system, in a hypothetical cohort of women aged 40-69 years at risk of developing breast cancer. Model parameters were collected from NMPOA and the national literature. In the NMPOA strategy, effectiveness was modeled taking into account the actual observed screening adherence. Effectiveness was measured in quality-adjusted life years (QALYs). Incremental cost-effectiveness ratio in the base case was R$ 13,426 per QALY. This result was not sensitive to variation in the main model parameters in sensitivity analyses. Considering the threshold usually suggested as highly attractive in Brazil, breast cancer screening as performed in NMPOA is cost-effective in cities with high incidence of breast cancer.

  12. Cost-effective conservation of an endangered frog under uncertainty.

    Science.gov (United States)

    Rose, Lucy E; Heard, Geoffrey W; Chee, Yung En; Wintle, Brendan A

    2016-04-01

    How should managers choose among conservation options when resources are scarce and there is uncertainty regarding the effectiveness of actions? Well-developed tools exist for prioritizing areas for one-time and binary actions (e.g., protect vs. not protect), but methods for prioritizing incremental or ongoing actions (such as habitat creation and maintenance) remain uncommon. We devised an approach that combines metapopulation viability and cost-effectiveness analyses to select among alternative conservation actions while accounting for uncertainty. In our study, cost-effectiveness is the ratio between the benefit of an action and its economic cost, where benefit is the change in metapopulation viability. We applied the approach to the case of the endangered growling grass frog (Litoria raniformis), which is threatened by urban development. We extended a Bayesian model to predict metapopulation viability under 9 urbanization and management scenarios and incorporated the full probability distribution of possible outcomes for each scenario into the cost-effectiveness analysis. This allowed us to discern between cost-effective alternatives that were robust to uncertainty and those with a relatively high risk of failure. We found a relatively high risk of extinction following urbanization if the only action was reservation of core habitat; habitat creation actions performed better than enhancement actions; and cost-effectiveness ranking changed depending on the consideration of uncertainty. Our results suggest that creation and maintenance of wetlands dedicated to L. raniformis is the only cost-effective action likely to result in a sufficiently low risk of extinction. To our knowledge we are the first study to use Bayesian metapopulation viability analysis to explicitly incorporate parametric and demographic uncertainty into a cost-effective evaluation of conservation actions. The approach offers guidance to decision makers aiming to achieve cost-effective

  13. Cost-effectiveness of opportunistic salpingectomy for ovarian cancer prevention.

    Science.gov (United States)

    Dilley, Sarah E; Havrilesky, Laura J; Bakkum-Gamez, Jamie; Cohn, David E; Michael Straughn, J; Caughey, Aaron B; Rodriguez, Maria I

    2017-08-01

    Data suggesting a link between the fallopian tube and ovarian cancer have led to an increase in rates of salpingectomy at the time of pelvic surgery, a practice known as opportunistic salpingectomy (OS). However, the potential benefits, risks and costs for this new practice are not well established. Our objective was to assess the cost-effectiveness of opportunistic salpingectomy at the time of laparoscopic permanent contraception or hysterectomy for benign indications. We created two models to compare the cost-effectiveness of salpingectomy versus usual care. The hypothetical study population is 50,000 women aged 45 undergoing laparoscopic hysterectomy with ovarian preservation for benign indications, and 300,000 women aged 35 undergoing laparoscopic permanent contraception. SEER data were used for probabilities of ovarian cancer cases and deaths. The ovarian cancer risk reduction, complication rates, utilities and associated costs were obtained from published literature. Sensitivity analyses and Monte Carlo simulation were performed, and incremental cost-effectiveness ratios (ICERs) were calculated to determine the cost per quality adjusted life year (QALY) gained. In the laparoscopic hysterectomy cohort, OS is cost saving and would yield $23.9 million in health care dollars saved. In the laparoscopic permanent contraception cohort, OS is cost-effective with an ICER of $31,432/QALY compared to tubal ligation, and remains cost-effective as long as it reduces ovarian cancer risk by 54%. Monte Carlo simulation demonstrated cost-effectiveness with hysterectomy and permanent contraception in 62.3% and 55% of trials, respectively. Opportunistic salpingectomy for low-risk women undergoing pelvic surgery may be a cost-effective strategy for decreasing ovarian cancer risk at time of hysterectomy or permanent contraception. In our model, salpingectomy was cost-effective with both procedures, but the advantage greater at time of hysterectomy. Copyright © 2017. Published by

  14. Cost-effective reductions of PM2.5 concentrations and exposure in Italy

    Science.gov (United States)

    Ciucci, A.; D'Elia, I.; Wagner, F.; Sander, R.; Ciancarella, L.; Zanini, G.; Schöpp, W.

    2016-09-01

    In recent years several European air pollution policies have been based on a cost-effectiveness approach. In the European Union, the European Commission starts using the multi-pollutant, multi-effect GAINS (Greenhouse Gas Air Pollution Interactions and Synergies) model to identify cost-effective National Emission Ceilings and specific emission control measures for each Member State to reach these targets. In this paper, we apply the GAINS methodology to the case of Italy with 20 subnational regions. We present regional results for different approaches to environmental target setting for PM2.5 pollution in the year 2030. We have obtained these results using optimization techniques consistent with those of GAINS-Europe, but at a higher resolution. Our results show that an overall health-impact oriented approach is more cost-effective than setting a nation-wide limit value on ambient air quality, such as the one set for the year 2030 by the European Directive on ambient air quality and cleaner air for Europe. The health-impact oriented approach implies additional emission control costs of 153 million €/yr on top of the baseline costs, compared to 322 million €/yr for attaining the nation-wide air quality limit. We provide insights into the distribution of costs and benefits for regions within Italy and identify the main beneficiaries of a health-impact approach over a limit-value approach.

  15. Colorectal cancer surveillance in inflammatory bowel disease: A critical analysis

    Institute of Scientific and Technical Information of China (English)

    Devendra; Desai; Nutan; Desai

    2014-01-01

    Colonoscopic surveillance is advocated in patients with inflammatory bowel disease(IBD) for detection of dys-plasia. There are many issues regarding surveillance in IBD: the risk of colorectal cancer seems to be de-creasing in the majority of recently published studies, necessitating revisions of surveillance strategy; surveil-lance guidelines are not based on concrete evidence; commencement and frequency of surveillance, cost-effectiveness and adherence to surveillance have been issues that are only partly answered. The traditional technique of random biopsy is neither evidence-based nor easy to practice. Therefore, highlighting abnormal areas with newer technology and biopsy from these areas are the way forward. Of the newer technology, digital mucosal enhancement, such as high-definition white light endoscopy and chromoendoscopy(with magnification) have been incorporated in guidelines. Dyeless chromoendoscopy(narrow band imaging) has not yet shown potential, whereas some forms of digital chromoendoscopy(i-Scan more than Fujinon intelligent color enhancement) have shown promise for colonoscopic surveillance in IBD. Other techniquessuch as autofluorescence imaging, endomicroscopy and endocytoscopy need further evidence. Surveillance with genetic markers(tissue, serum or stool) is at an early stage. This article discusses changing epidemiology of colorectal cancer development in IBD and critically evaluates issues regarding colonoscopic surveillance in IBD.

  16. Towards a standardised surveillance for Trichinella in the European Union.

    Science.gov (United States)

    Alban, L; Pozio, E; Boes, J; Boireau, P; Boué, F; Claes, M; Cook, A J C; Dorny, P; Enemark, H L; van der Giessen, J; Hunt, K R; Howell, M; Kirjusina, M; Nöckler, K; Rossi, P; Smith, G C; Snow, L; Taylor, M A; Theodoropoulos, G; Vallée, I; Viera-Pinto, M M; Zimmer, I A

    2011-05-01

    Each year, more than 167 million pigs in the European Union (EU) are tested for Trichinella spp. under the current meat hygiene regulations. This imposes large economic costs on countries, yet the vast majority of these pigs test negative and the public health risk in many countries is therefore considered very low. This work reviewed the current Trichinella status across the EU as well as the national level of monitoring and reporting. It also reviewed which animal species were affected by Trichinella and in which species it should be surveyed. This information was used to design a cost-effective surveillance programme that enables a standardised monitoring approach within the EU. The proposed surveillance programme relies on identifying sub-populations of animals with a distinct risk. Low-risk pigs are finisher pigs that originate from so-called controlled housing. All other pigs are considered high-risk pigs. Controlled housing is identified by the application of a specific list of management and husbandry practices. We suggest that member states (MS) be categorised into three classes based on the confidence that Trichinella can be considered absent, in the specified sub-population of pigs above a specified design prevalence which we set to 1 per million pigs. A simple and transparent method is proposed to estimate this confidence, based on the sensitivity of the surveillance system, taking into account the sensitivity of testing and the design prevalence. The probability of detecting a positive case, if present, must be high (>95 or >99%) to ensure that there is a low or negligible risk of transmission to humans through the food chain. In MS where the probability of a positive pig is demonstrated to be negligible, testing of fattening pigs from a sub-population consisting of pigs from controlled housing can be considered unnecessary. Furthermore, reduced testing of finishers from the sub-population consisting of pigs from non-controlled housing might even be

  17. Cost-Effectiveness of Chemotherapy for Breast Cancer and Age Effect in Older Women.

    Science.gov (United States)

    Lairson, David R; Parikh, Rohan C; Cormier, Janice N; Chan, Wenyaw; Du, Xianglin L

    2015-12-01

    Previous economic evaluations compared specific chemotherapy agents using input parameters from clinical trials and resource utilization costs. Cost-effectiveness of treatment groups (drug classes) using community-level effectiveness and cost data, however, has not been assessed for elderly patients with breast cancer. To assess the cost-effectiveness of chemotherapy regimens by age and disease stage under "real-world" conditions for patients with breast cancer. The Surveillance Epidemiology and End Results-Medicare data were used to identify patients with breast cancer with American Joint Committee on Cancer stage I/II/IIIa, hormone receptor-negative (estrogen receptor-negative and progesterone receptor-negative) patients from 1992 to 2009. Patients were categorized into three adjuvant treatment groups: 1) no chemotherapy, 2) anthracycline, and 3) non-anthracycline-based chemotherapy. Median life-years and quality-adjusted life-years (QALYs) were measured using Kaplan-Meier analysis and were evaluated against average total health care costs (2013 US dollars). A total of 4575 patients (propensity score-matched) were included for the primary analysis. The anthracycline group experienced 12.05 QALYs and mean total health care costs of $119,055, resulting in an incremental cost-effectiveness ratio of $7,688 per QALY gained as compared with the no chemotherapy group (QALYs 7.81; average health care cost $86,383). The non-anthracycline-based group was dominated by the anthracycline group with lower QALYs (9.56) and higher health care costs ($122,791). Base-case results were found to be consistent with the best-case and worst-case scenarios for utility assignments. Incremental cost-effectiveness ratios varied by age group (range $3,790-$90,405 per QALY gained). Anthracycline-based chemotherapy was found cost-effective for elderly patients with early stage (stage I, II, IIIa) breast cancer considering the US threshold of $100,000 per QALY. Further research may be needed

  18. The Cost-Effectiveness of Treatment Modalities for Ureteral Stones

    Directory of Open Access Journals (Sweden)

    Justin Ji-Yuen Siu MD

    2016-10-01

    Full Text Available Additional intervention and medical treatment of complications may follow the primary treatment of a ureteral stone. We investigated the cost of the treatment of ureteral stone(s within 45 days after initial intervention by means of retrospective analysis of the National Health Insurance Research Database of Taiwan. All patients of ages ≥20 years diagnosed with ureteral stone(s( International Classification of Diseases, Ninth Revision, Clinical Modification/ICD-9-CM: 592.1 from January 2001 to December 2011 were enrolled. We included a comorbidity code only if the diagnosis appeared in at least 2 separate claims in a patient’s record. Treatment modalities (code included extracorporeal shock-wave lithotripsy (SWL; 98.51, ureteroscopic lithotripsy (URSL; 56.31, percutaneous nephrolithotripsy (PNL; 55.04, (open ureterolithotomy (56.20, and laparoscopy (ie, laparoscopic ureterolithotomy; 54.21. There were 28 513 patients with ureteral stones (13 848 men and 14 665 women in the randomized sample of 1 million patients. The mean cost was 526.4 ± 724.1 United States Dollar (USD. The costs of treatment were significantly increased in patients with comorbidities. The costs of treatment among each primary treatment modalities were 1212.2 ± 627.3, 1146.7 ± 816.8, 2507.4 ± 1333.5, 1533.3 ± 1137.1, 2566.4 ± 2594.3, and 209.8 ± 473.2 USD in the SWL, URSL, PNL, (open ureterolithotomy, laparoscopy (laparoscopic ureterolithotomy, and conservative treatment group, respectively. In conclusion, URSL was more cost-effective than SWL and PNL as a primary treatment modality for ureteral stone(s when the possible additional costs within 45 days after the initial operation were included in the calculation.

  19. Cost-effective electric vehicle charging infrastructure siting for Delhi

    Science.gov (United States)

    Sheppard, Colin J. R.; Gopal, Anand R.; Harris, Andrew; Jacobson, Arne

    2016-06-01

    Plug-in electric vehicles (PEVs) represent a substantial opportunity for governments to reduce emissions of both air pollutants and greenhouse gases. The Government of India has set a goal of deploying 6-7 million hybrid and PEVs on Indian roads by the year 2020. The uptake of PEVs will depend on, among other factors like high cost, how effectively range anxiety is mitigated through the deployment of adequate electric vehicle charging stations (EVCS) throughout a region. The Indian Government therefore views EVCS deployment as a central part of their electric mobility mission. The plug-in electric vehicle infrastructure (PEVI) model—an agent-based simulation modeling platform—was used to explore the cost-effective siting of EVCS throughout the National Capital Territory (NCT) of Delhi, India. At 1% penetration in the passenger car fleet, or ˜10 000 battery electric vehicles (BEVs), charging services can be provided to drivers for an investment of 4.4 M (or 440/BEV) by siting 2764 chargers throughout the NCT of Delhi with an emphasis on the more densely populated and frequented regions of the city. The majority of chargers sited by this analysis were low power, Level 1 chargers, which have the added benefit of being simpler to deploy than higher power alternatives. The amount of public infrastructure needed depends on the access that drivers have to EVCS at home, with 83% more charging capacity required to provide the same level of service to a population of drivers without home chargers compared to a scenario with home chargers. Results also depend on the battery capacity of the BEVs adopted, with approximately 60% more charging capacity needed to achieve the same level of service when vehicles are assumed to have 57 km versus 96 km of range.

  20. National Surveillance Study on Carbapenem Non-Susceptible Klebsiella pneumoniae in Taiwan: The Emergence and Rapid Dissemination of KPC-2 Carbapenemase

    Science.gov (United States)

    Chiu, Sheng-Kang; Wu, Tsu-Lan; Chuang, Yin-Ching; Lin, Jung-Chung; Fung, Chang-Phone; Lu, Po-Liang; Wang, Jann-Tay; Wang, Lih-Shinn; Siu, L. Kristopher; Yeh, Kuo-Ming

    2013-01-01

    Objectives The global spread and increasing incidence of carbapenem non-susceptible Klebsiella pneumoniae (CnSKP) has made its treatment difficult, increasing the mortality. To establish nationwide data on CnSKP spread and carbapenem-resistance mechanisms, we conducted a national surveillance study in Taiwanese hospitals. Methods We collected 100 and 247 CnSKP isolates in 2010 and 2012, respectively. The tests performed included antibiotic susceptibility tests; detection of carbapenemase, extended-spectrum β-lactamases (ESBL), and AmpC β-lactamases genes; outer membrane porin profiles; and genetic relationship with pulsed-field gel electrophoresis and multilocus sequence type. Results The resistance rate of CnSKP isolates to cefazolin, cefotaxime, cefoxitin, ceftazidime, and ciprofloxacin was over 90%. Susceptibility rate to tigecycline and colistin in 2010 was 91.0% and 83.0%, respectively; in 2012, it was 91.9% and 87.9%, respectively. In 2010, carbapenemase genes were detected in only 6.0% of isolates (4 blaIMP-8 and 2 blaVIM-1). In 2012, carbapenemase genes were detected in 22.3% of isolates (41 blaKPC-2, 7 blaVIM-1, 6 blaIMP-8, and 1 blaNDM-1). More than 95% of isolates exhibited either OmpK35 or OmpK36 porin loss or both. Impermeability due to porin mutation coupled with AmpC β-lactamases or ESBLs were major carbapenem-resistance mechanisms. Among 41 KPC-2-producing K. pneumoniae isolates, all were ST11 with 1 major pulsotype. Conclusions In 2010 and 2012, the major mechanisms of CnSKP in Taiwan were the concomitance of AmpC with OmpK35/36 loss. KPC-2-KP dissemination with the same ST11 were observed in 2012. The emergence and rapid spread of KPC-2-KP is becoming an endemic problem in Taiwan. The identification of NDM-1 K. pneumoniae case is alarming. PMID:23894478

  1. Future Airportal Surveillance and Prediction Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Recent advances in airport surface surveillance and other sensor, automation, and data sharing technologies now allow the consideration of a significant change in...

  2. Analyses of Blood Bank Efficiency, Cost-Effectiveness and Quality

    Science.gov (United States)

    Lam, Hwai-Tai Chen

    In view of the increasing costs of hospital care, it is essential to investigate methods to improve the labor efficiency and the cost-effectiveness of the hospital technical core in order to control costs while maintaining the quality of care. This study was conducted to develop indices to measure efficiency, cost-effectiveness, and the quality of blood banks; to identify factors associated with efficiency, cost-effectiveness, and quality; and to generate strategies to improve blood bank labor efficiency and cost-effectiveness. Indices developed in this study for labor efficiency and cost-effectiveness were not affected by patient case mix and illness severity. Factors that were associated with labor efficiency were identified as managerial styles, and organizational designs that balance workload and labor resources. Medical directors' managerial involvement was not associated with labor efficiency, but their continuing education and specialty in blood bank were found to reduce the performance of unnecessary tests. Surprisingly, performing unnecessary tests had no association with labor efficiency. This suggested the existence of labor slack in blood banks. Cost -effectiveness was associated with workers' benefits, wages, and the production of high-end transfusion products by hospital-based donor rooms. Quality indices used in this study included autologous transfusion rates, platelet transfusion rates, and the check points available in an error-control system. Because the autologous transfusion rate was related to patient case mix, severity of illness, and possible inappropriate transfusion, it was not recommended to be used for quality index. Platelet-pheresis transfusion rates were associated with the transfusion preferences of the blood bank medical directors. The total number of check points in an error -control system was negatively associated with government ownership and workers' experience. Recommendations for improving labor efficiency and cost-effectiveness

  3. Cost-effectiveness analysis of sandhill crane habitat management

    Science.gov (United States)

    Kessler, Andrew C.; Merchant, James W.; Shultz, Steven D.; Allen, Craig R.

    2013-01-01

    Invasive species often threaten native wildlife populations and strain the budgets of agencies charged with wildlife management. We demonstrate the potential of cost-effectiveness analysis to improve the efficiency and value of efforts to enhance sandhill crane (Grus canadensis) roosting habitat. We focus on the central Platte River in Nebraska (USA), a region of international ecological importance for migrating avian species including sandhill cranes. Cost-effectiveness analysis is a valuation process designed to compare alternative actions based on the cost of achieving a pre-determined objective. We estimated costs for removal of invasive vegetation using geographic information system simulations and calculated benefits as the increase in area of sandhill crane roosting habitat. We generated cost effectiveness values for removing invasive vegetation on 7 land parcels and for the entire central Platte River to compare the cost-effectiveness of management at specific sites and for the central Platte River landscape. Median cost effectiveness values for the 7 land parcels evaluated suggest that costs for creating 1 additional hectare of sandhill crane roosting habitat totaled US $1,595. By contrast, we found that creating an additional hectare of sandhill crane roosting habitat could cost as much as US $12,010 for some areas in the central Platte River, indicating substantial cost savings can be achieved by using a cost effectiveness analysis to target specific land parcels for management. Cost-effectiveness analysis, used in conjunction with geographic information systems, can provide decision-makers with a new tool for identifying the most economically efficient allocation of resources to achieve habitat management goals.

  4. Dengue dynamics and vaccine cost-effectiveness in Brazil.

    Science.gov (United States)

    Durham, David P; Ndeffo Mbah, Martial L; Medlock, Jan; Luz, Paula M; Meyers, Lauren A; Paltiel, A David; Galvani, Alison P

    2013-08-20

    Recent Phase 2b dengue vaccine trials have demonstrated the safety of the vaccine and estimated the vaccine efficacy with further trials underway. In anticipation of vaccine roll-out, cost-effectiveness analysis of potential vaccination policies that quantify the dynamics of disease transmission are fundamental to the optimal allocation of available doses. We developed a dengue transmission and vaccination model and calculated, for a range of vaccination costs and willingness-to-pay thresholds, the level of vaccination coverage necessary to sustain herd-immunity, the price at which vaccination is cost-effective and is cost-saving, and the sensitivity of our results to parameter uncertainty. We compared two vaccine efficacy scenarios, one a more optimistic scenario and another based on the recent lower-than-expected efficacy from the latest clinical trials. We found that herd-immunity may be achieved by vaccinating 82% (95% CI 58-100%) of the population at a vaccine efficacy of 70%. At this efficacy, vaccination may be cost-effective for vaccination costs up to US$ 534 (95% CI $369-1008) per vaccinated individual and cost-saving up to $204 (95% CI $39-678). At the latest clinical trial estimates of an average of 30% vaccine efficacy, vaccination may be cost-effective and cost-saving at costs of up to $237 (95% CI $159-512) and $93 (95% CI $15-368), respectively. Our model provides an assessment of the cost-effectiveness of dengue vaccination in Brazil and incorporates the effect of herd immunity into dengue vaccination cost-effectiveness. Our results demonstrate that at the relatively low vaccine efficacy from the recent Phase 2b dengue vaccine trials, age-targeted vaccination may still be cost-effective provided the total vaccination cost is sufficiently low.

  5. Using Hemospray Improves the Cost-effectiveness Ratio in the Management of Upper Gastrointestinal Nonvariceal Bleeding.

    Science.gov (United States)

    Barkun, Alan N; Adam, Viviane; Lu, Yidan; Chen, Yen-I; Martel, Myriam

    2016-10-04

    We compared the cost-effectiveness of traditional recommended endoscopic hemostatic therapies and Hemospray alone or in combination when treating nonvariceal upper gastrointestinal bleeding (NVUGIB). Hemospray (TC-325) is a novel endoscopic hemostatic powder, achieving hemostasis through adherence to actively bleeding biological surfaces. A decision tree of patients with NVUGIB assessed 4 possible treatment strategies: traditional therapy alone (T), Hemospray alone (H), traditional therapy completed by Hemospray if needed (T+H), or Hemospray completed by traditional therapy if needed (H+T). Using published probabilities, effectiveness was the likelihood of avoiding rebleeding over 30 days. Costs in 2014 US$ were based on the US National Inpatient Sample. A third-party payer perspective was adopted. Sensitivity and subgroup analyses were performed. For all patients, T+H was more efficacious (97% avoiding rebleeding) and less expensive (average cost per patient of US$9150) than all other approaches. The second most cost-effective approach was H+T (5.57% less effective and US$635 more per patient). Sensitivity analyses showed T+H followed by a strategy of H+T remained more cost-effective than H or T alone when varying all probability assumptions across plausible ranges. Subgroup analysis showed that the inclusion of H (especially alone) was least adapted for ulcers and was more cost-effective when treating lesions at low risk of delayed rebleeding. Hemospray improves the effectiveness of traditional hemostasis, being less costly in most NVUGIB patient populations. A Hemospray first approach is most cost-effective for nonulcer bleeding lesions at low risk of delayed hemorrhage.

  6. Cost-effectiveness of sofosbuvir for the treatment of chronic hepatitis C-infected patients.

    Science.gov (United States)

    Cure, S; Guerra, I; Dusheiko, G

    2015-11-01

    The efficacy of treatment for hepatitis C genotype 1 infection has significantly improved with the introduction of first-generation protease inhibitors. However, there remains a need for effective treatments for patients infected with other genotypes, for nonresponders and patients unsuitable for interferon. Sofosbuvir is the first nucleotide polymerase inhibitor with pan-genotypic activity. Sofosbuvir-based regimens have resulted in >90% sustained virological response across treatment-naïve genotype 1-6 patients in five phase III clinical trials of sofosbuvir administered with ribavirin or pegylated interferon and ribavirin. This analysis evaluates the cost-effectiveness of sofosbuvir within the current licensed indication, for genotype 1-6 in the UK. A Markov model followed a cohort of 10 000 patients over lifetime, with approximately 20% initiating treatment for compensated cirrhosis. Sofosbuvir-regimens were compared to telaprevir, boceprevir, pegylated interferon and ribavirin, or no treatment. Costs and outcomes were discounted at 3.5%. The cost perspective utilized costs applicable to the National Health Service in the UK. Sofosbuvir proved to be cost-effective in most patient populations with incremental cost-effectiveness ratios (ICERs) at £11 836/QALY and £7292/QALY against telaprevir and boceprevir, respectively. In genotype 3, sofosbuvir had a weighted ICER of £18 761/QALY. Sofosbuvir-based regimens are a cost-effective option for the majority of hepatitis C-infected patients in the United Kingdom although the incremental cost-effectiveness varies by genotype and regimen. Sofosbuvir and ribavirin is an alternative regimen for patients unsuitable for interferon.

  7. Cost-effectiveness of antibiotics for COPD management: observational analysis using CPRD data

    Directory of Open Access Journals (Sweden)

    Sarah J. Ronaldson

    2017-06-01

    Full Text Available It is often difficult to determine the cause of chronic obstructive pulmonary disease (COPD exacerbations, and antibiotics are frequently prescribed. This study conducted an observational cost-effectiveness analysis of prescribing antibiotics for exacerbations of COPD based on routinely collected data from patient electronic health records. A cohort of 45 375 patients aged 40 years or more who attended their general practice for a COPD exacerbation during 2000–2013 was identified from the Clinical Practice Research Datalink. Two groups were formed (“immediate antibiotics” or “no antibiotics” based on whether antibiotics were prescribed during the index general practice (GP consultation, with data analysed according to subsequent healthcare resource use. A cost-effectiveness analysis was undertaken from the perspective of the UK National Health Service, using a time horizon of 4 weeks in the base case. The use of antibiotics for COPD exacerbations resulted in cost savings and an improvement in all outcomes analysed; i.e. GP visits, hospitalisations, community respiratory team referrals, all referrals, infections and subsequent antibiotics prescriptions were lower for the antibiotics group. Hence, the use of antibiotics was dominant over no antibiotics. The economic analysis suggests that use of antibiotics for COPD exacerbations is a cost-effective alternative to not prescribing antibiotics for patients who present to their GP, and remains cost-effective when longer time horizons of 3 months and 12 months are considered. It would be useful for a definitive trial to be undertaken in this area to determine the cost-effectiveness of antibiotics for COPD exacerbations.

  8. Cost-effective treatment of patients with symptomatic cholelithiasis and possible common bile duct stones.

    Science.gov (United States)

    Brown, Lisa M; Rogers, Stanley J; Cello, John P; Brasel, Karen J; Inadomi, John M

    2011-06-01

    Clinicians must choose a treatment strategy for patients with symptomatic cholelithiasis without knowing whether common bile duct (CBD) stones are present. The purpose of this study was to determine the most cost-effective treatment strategy for patients with symptomatic cholelithiasis and possible CBD stones. Our decision model included 5 treatment strategies: laparoscopic cholecystectomy (LC) alone followed by expectant management; preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by LC; LC with intraoperative cholangiography (IOC) ± common bile duct exploration (CBDE); LC followed by postoperative ERCP; and LC with IOC ± postoperative ERCP. The rates of successful completion of diagnostic testing and therapeutic intervention, test characteristics (sensitivity and specificity), morbidity, and mortality for all procedures are from current literature. Hospitalization costs and lengths of stay are from the 2006 National Centers for Medicare and Medicaid Services data. The probability of CBD stones was varied from 0% to 100% and the most cost-effective strategy was determined at each probability. Across the CBD stone probability range of 4% to 100%, LC with IOC ± ERCP was the most cost-effective. If the probability was 0%, LC alone was the most cost-effective. Our model was sensitive to 1 health input: specificity of IOC, and 3 costs: cost of hospitalization for LC with CBDE, cost of hospitalization for LC without CBDE, and cost of LC with IOC. The most cost-effective treatment strategy for the majority of patients with symptomatic cholelithiasis is LC with routine IOC. If stones are detected, CBDE should be forgone and the patient referred for ERCP. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Cost-effectiveness of HCV screening: a systematic review of the literature from 2007 to 2012

    Directory of Open Access Journals (Sweden)

    Alessandro Camera

    2013-07-01

    Full Text Available Background: currently, 123-170 million people in the world are infected with Hepatitis C Virus (HCV and 75% of them remain undiagnosed. HCV-positive individuals will develop Chronic Hepatitis C (CHC or hepatocellular carcinoma (HCC within 25 years in 20-30% of cases. Early detection of HCV has been demonstrated to increase quality-adjusted life years (QALY and to improve the behaviour of the infected population. Current national policies usually recommend regular screenings only for at-risk populations. A systematic review of the recent evidence on long-term cost-effectiveness of HCV screening in different populations was performed.Methods: resources were searched on publicly available databases (PubMed, ScienceDirect, NHS EED, Cochrane Library and Google®. Studies were considered eligible if published between 2007 and 2012 and if providing measures of incremental cost-effectiveness ratio (ICER or incremental cost utility ratio (ICUR of HCV screening in terms of cost/life years gained (LYG and cost/QALY. All the costs were converted into Euro (€ for 2011. A weighted version of the Drummond checklist was used to further assess the quality of the included studies.Results: six articles were selected and analysed. Three U.S. and one Japanese studies suggested a positive cost-effectiveness profile of broad birth-cohort and population screening. Other studies conducted in Italy and the UK demonstrated high variability in the cost-effectiveness in different study populations. All the studies were judged of medium-high quality.Conclusions: cost-effectiveness of HCV screening significantly varies among countries and study populations. Prevalence in the population should be one of the criteria for policy-makers for future decisions and recommendations. New Direct-Acting Antiviral agents might increase the costeffectiveness of early HCV screening. Future studies should also focus on migrants and men who have sex with men (MSM populations.

  10. Cost Effectiveness of the Earned Income Tax Credit as a Health Policy Investment.

    Science.gov (United States)

    Muennig, Peter A; Mohit, Babak; Wu, Jinjing; Jia, Haomiao; Rosen, Zohn

    2016-12-01

    Lower-income Americans are suffering from declines in income, health, and longevity over time. Income and employment policies have been proposed as a potential non-medical solution to this problem. An interrupted time series analysis of state-level incremental supplements to the Earned Income Tax Credit (EITC) program was performed using data from 1993 to 2010 Behavioral Risk Factor Surveillance System surveys and state-level life expectancy. The cost effectiveness of state EITC supplements was estimated using a microsimulation model, which was run in 2015. Supplemental EITC programs increased health-related quality of life and longevity among the poor. The program costs about $7,786/quality-adjusted life-year gained (95% CI=$4,100, $13,400) for the average recipient. This ratio increases with larger family sizes, costing roughly $14,261 (95% CI=$8,735, $19,716) for a family of three. State supplements to EITC appear to be highly cost effective, but randomized trials are needed to confirm these findings. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  11. Groundwater remediation and the cost effectiveness of phytoremediation.

    Science.gov (United States)

    Compernolle, T; Van Passel, S; Weyens, N; Vangronsveld, J; Lebbe, L; Thewys, T

    2012-10-01

    In 1999, phytoremediation was applied at the site of a Belgian car factory to contain two BTEX plumes. This case study evaluates the cost effectiveness of phytoremediation compared to other remediation options, applying a tailored approach for economic evaluation. Generally, when phytoremediation is addressed as being cost effective, the cost effectiveness is only determined on an average basis. This study however, demonstrates that an incremental analysis may provide a more nuanced conclusion. When the cost effectiveness is calculated on an average basis, in this particular case, the no containment strategy (natural attenuation) has the lowest cost per unit mass removed and hence, should be preferred. However, when the cost effectiveness is determined incrementally, no containment should only be preferred if the value of removing an extra gram of contaminant mass is lower than 320 euros. Otherwise, a permeable reactive barrier should be adopted. A similar analysis is provided for the effect determined on the basis of remediation time. Phytoremediation is preferred compared to 'no containment' if reaching the objective one year earlier is worth 7 000 euros.

  12. Cost-effectiveness and pricing of antibacterial drugs.

    Science.gov (United States)

    Verhoef, Talitha I; Morris, Stephen

    2015-01-01

    Growing resistance to antibacterial agents has increased the need for the development of new drugs to treat bacterial infections. Given increasing pressure on limited health budgets, it is important to study the cost-effectiveness of these drugs, as well as their safety and efficacy, to find out whether or not they provide value for money and should be reimbursed. In this article, we systematically reviewed 38 cost-effectiveness analyses of new antibacterial agents. Most studies showed the new antibacterial drugs were cost-effective compared to older generation drugs. Drug pricing is a complicated process, involving different stakeholders, and has a large influence on cost-effectiveness. Value-based pricing is a method to determine the price of a drug at which it can be cost-effective. It is currently unclear what the influence of value-based pricing will be on the prices of new antibacterial agents, but an important factor will be the definition of 'value', which as well as the impact of the drug on patient health might also include other factors such as wider social impact and the health impact of disease. © 2015 The Authors. Chemical Biology & Drug Design Published by John Wiley & Sons Ltd.

  13. Cost effectiveness of type 2 diabetes screening: A systematic review.

    Science.gov (United States)

    Najafi, Behzad; Farzadfar, Farshad; Ghaderi, Hossein; Hadian, Mohammad

    2016-01-01

    Although studies reported diabetes mellitus screening cost effective, the mass screening for type2 diabetes remains controversial. In this study we reviewed the recently evidence about the cost effectiveness of mass screening systematically. We reviewed the MEDLINE, Scopus, Web of Science (WOS), and Cochrane library databases by MeSH terms to identify relevant studies from 2000 to 2013. We had 4 inclusion and 6 exclusion criteria and used the Drummond's checklist for appraising the quality of studies. The initial search yielded 358 potentially related studies from selected databases. 6 studies met our inclusion and exclusion criteria and included in final review. 3 and 2 of them were conducted in Europe and America and only one of them in Asia. Quality-adjusted life year (QALY) was the main outcome to appraise the effectiveness in the studies. Incremental cost effectiveness ratio (ICER) was computed in range from $516.33 to $126,238 per QALY in the studies. A review of previous diabetes screening cost effectiveness analysis showed that the studies varied in some aspects but reached similar conclusions. They concluded that the screening may be cost effective, however further studies is required to support the diabetes mass screening.

  14. Reviewing the evidence on effectiveness and cost-effectiveness of HIV prevention strategies in Thailand

    Directory of Open Access Journals (Sweden)

    Teerawattananon Yot

    2010-07-01

    Full Text Available Abstract Background Following universal access to antiretroviral therapy in Thailand, evidence from National AIDS Spending Assessment indicates a decreasing proportion of expenditure on prevention interventions. To prompt policymakers to revitalize HIV prevention, this study identifies a comprehensive list of HIV/AIDs preventive interventions that are likely to be effective and cost-effective in Thailand. Methods A systematic review of the national and international literature on HIV prevention strategies from 1997 to 2008 was undertaken. The outcomes used to consider the effectiveness of HIV prevention interventions were changes in HIV risk behaviour and HIV incidence. Economic evaluations that presented their results in terms of cost per HIV infection averted or cost per quality-adjusted life year (QALY gained were also included. All studies were assessed against quality criteria. Results The findings demonstrated that school based-sex education plus life-skill programs, voluntary and routine HIV counselling and testing, male condoms, street outreach programs, needle and syringe programs, programs for the prevention of mother-to-child HIV transmission, male circumcision, screening blood products and donated organs for HIV, and increased alcohol tax were all effective in reducing HIV infection among target populations in a cost-effective manner. Conclusion We found very limited local evidence regarding the effectiveness of HIV interventions amongst specific high risk populations. This underlines the urgent need to prioritise health research resources to assess the effectiveness and cost-effectiveness of HIV interventions aimed at reducing HIV infection among high risk groups in Thailand.

  15. The surveillant assemblage.

    Science.gov (United States)

    Haggerty, K D; Ericson, R V

    2000-12-01

    George Orwell's 'Big Brother' and Michel Foucault's 'panopticon' have dominated discussion of contemporary developments in surveillance. While such metaphors draw our attention to important attributes of surveillance, they also miss some recent dynamics in its operation. The work of Gilles Deleuze and Felix Guattari is used to analyse the convergence of once discrete surveillance systems. The resultant 'surveillant assemblage' operates by abstracting human bodies from their territorial settings, and separating them into a series of discrete flows. These flows are then reassembled in different locations as discrete and virtual 'data doubles'. The surveillant assemblage transforms the purposes of surveillance and the hierarchies of surveillance, as well as the institution of privacy.

  16. A Cost-Effectiveness Analysis of the First Federally Funded Antismoking Campaign

    Science.gov (United States)

    Xu, Xin; Alexander, Robert L.; Simpson, Sean A.; Goates, Scott; Nonnemaker, James M.; Davis, Kevin C.; McAfee, Tim

    2015-01-01

    Background In 2012, CDC launched the first federally funded national mass media antismoking campaign. The Tips From Former Smokers (Tips) campaign resulted in a 12% relative increase in population-level quit attempts. Purpose Cost-effectiveness analysis was conducted in 2013 to evaluate Tips from a funding agency’s perspective. Methods Estimates of sustained cessations; premature deaths averted; undiscounted life years (LYs) saved; and quality-adjusted life years (QALYs) gained by Tips were estimated. Results Tips saved about 179,099 QALYs and prevented 17,109 premature deaths in the U.S. With the campaign cost of roughly $48 million, Tips spent approximately $480 per quitter, $2,819 per premature death averted, $393 per LY saved, and $268 per QALY gained. Conclusions Tips was not only successful at reducing smoking-attributable morbidity and mortality but also was a highly cost-effective mass media intervention. PMID:25498550

  17. 2011年全国碘缺乏病病情监测结果分析%National iodine deficiency disorders: an analysis of surveillance data in 2011

    Institute of Scientific and Technical Information of China (English)

    刘鹏; 苏晓辉; 申红梅; 孟凡刚; 范丽珺; 刘守军; 孙殿军

    2015-01-01

    MUI at 100-199 μg/L,more than adequate is MUI at 200-299 μg/L,and excessive is MUI equal to or greater than 300 μg/L;salt iodine:definition of qualified iodized salt is (35-± 15) mg/kg; non-iodized salt (GB 5461-2000) is iodine less than 5 mg/kg; definition of unqualified iodized salt is iodine between 5-< 20 mg/kg or higher than 50 mg/kg.The total population of the sixth national census was used for statistical data correction.Results Among 31 provinces and Corps,children's goiter rate was 2.4%,which was obviously lower than the IDD elimination standard at the national level (< 5%); the national iodized salt coverage rate was 98.0% and the consumption rate of qualified iodized salt was 95.3%,both figures had achieved the national standard (the iodized salt coverage should be greater than 95% and the consumption rate of qualified iodized salt greater than 90%).The median of salt iodine was at 30.2 mg/kg; the MUI of children,pregnant women and lactating women was 238.6,184.4 and 174.4 μg/L,respectively.Urinary iodine of children was higher than adequate level,of both pregnant women and lactating women were at adequate level.The surveillance results of water iodine in 25 provinces revealed that the median was at 5.6 μg/L; the salt intake surveillance results among students' households in 24 provinces and the Corps revealed that the daily intake was 10.1 g per person a day.Conclusions National IDD prevention and control strategy integrated with universal salt iodization as a key measure has achieved remarkable impacts.IDD has been eliminated at the national level.%目的 了解全国碘缺乏病防治工作现状,评估我国31个省份及新疆生产建设兵团(简称兵团)持续消除碘缺乏病进展.方法 2011年,在我国的31个省份及兵团按人口比例概率抽样法进行抽样,每个省份及兵团各抽取30个抽样单位.在除外水碘含量> 150 μg/L的乡镇后,采用单纯随机抽样方法,从上

  18. Nosocomial urinary tract infection in the intensive care unit: when should Pseudomonas aeruginosa be suspected? Experience of the French national surveillance of nosocomial infections in the intensive care unit, Rea-Raisin.

    Science.gov (United States)

    Venier, A-G; Lavigne, T; Jarno, P; L'heriteau, F; Coignard, B; Savey, A; Rogues, A-M

    2012-01-01

    Individual and ward risk factors for P. aeruginosa-induced urinary tract infection in the case of nosocomial urinary tract infection in the intensive care unit were determined with hierarchical (multilevel) logistic regression. The 2004-2006 prospective French national intensive care unit nosocomial infection surveillance dataset was used and 3252 patients with urinary tract infection were included; 16% were infected by P. aeruginosa. Individual risk factors were male sex, duration of stay, antibiotics at admission and transfer from another intensive care unit. Ward risk factors were patient turnover and incidence of P. aeruginosa-infected patients.

  19. The Cost Effectiveness of Psychological and Pharmacological Interventions for Social Anxiety Disorder: A Model-Based Economic Analysis.

    Directory of Open Access Journals (Sweden)

    Ifigeneia Mavranezouli

    Full Text Available Social anxiety disorder is one of the most persistent and common anxiety disorders. Individually delivered psychological therapies are the most effective treatment options for adults with social anxiety disorder, but they are associated with high intervention costs. Therefore, the objective of this study was to assess the relative cost effectiveness of a variety of psychological and pharmacological interventions for adults with social anxiety disorder.A decision-analytic model was constructed to compare costs and quality adjusted life years (QALYs of 28 interventions for social anxiety disorder from the perspective of the British National Health Service and personal social services. Efficacy data were derived from a systematic review and network meta-analysis. Other model input parameters were based on published literature and national sources, supplemented by expert opinion.Individual cognitive therapy was the most cost-effective intervention for adults with social anxiety disorder, followed by generic individual cognitive behavioural therapy (CBT, phenelzine and book-based self-help without support. Other drugs, group-based psychological interventions and other individually delivered psychological interventions were less cost-effective. Results were influenced by limited evidence suggesting superiority of psychological interventions over drugs in retaining long-term effects. The analysis did not take into account side effects of drugs.Various forms of individually delivered CBT appear to be the most cost-effective options for the treatment of adults with social anxiety disorder. Consideration of side effects of drugs would only strengthen this conclusion, as it would improve even further the cost effectiveness of individually delivered CBT relative to phenelzine, which was the next most cost-effective option, due to the serious side effects associated with phenelzine. Further research needs to determine more accurately the long

  20. The Cost Effectiveness of Psychological and Pharmacological Interventions for Social Anxiety Disorder: A Model-Based Economic Analysis

    Science.gov (United States)

    Mavranezouli, Ifigeneia; Mayo-Wilson, Evan; Dias, Sofia; Kew, Kayleigh; Clark, David M.; Ades, A. E.; Pilling, Stephen

    2015-01-01

    Background Social anxiety disorder is one of the most persistent and common anxiety disorders. Individually delivered psychological therapies are the most effective treatment options for adults with social anxiety disorder, but they are associated with high intervention costs. Therefore, the objective of this study was to assess the relative cost effectiveness of a variety of psychological and pharmacological interventions for adults with social anxiety disorder. Methods A decision-analytic model was constructed to compare costs and quality adjusted life years (QALYs) of 28 interventions for social anxiety disorder from the perspective of the British National Health Service and personal social services. Efficacy data were derived from a systematic review and network meta-analysis. Other model input parameters were based on published literature and national sources, supplemented by expert opinion. Results Individual cognitive therapy was the most cost-effective intervention for adults with social anxiety disorder, followed by generic individual cognitive behavioural therapy (CBT), phenelzine and book-based self-help without support. Other drugs, group-based psychological interventions and other individually delivered psychological interventions were less cost-effective. Results were influenced by limited evidence suggesting superiority of psychological interventions over drugs in retaining long-term effects. The analysis did not take into account side effects of drugs. Conclusion Various forms of individually delivered CBT appear to be the most cost-effective options for the treatment of adults with social anxiety disorder. Consideration of side effects of drugs would only strengthen this conclusion, as it would improve even further the cost effectiveness of individually delivered CBT relative to phenelzine, which was the next most cost-effective option, due to the serious side effects associated with phenelzine. Further research needs to determine more accurately

  1. Cost-effectiveness of Intensive Blood Pressure Management

    DEFF Research Database (Denmark)

    Richman, Ilana B; Fairley, Michael; Jørgensen, Mads Emil

    2016-01-01

    . Objective: To evaluate the incremental cost-effectiveness of intensive blood pressure management compared with standard management. Design, Setting, and Participants: This cost-effectiveness analysis conducted from September 2015 to August 2016 used a Markov cohort model to estimate cost-effectiveness...... of intensive blood pressure management among 68-year-old high-risk adults with hypertension but not diabetes. We used the Systolic Blood Pressure Intervention Trial (SPRINT) to estimate treatment effects and adverse event rates. We used Centers for Disease Control and Prevention Life Tables to project age....... Interventions: Treatment of hypertension to a systolic blood pressure goal of 120 mm Hg (intensive management) or 140 mm Hg (standard management). Main Outcomes and Measures: Lifetime costs and quality-adjusted life-years (QALYs), discounted at 3% annually. Results: Standard management yielded 9.6 QALYs...

  2. A Layered Decision Model for Cost-Effective System Security

    Energy Technology Data Exchange (ETDEWEB)

    Wei, Huaqiang; Alves-Foss, James; Soule, Terry; Pforsich, Hugh; Zhang, Du; Frincke, Deborah A.

    2008-10-01

    System security involves decisions in at least three areas: identification of well-defined security policies, selection of cost-effective defence strategies, and implementation of real-time defence tactics. Although choices made in each of these areas affect the others, existing decision models typically handle these three decision areas in isolation. There is no comprehensive tool that can integrate them to provide a single efficient model for safeguarding a network. In addition, there is no clear way to determine which particular combinations of defence decisions result in cost-effective solutions. To address these problems, this paper introduces a Layered Decision Model (LDM) for use in deciding how to address defence decisions based on their cost-effectiveness. To validate the LDM and illustrate how it is used, we used simulation to test model rationality and applied the LDM to the design of system security for an e-commercial business case.

  3. Bayesian cost-effectiveness analysis with the R package BCEA

    CERN Document Server

    Baio, Gianluca; Heath, Anna

    2017-01-01

    The book provides a description of the process of health economic evaluation and modelling for cost-effectiveness analysis, particularly from the perspective of a Bayesian statistical approach. Some relevant theory and introductory concepts are presented using practical examples and two running case studies. The book also describes in detail how to perform health economic evaluations using the R package BCEA (Bayesian Cost-Effectiveness Analysis). BCEA can be used to post-process the results of a Bayesian cost-effectiveness model and perform advanced analyses producing standardised and highly customisable outputs. It presents all the features of the package, including its many functions and their practical application, as well as its user-friendly web interface. The book is a valuable resource for statisticians and practitioners working in the field of health economics wanting to simplify and standardise their workflow, for example in the preparation of dossiers in support of marketing authorisation, or acade...

  4. Cost effectiveness and efficiency in assistive technology service delivery.

    Science.gov (United States)

    Warren, C G

    1993-01-01

    In order to develop and maintain a viable service delivery program, the realities of cost effectiveness and cost efficiency in providing assistive technology must be addressed. Cost effectiveness relates to value of the outcome compared to the expenditures. Cost efficiency analyzes how a provider uses available resources to supply goods and services. This paper describes how basic business principles of benefit/cost analysis can be used to determine cost effectiveness. In addition, basic accounting principles are used to illustrate methods of evaluating a program's cost efficiency. Service providers are encouraged to measure their own program's effectiveness and efficiency (and potential viability) in light of current trends. This paper is meant to serve as a catalyst for continued dialogue on this topic.

  5. The cost-effectiveness of a school-based overweight program

    Directory of Open Access Journals (Sweden)

    Hoelscher Deanna M

    2007-10-01

    Full Text Available Abstract Background This study assesses the net benefit and the cost-effectiveness of the Coordinated Approach to Child Health (CATCH intervention program, using parameter estimates from the El Paso trial. There were two standard economic measures used. First, from a societal perspective on costs, cost-effectiveness ratios (CER were estimated, revealing the intervention costs per quality-adjusted life years (QALYs saved. QALY weights were estimated using National Health Interview Survey (NHIS data. Second, the net benefit (NB of CATCH was estimated, which compared the present value of averted future costs with the cost of the CATCH intervention. Using National Health and Nutrition Examination Survey I (NHANES and NHANES follow-up data, we predicted the number of adult obesity cases avoided for ages 40–64 with a lifetime obesity progression model. Results The results show that CATCH is cost-effective and net beneficial. The CER was US$900 (US$903 using Hispanic parameters and the NB was US$68,125 (US$43,239 using Hispanic parameters, all in 2004 dollars. This is much lower than the benchmark for CER of US$30,000 and higher than the NB of US$0. Both were robust to sensitivity analyses. Conclusion Childhood school-based programs such as CATCH are beneficial investments. Both NB and CER declined when Hispanic parameters were included, primarily due to the lower wages earned by Hispanics. However, both NB and CER for Hispanics were well within standard cost-effectiveness and net benefit thresholds.

  6. Cost-effectiveness analysis of computer-based assessment

    Directory of Open Access Journals (Sweden)

    Pauline Loewenberger

    2003-12-01

    Full Text Available The need for more cost-effective and pedagogically acceptable combinations of teaching and learning methods to sustain increasing student numbers means that the use of innovative methods, using technology, is accelerating. There is an expectation that economies of scale might provide greater cost-effectiveness whilst also enhancing student learning. The difficulties and complexities of these expectations are considered in this paper, which explores the challenges faced by those wishing to evaluate the costeffectiveness of computer-based assessment (CBA. The paper outlines the outcomes of a survey which attempted to gather information about the costs and benefits of CBA.

  7. Cost Effectiveness Analysis of Optimal Malaria Control Strategies in Kenya

    Directory of Open Access Journals (Sweden)

    Gabriel Otieno

    2016-03-01

    Full Text Available Malaria remains a leading cause of mortality and morbidity among the children under five and pregnant women in sub-Saharan Africa, but it is preventable and controllable provided current recommended interventions are properly implemented. Better utilization of malaria intervention strategies will ensure the gain for the value for money and producing health improvements in the most cost effective way. The purpose of the value for money drive is to develop a better understanding (and better articulation of costs and results so that more informed, evidence-based choices could be made. Cost effectiveness analysis is carried out to inform decision makers on how to determine where to allocate resources for malaria interventions. This study carries out cost effective analysis of one or all possible combinations of the optimal malaria control strategies (Insecticide Treated Bednets—ITNs, Treatment, Indoor Residual Spray—IRS and Intermittent Preventive Treatment for Pregnant Women—IPTp for the four different transmission settings in order to assess the extent to which the intervention strategies are beneficial and cost effective. For the four different transmission settings in Kenya the optimal solution for the 15 strategies and their associated effectiveness are computed. Cost-effective analysis using Incremental Cost Effectiveness Ratio (ICER was done after ranking the strategies in order of the increasing effectiveness (total infections averted. The findings shows that for the endemic regions the combination of ITNs, IRS, and IPTp was the most cost-effective of all the combined strategies developed in this study for malaria disease control and prevention; for the epidemic prone areas is the combination of the treatment and IRS; for seasonal areas is the use of ITNs plus treatment; and for the low risk areas is the use of treatment only. Malaria transmission in Kenya can be minimized through tailor-made intervention strategies for malaria control

  8. Privacy Enforcement in a Cost-Effective Smart Grid

    DEFF Research Database (Denmark)

    Mikkelsen, Søren Aagaard

    In this technical report we present the current state of the research conducted during the first part of the PhD period. The PhD thesis “Privacy Enforcement in a Cost-Effective Smart Grid” focuses on ensuring privacy when generating market for energy service providers that develop web services...... and privacy challenges that emerge when designing a system architecture and infrastructure. The resulting architecture is a consumer-centric and agent-based design and uses open Internet-based communication protocols for enabling interoperability while being cost-effective. Finally, the PhD report present...

  9. Surveillance and Maintenance Plan for the ORNL Decontamination and Decommissioning Program FY 1993--2002

    Energy Technology Data Exchange (ETDEWEB)

    Ford, M.K.; Holder, L. Jr.

    1992-07-01

    The Decontamination and Decommissioning (D&D) Program at the Oak Ridge National Laboratory (ORNL) is part of the Department of Energy (DOE) Environmental Restoration D&D program. The purpose and objectivesof this program include: (1) surveillance and maintenance (S&M) of facilities awaiting decommissioning; (2) planning for the orderly decommissioning of these facilities; and (3) implementation of a program to accomplish facility disposition in a safe, cost-effective, and timely manner. Participating D&D contractors are required to prepare formal plans that document the S&M programs established for each site. This report has been prepared to provide this documentation for those facilities included in the ORNL D&D Program.

  10. AIDS-case surveillance.

    Science.gov (United States)

    Lal, S; Khodakevich, L; Sengupta, D

    1994-01-01

    In 1991 in India, the Ministry of Health realized that the diagnostic and reporting network for AIDS cases was inadequate as AIDS cases grew and that the establishment of specialized AIDS units in hospitals was not the best strategy. It decided to integrate AIDS diagnostic and management facilities into primary health services. It would arrange training for 1 physician from each district and peripheral hospital, private hospital, and inpatient service of other medical institutions in AIDS diagnosis and management. These physicians would then train others in the clinical diagnosis and management of AIDS cases. The physicians would use the World Health Organization [WHO] case definition of AIDS supported by HIV serological test results. All AIDS cases would be transferred to the Medical College Hospitals of the States and Union Territories (UTs), regional hospitals, and perhaps some private hospitals. Between May 1986 and October 1993, India had 459 AIDS cases reported from 19 States and UTs, especially the States of Tamil Nadul and Maharashtra. This AIDS case surveillance system should motivate political will, describe the underlying and preceding HIV epidemic, and contribute to the understanding of current and future course of the epidemic. Thus, it will guide decision makers to develop sound preventive strategies, to plan health care, and to evaluate interventions. The surveillance system's target population is all outpatients and inpatients at medical institutions. During 1993-1994, 1000 hospitals should make up the network of referral institutions. AIDS case surveillance coordinators (ASCs) at each institution form the basis of the network. The individual case record of each suspected AIDS case will have details on his/her life and medical history. Records of confirmed cases will be sent to State ASCs who will compile them for the National AIDS Control Organisation. After 3-4 year of training and practice in AIDS diagnosis and reporting, AIDS reporting will be

  11. Cost/effectiveness analysis of atorvastatin in patients with acute coronary syndromes

    Directory of Open Access Journals (Sweden)

    Simona Cammarota

    2010-06-01

    Full Text Available Introduction: recent clinical trials found that high-dose statin therapy, compared with conventional-dose statin therapy, reduces the risk of cardiovascular events in patients with acute coronary syndromes (ACS and stable coronary artery disease (CAD. With the introduction of simvastatin and pravastatin generics and the next patent expiration of atorvastatin, projected for 2011 in Italy, it is natural to ask: what is the most cost-effective treatment for a rational use of resources?Aim: the aim of this study was to estimate the cost-effectiveness of high-dose atorvastatin versus conventional standard-dose statins based on the scenario of atovastatin price evolution.Methods: a cost-effectiveness analysis was conducted in the perspective of the Italian National Health Service over the 4.9 years time horizon. Clinical data were obtained from a pooled analyses of the 3 clinical trials that directly compared high-dose atorvastatin with conventional standard-dose statins in patients with either ACS or CAD. Hospitalizations were quantified based on the Italian National Health Service tariffs and drug costs according to the Italian National Therapeutic Formulary (2009. Assuming the cost of atorvastatin reduces in line with that observed for simvastatin when the patent expires, 3 scenarios were constructed: atorvastatin current price (scenario 1; 55% price discount (scenario 2; 65% price discount (scenario 3. Effects were measured in terms of primary composite endpoint (coronary death or any adverse cardiovascular event. All costs were discounted at 3% per annum. Sensitivity analyses were performed to assess the robustness of findings. Results: intensive therapy with atorvastatin provided a hospitalization cost saving of 245,519.36 € per 1,000 patients. Under the assumptions established for scenario 1 and scenario 2, the incremental cost-effectiveness of treatment with atorvastatin 80 mg was estimated to be 20,289.72 € and 917.05 € for patient free

  12. Cost-Effectiveness Analysis of Family Planning Services Offered by ...

    African Journals Online (AJOL)

    USER

    Keywords: Mobile clinics; Staic clinic; Family planning; Cost-effectiveness. Résumé ... revealed surprisingly low use of mobile clinic services ... provider point of view. Cost data ..... this is an even more attractive strategy than tying free IUDs to ...

  13. Cost-effectiveness of hepatitis a vaccination in indonesia

    NARCIS (Netherlands)

    Suwantika, A.A.; Beutels, P.; Postma, M.J.

    2014-01-01

    Objectives: This study aims to assess the cost-effectiveness of hepatitis A vaccination in Indonesia, including an explicit comparison between one-dose and twodose vaccines. Methods: An age-structured cohort model based on a decision tree was developed for the 2012 Indonesia birth cohort. Using the

  14. Cost-effectiveness of hepatitis A vaccination in Indonesia

    NARCIS (Netherlands)

    Suwantika, Auliya A.; Beutels, Philippe; Postma, Maarten J.

    2014-01-01

    Objective: This study aims to assess the cost-effectiveness of hepatitis A immunization in Indonesia, including an explicit comparison between one-dose and two-dose vaccines. Methods: An age-structured cohort model based on a decision tree was developed for the 2012 Indonesia birth cohort. Using the

  15. Cost-effectiveness of varenicline for smoking cessation

    DEFF Research Database (Denmark)

    Keiding, Hans

    2009-01-01

    Smoking cessation therapies are among the most cost-effective preventive healthcare measures. Varenicline is a relatively new drug developed especially for this purpose, and it has been shown to achieve better quit rates than nicotine replacement therapies and the non-nicotine-based drug, bupropion...

  16. The Cost Effectiveness of Hepatitis Immunization for US College Students

    Science.gov (United States)

    Jacobs, R. Jake; Saab, Sammy; Meyerhoff, Allen S.

    2003-01-01

    Hepatitis B immunization is recommended for all American children, and hepatitis A immunization is recommended for children who live in areas with elevated disease rates. Because hepatitis A and B occur most commonly in young adults, the authors examined the cost effectiveness of college-based vaccination. They developed epidemiologic models to…

  17. Cost-effectiveness of private umbilical cord blood banking.

    Science.gov (United States)

    Kaimal, Anjali J; Smith, Catherine C; Laros, Russell K; Caughey, Aaron B; Cheng, Yvonne W

    2009-10-01

    To investigate the cost-effectiveness of private umbilical cord blood banking. A decision-analytic model was designed comparing private umbilical cord blood banking with no umbilical cord blood banking. Baseline assumptions included a cost of $3,620 for umbilical cord blood banking and storage for 20 years, a 0.04% chance of requiring an autologous stem cell transplant, a 0.07% chance of a sibling requiring an allogenic stem cell transplant, and a 50% reduction in risk of graft-versus-host disease if a sibling uses banked umbilical cord blood. Private cord blood banking is not cost-effective because it cost an additional $1,374,246 per life-year gained. In sensitivity analysis, if the cost of umbilical cord blood banking is less than $262 or the likelihood of a child needing a stem cell transplant is greater than 1 in 110, private umbilical cord blood banking becomes cost-effective. Currently, private umbilical cord blood banking is cost-effective only for children with a very high likelihood of needing a stem cell transplant. Patients considering private blood banking should be informed of the remote likelihood that a unit will be used for a child or another family member. III.

  18. Methods for analyzing cost effectiveness data from cluster randomized trials

    Directory of Open Access Journals (Sweden)

    Clark Allan

    2007-09-01

    Full Text Available Abstract Background Measurement of individuals' costs and outcomes in randomized trials allows uncertainty about cost effectiveness to be quantified. Uncertainty is expressed as probabilities that an intervention is cost effective, and confidence intervals of incremental cost effectiveness ratios. Randomizing clusters instead of individuals tends to increase uncertainty but such data are often analysed incorrectly in published studies. Methods We used data from a cluster randomized trial to demonstrate five appropriate analytic methods: 1 joint modeling of costs and effects with two-stage non-parametric bootstrap sampling of clusters then individuals, 2 joint modeling of costs and effects with Bayesian hierarchical models and 3 linear regression of net benefits at different willingness to pay levels using a least squares regression with Huber-White robust adjustment of errors, b a least squares hierarchical model and c a Bayesian hierarchical model. Results All five methods produced similar results, with greater uncertainty than if cluster randomization was not accounted for. Conclusion Cost effectiveness analyses alongside cluster randomized trials need to account for study design. Several theoretically coherent methods can be implemented with common statistical software.

  19. Flipping the Calculus Classroom: A Cost-Effective Approach

    Science.gov (United States)

    Young, Andrea

    2015-01-01

    This article discusses a cost-effective approach to flipping the calculus classroom. In particular, the emphasis is on low-cost choices, both monetarily and with regards to faculty time, that make the daunting task of flipping a course manageable for a single instructor. Student feedback and overall impressions are also presented.

  20. Flipping the Calculus Classroom: A Cost-Effective Approach

    Science.gov (United States)

    Young, Andrea

    2015-01-01

    This article discusses a cost-effective approach to flipping the calculus classroom. In particular, the emphasis is on low-cost choices, both monetarily and with regards to faculty time, that make the daunting task of flipping a course manageable for a single instructor. Student feedback and overall impressions are also presented.

  1. Systemic cost-effectiveness analysis of food hazard reduction

    DEFF Research Database (Denmark)

    Jensen, Jørgen Dejgård; Lawson, Lartey Godwin; Lund, Mogens

    2015-01-01

    stage are considered. Cost analyses are conducted for different risk reduction targets and for three alternative scenarios concerning the acceptable range of interventions. Results demonstrate that using a system-wide policy approach to risk reduction can be more cost-effective than a policy focusing...

  2. Cost-effectiveness of colorectal cancer screening - An overview

    NARCIS (Netherlands)

    I. Lansdorp-Vogelaar (Iris); A.B. Knudsen (Amy); H. Brenner (Hermann)

    2010-01-01

    textabstractThere are several modalities available for a colorectal cancer (CRC) screening program. When determining which CRC screening program to implement, the costs of such programs should be considered in comparison to the health benefits they are expected to provide. Cost-effectiveness analysi

  3. Is population screening for abdominal aortic aneurysm cost-effective?

    Directory of Open Access Journals (Sweden)

    Jensen Lotte

    2008-11-01

    Full Text Available Abstract Background Ruptured abdominal aortic aneurysm (AAA is responsible for 1–2% of all male deaths over the age of 65 years. Early detection of AAA and elective surgery can reduce the mortality risk associated with AAA. However, many patients will not be diagnosed with AAA and have therefore an increased death risk due to the untreated AAA. It has been suggested that population screening for AAA in elderly males is effective and cost-effective. The purpose of this study was to perform a systematic review of published cost-effectiveness analyses of screening elderly men for AAA. Methods We performed a systematic search for economic evaluations in NHSEED, EconLit, Medline, Cochrane, Embase, Cinahl and two Scandinavian HTA data bases (DACEHTA and SBU. All identified studies were read in full and each study was systematically assessed according to international guidelines for critical assessment of economic evaluations in health care. Results The search identified 16 cost-effectiveness studies. Most studies considered only short term cost consequences. The studies seemed to employ a number of "optimistic" assumptions in favour of AAA screening, and included only few sensitivity analyses that assessed less optimistic assumptions. Conclusion Further analyses of cost-effectiveness of AAA screening are recommended.

  4. Cost-effectiveness modelling in diagnostic imaging: a stepwise approach

    NARCIS (Netherlands)

    Sailer, A.M.; Zwam, W.H. van; Wildberger, J.E.; Grutters, J.P.C.

    2015-01-01

    Diagnostic imaging (DI) is the fastest growing sector in medical expenditures and takes a central role in medical decision-making. The increasing number of various and new imaging technologies induces a growing demand for cost-effectiveness analysis (CEA) in imaging technology assessment. In this ar

  5. Cost-Effective School Alarm Systems. Security Topics Series.

    Science.gov (United States)

    Kaufer, Steve

    This document outlines considerations in the selection of a cost-effective school-alarm system. Steps in the planning process include: conducting a district needs assessment; gathering input from all staff levels; consulting technical expertise; and selecting a security system that can be integrated with other site needs. It further describes the…

  6. Cost-effectiveness of periconceptional supplementation of folic acid

    NARCIS (Netherlands)

    Postma, MJ; Londeman, J; Veenstra, M; de Walle, HEK; de Jong-van den Berg, LTW

    2002-01-01

    Background: Supplementation of folic acid prior to and in the beginning of pregnancy may prevent neural tube defects (NTDs) in newborns - such as spina bifida - and possibly other congenital malformations. Objective. To estimate cost effectiveness of periconceptional supplementation of folk: acid us

  7. Cost-effective utilisation of basic biochemical laboratory ...

    African Journals Online (AJOL)

    Cost-effective use of laboratory investigations is vital in primary care. Tahir Pillay, MB ChB, ... He is passionate about strengthening the role of the generalist in healthcare in South Africa. Correspondence to: .... Laboratories can bill for this extra ...

  8. Cost-Effectiveness Affirmative Reading Skills Program, 1984-85.

    Science.gov (United States)

    Gallagher, Michael P.

    The 1984-85 cost-effects study represents the third annual analysis of the components of Cleveland's Affirmative Reading Skills Plan, which offers three instructional strands--developmental (regular reading/language arts), support (additional enrichment, corrective or remedial), and compensatory (instruction for students having reading scores in…

  9. Priority Setting, Cost-Effectiveness, and the Affordable Care Act.

    Science.gov (United States)

    Persad, Govind

    2015-01-01

    The Affordable Care Act (ACA) may be the most important health law statute in American history, yet much of the most prominent legal scholarship examining it has focused on the merits of the court challenges it has faced rather than delving into the details of its priority-setting provisions. In addition to providing an overview of the ACA's provisions concerning priority setting and their developing interpretations, this Article attempts to defend three substantive propositions. First, I argue that the ACA is neither uniformly hostile nor uniformly friendly to efforts to set priorities in ways that promote cost and quality. Second, I argue that the ACA does not take a single, unified approach to priority setting; rather, its guidance varies depending on the aspect of the healthcare system at issue (Patient Centered Outcomes Research Institute, Medicare, essential health benefits) and the factors being excluded from priority setting (age, disability, life expectancy). Third, I argue that cost-effectiveness can be achieved within the ACA's constraints, but that doing so will require adopting new approaches to cost-effectiveness and priority setting. By limiting the use of standard cost-effectiveness analysis, the ACA makes the need for workable rivals to cost-effectiveness analysis a pressing practical concern rather than a mere theoretical worry.

  10. Cost Effectiveness of Current Awareness Sources in the Pharmaceutical Industry

    Science.gov (United States)

    Ashmole, R. F.; And Others

    1973-01-01

    The cost effectiveness of several commercial data bases, journal scanning by information scientists, and the impact of private communication are compared in this study. A previously developed technique for measuring the usefulness of commercial data bases is utilized. (21 references) (Author/KE)

  11. Final report: Compiled MPI. Cost-Effective Exascale Application Development

    Energy Technology Data Exchange (ETDEWEB)

    Gropp, William Douglas [Univ. of Illinois, Urbana-Champaign, IL (United States)

    2015-12-21

    This is the final report on Compiled MPI: Cost-Effective Exascale Application Development, and summarizes the results under this project. The project investigated runtime enviroments that improve the performance of MPI (Message-Passing Interface) programs; work at Illinois in the last period of this project looked at optimizing data access optimizations expressed with MPI datatypes.

  12. [Cost-effectiveness analysis of professional oral hygiene].

    Science.gov (United States)

    Olesov, E E; Shaĭmieva, N I; Kononenko, V I; Bersanov, R U; Monakova, N E

    2014-01-01

    Periodontal status and oral hygiene indexes were studied in 125 young employee of Kurchatov Institute. Oral hygiene values dynamic was assessed after professional oral hygiene in persons with unsatisfactory oral hygiene at baseline examination. When compared with the same values in the absence of professional oral hygiene procedures the results allowed calculating cost-effectiveness rate for biannual professional oral hygiene.

  13. Cost-effectiveness of PET and PET/Computed Tomography

    DEFF Research Database (Denmark)

    Gerke, Oke; Hermansson, Ronnie; Hess, Søren

    2015-01-01

    measure by means of incremental cost-effectiveness ratios when considering the replacement of the standard regimen by a new diagnostic procedure. This article discusses economic assessments of PET and PET/computed tomography reported until mid-July 2014. Forty-seven studies on cancer and noncancer...

  14. Cost Effectiveness of Infant Vaccination for Rotavirus in Canada

    Directory of Open Access Journals (Sweden)

    Doug Coyle

    2012-01-01

    Full Text Available INTRODUCTION: Rotavirus is the main cause of gastroenteritis in Canadian children younger than five years of age, resulting in significant morbidity and cost. The present study provides evidence on the cost effectiveness of two alternative rotavirus vaccinations (RotaTeq [Merck Frosst Canada Ltd, Canada] and Rotarix [GlaxoSmithKline, Canada] available in Canada.

  15. Cost-effectiveness of pharmacological and psychosocial interventions for schizophrenia

    Directory of Open Access Journals (Sweden)

    Vos Theo

    2011-05-01

    Full Text Available Abstract Background Information on cost-effectiveness of interventions to treat schizophrenia can assist health policy decision making, particularly given the lack of health resources in developing countries like Thailand. This study aims to determine the optimal treatment package, including drug and non-drug interventions, for schizophrenia in Thailand. Methods A Markov model was used to evaluate the cost-effectiveness of typical antipsychotics, generic risperidone, olanzapine, clozapine and family interventions. Health outcomes were measured in disability adjusted life years. We evaluated intervention benefit by estimating a change in disease severity, taking into account potential side effects. Intervention costs included outpatient treatment costs, hospitalization costs as well as time and travel costs of patients and families. Uncertainty was evaluated using Monte Carlo simulation. A sensitivity analysis of the expected range cost of generic risperidone was undertaken. Results Generic risperidone is more cost-effective than typicals if it can be produced for less than 10 baht per 2 mg tablet. Risperidone was the cheapest treatment with higher drug costs offset by lower hospital costs in comparison to typicals. The most cost-effective combination of treatments was a combination of risperidone (dominant intervention. Adding family intervention has an incremental cost-effectiveness ratio of 1,900 baht/DALY with a 100% probability of a result less than a threshold for very cost-effective interventions of one times GDP or 110,000 baht per DALY. Treating the most severe one third of patients with clozapine instead of risperidone had an incremental cost-effectiveness ratio of 320,000 baht/DALY with just over 50% probability of a result below three times GDP per capita. Conclusions There are good economic arguments to recommend generic risperidone as first line treatment in combination with family intervention. As the uncertainty interval indicates

  16. Costs and cost-effectiveness of delivering intermittent preventive treatment through schools in western Kenya

    Directory of Open Access Journals (Sweden)

    Jukes Matthew CH

    2008-09-01

    Full Text Available Abstract Background Awareness of the potential impact of malaria among school-age children has stimulated investigation into malaria interventions that can be delivered through schools. However, little evidence is available on the costs and cost-effectiveness of intervention options. This paper evaluates the costs and cost-effectiveness of intermittent preventive treatment (IPT as delivered by teachers in schools in western Kenya. Methods Information on actual drug and non-drug associated costs were collected from expenditure and salary records, government budgets and interviews with key district and national officials. Effectiveness data were derived from a cluster-randomised-controlled trial of IPT where a single dose of sulphadoxine-pyrimethamine and three daily doses of amodiaquine were provided three times in year (once termly. Both financial and economic costs were estimated from a provider perspective, and effectiveness was estimated in terms of anaemia cases averted. A sensitivity analysis was conducted to assess the impact of key assumptions on estimated cost-effectiveness. Results The delivery of IPT by teachers was estimated to cost US$ 1.88 per child treated per year, with drug and teacher training costs constituting the largest cost components. Set-up costs accounted for 13.2% of overall costs (equivalent to US$ 0.25 per child whilst recurrent costs accounted for 86.8% (US$ 1.63 per child per year. The estimated cost per anaemia case averted was US$ 29.84 and the cost per case of Plasmodium falciparum parasitaemia averted was US$ 5.36, respectively. The cost per case of anaemia averted ranged between US$ 24.60 and 40.32 when the prices of antimalarial drugs and delivery costs were varied. Cost-effectiveness was most influenced by effectiveness of IPT and the background prevalence of anaemia. In settings where 30% and 50% of schoolchildren were anaemic, cost-effectiveness ratios were US$ 12.53 and 7.52, respectively. Conclusion This

  17. Toward More Efficient Surveillance of Barrett's Esophagus: Identification and Exclusion of Patients at Low Risk of Cancer.

    Science.gov (United States)

    Lindblad, Mats; Bright, Tim; Schloithe, Ann; Mayne, George C; Chen, Gang; Bull, Jeff; Bampton, Peter A; Fraser, Robert J L; Gatenby, Piers A; Gordon, Louisa G; Watson, David I

    2017-04-01

    Endoscopic surveillance of Barrett's esophagus (BE) is probably not cost-effective. A sub-population with BE at increased risk of high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) who could be targeted for cost-effective surveillance was sought. The outcome for BE surveillance from 2003 to 2012 in a structured program was reviewed. Incidence rates and incidence rate ratios for developing HGD or EAC were calculated. Risk stratification identified individuals who could be considered for exclusion from surveillance. A health-state transition Markov cohort model evaluated the cost-effectiveness of focusing on higher-risk individuals. During 2067 person-years of follow-up of 640 patients, 17 individuals progressed to HGD or EAC (annual IR 0.8%). Individuals with columnar-lined esophagus (CLE) ≥2 cm had an annual IR of 1.2% and >8-fold increased relative risk of HGD or EAC, compared to CLE surveillance cohort after the first endoscopy to individuals with CLE ≥2 cm, or dysplasia, followed by a further restriction after the second endoscopy-exclusion of patients without intestinal metaplasia-removed 296 (46%) patients, and 767 (37%) person-years from surveillance. Limiting surveillance to the remaining individuals reduced the incremental cost-effectiveness ratio from US$60,858 to US$33,807 per quality-adjusted life year (QALY). Further restrictions were tested but failed to improve cost-effectiveness. Based on stratification of risk, the number of patients requiring surveillance can be reduced by at least a third. At a willingness-to-pay threshold of US$50,000 per QALY, surveillance of higher-risk individuals becomes cost-effective.

  18. Microbiological Food Safety Surveillance in China

    Directory of Open Access Journals (Sweden)

    Xiaoyan Pei

    2015-08-01

    Full Text Available Microbiological food safety surveillance is a system that collects data regarding food contamination by foodborne pathogens, parasites, viruses, and other harmful microbiological factors. It helps to understand the spectrum of food safety, timely detect food safety hazards, and provide relevant data for food safety supervision, risk assessment, and standards-setting. The study discusses the microbiological surveillance of food safety in China, and introduces the policies and history of the national microbiological surveillance system. In addition, the function and duties of different organizations and institutions are provided in this work, as well as the generation and content of the surveillance plan, quality control, database, and achievement of the microbiological surveillance of food safety in China.

  19. Microbiological Food Safety Surveillance in China.

    Science.gov (United States)

    Pei, Xiaoyan; Li, Ning; Guo, Yunchang; Liu, Xiumei; Yan, Lin; Li, Ying; Yang, Shuran; Hu, Jing; Zhu, Jianghui; Yang, Dajin

    2015-08-28

    Microbiological food safety surveillance is a system that collects data regarding food contamination by foodborne pathogens, parasites, viruses, and other harmful microbiological factors. It helps to understand the spectrum of food safety, timely detect food safety hazards, and provide relevant data for food safety supervision, risk assessment, and standards-setting. The study discusses the microbiological surveillance of food safety in China, and introduces the policies and history of the national microbiological surveillance system. In addition, the function and duties of different organizations and institutions are provided in this work, as well as the generation and content of the surveillance plan, quality control, database, and achievement of the microbiological surveillance of food safety in China.

  20. Evaluating the cost-effectiveness of cancer patient navigation programs: conceptual and practical issues.

    Science.gov (United States)

    Ramsey, Scott; Whitley, Elizabeth; Mears, Victoria Warren; McKoy, June M; Everhart, Rachel M; Caswell, Robert J; Fiscella, Kevin; Hurd, Thelma C; Battaglia, Tracy; Mandelblatt, Jeanne

    2009-12-01

    Patient navigators-individuals who assist patients through the healthcare system to improve access to and understanding of their health and healthcare-are increasingly used for underserved individuals at risk for or with cancer. Navigation programs can improve access, but it is unclear whether they improve the efficiency and efficacy of cancer diagnostic and therapeutic services at a reasonable cost, such that they would be considered cost-effective. In the current study, the authors outline a conceptual model for evaluating the cost-effectiveness of cancer navigation programs. They describe how this model is being applied to the Patient Navigation Research Program, a multicenter study supported by the National Cancer Institute's Center to Reduce Cancer Health Disparities. The Patient Navigation Research Program is testing navigation interventions that aim to reduce time to delivery of quality cancer care (noncancer resolution or cancer diagnosis and treatment) after identification of a screening abnormality. Examples of challenges to evaluating cost-effectiveness of navigation programs include the heterogeneity of navigation programs, the sometimes distant relation between navigation programs and outcome of interest (eg, improving access to prompt diagnostic resolution and life-years gained), and accounting for factors in underserved populations that may influence both access to services and outcomes. In this article, the authors discuss several strategies for addressing these barriers. Evaluating the costs and impact of navigation will require some novel methods, but will be critical in recommendations concerning dissemination of navigation programs.

  1. [Haute Autorite de sante opinion on cost-effectiveness of health products : results and perspectives].

    Science.gov (United States)

    Midy, Fabienne; Raimond, Véronique; Thébaut, Clémence; Sambuc, Cléa; Rumeau-Pichon, Catherine

    2015-01-01

    Since 3rd October 2013 in France, drug companies applying for reimbursement of an innovative and expensive drug or medical device are required to provide the French National Authority for Health (HAS) with a cost-effectiveness assessment of their product. After a methodological audit of the economic evaluation submitted by the drug company, the Health Economics and Public Health Committee (CEESP) issues an opinion on the expected or observed cost-effectiveness. This opinion is sent to the Pricing Committee (CEPS) which determines the price of the product. After summarizing the French reimburse'!lent and pricing system, the objective of this article is to review the first 22 months of activity, in which HAS issued 30 cost-effectiveness opinions. The process, based on exchanges between drug companies and HAS, allowed the pricing committee to document the economic criterion in the majority of applications, while characterizing the degree of uncertainty of the results. For ten applications, major methodological concerns led the CEESP to reject the drug company's assessment.

  2. Cost-effectiveness model for a specific mixture of prebiotics in The Netherlands.

    Science.gov (United States)

    Lenoir-Wijnkoop, I; van Aalderen, W M C; Boehm, G; Klaassen, D; Sprikkelman, A B; Nuijten, M J C

    2012-02-01

    The objective of this study was to assess the cost-effectiveness of the use of prebiotics for the primary prevention of atopic dermatitis in The Netherlands. A model was constructed using decision analytical techniques. The model was developed to estimate the health economic impact of prebiotic preventive disease management of atopic dermatitis. Data sources used include published literature, clinical trials and official price/tariff lists and national population statistics. The comparator was no supplementation with prebiotics. The primary perspective for conducting the economic evaluation was based on the situation in The Netherlands in 2009. The results show that the use of prebiotics infant formula (IMMUNOFORTIS(®)) leads to an additional cost of € 51 and an increase in Quality Adjusted Life Years (QALY) of 0.108, when compared with no prebiotics. Consequently, the use of infant formula with a specific mixture of prebiotics results in an incremental cost-effectiveness ratio (ICER) of € 472. The sensitivity analyses show that the ICER remains in all analyses far below the threshold of € 20,000/QALY. This study shows that the favourable health benefit of the use of a specific mixture of prebiotics results in positive short- and long-term health economic benefits. In addition, this study demonstrates that the use of infant formula with a specific mixture of prebiotics is a highly cost-effective way of preventing atopic dermatitis in The Netherlands.

  3. Cyclosporine versus tacrolimus: cost-effectiveness analysis for renal transplantation in Brazil

    Science.gov (United States)

    Guerra, Augusto Afonso; Silva, Grazielle Dias; Andrade, Eli Iola Gurgel; Cherchiglia, Mariângela Leal; Costa, Juliana de Oliveira; Almeida, Alessandra Maciel; Acurcio, Francisco de Assis

    2015-01-01

    OBJECTIVE To analyze the cost-effectiveness of treatment regimens with cyclosporine or tacrolimus, five years after renal transplantation. METHODS This cost-effectiveness analysis was based on historical cohort data obtained between 2000 and 2004 and involved 2,022 patients treated with cyclosporine or tacrolimus, matched 1:1 for gender, age, and type and year of transplantation. Graft survival and the direct costs of medical care obtained from the National Health System (SUS) databases were used as outcome results. RESULTS Most of the patients were women, with a mean age of 36.6 years. The most frequent diagnosis of chronic renal failure was glomerulonephritis/nephritis (27.7%). In five years, the tacrolimus group had an average life expectancy gain of 3.96 years at an annual cost of R$78,360.57 compared with the cyclosporine group with a gain of 4.05 years and an annual cost of R$61,350.44. CONCLUSIONS After matching, the study indicated better survival of patients treated with regimens using tacrolimus. However, regimens containing cyclosporine were more cost-effective. PMID:25741648

  4. Cyclosporine versus tacrolimus: cost-effectiveness analysis for renal transplantation in Brazil.

    Science.gov (United States)

    Guerra Júnior, Augusto Afonso; Silva, Grazielle Dias; Andrade, Eli Iola Gurgel; Cherchiglia, Mariângela Leal; Costa, Juliana de Oliveira; Almeida, Alessandra Maciel; Acurcio, Francisco de Assis

    2015-01-01

    OBJECTIVE To analyze the cost-effectiveness of treatment regimens with cyclosporine or tacrolimus, five years after renal transplantation. METHODS This cost-effectiveness analysis was based on historical cohort data obtained between 2000 and 2004 and involved 2,022 patients treated with cyclosporine or tacrolimus, matched 1:1 for gender, age, and type and year of transplantation. Graft survival and the direct costs of medical care obtained from the National Health System (SUS) databases were used as outcome results. RESULTS Most of the patients were women, with a mean age of 36.6 years. The most frequent diagnosis of chronic renal failure was glomerulonephritis/nephritis (27.7%). In five years, the tacrolimus group had an average life expectancy gain of 3.96 years at an annual cost of R$78,360.57 compared with the cyclosporine group with a gain of 4.05 years and an annual cost of R$61,350.44. CONCLUSIONS After matching, the study indicated better survival of patients treated with regimens using tacrolimus. Moreover, regimens containing cyclosporine were more cost-effective [corrected].

  5. Cost-effectiveness of the Health X Project for tuberculosis control in China.

    Science.gov (United States)

    Wang, W-B; Zhang, H; Petzold, M; Zhao, Q; Xu, B; Zhao, G-M

    2014-08-01

    Between 2002 and 2008, China's National Tuberculosis Control Programme created the Health X Project, financed in part by a World Bank loan, with additional funding from the UK Department for International Development. To assess the cost-effectiveness of the Project and its impact from a financial point of view on tuberculosis (TB) control in China. A decision-analytic model was used to evaluate the cost-effectiveness of the Project. Sensitivity analysis was used to assess the impact of different scenarios and assumptions on results. The primary outcome of the study was cost per disability-adjusted life-year (DALY) saved and incremental DALYs saved. In comparison with alternative scenario 1, the Project detected 1.6 million additional cases, 44 000 deaths were prevented and a total of 18.4 million DALYs saved. The Project strategies cost approximately Chinese yuan (CNY) 953 per DALY saved (vs. CNY1140 in the control areas), and saved an estimated CNY17.5 billion in comparison with the unchanged alternative scenario (scenario 1) or CNY10.8 billion with the control scenario (scenario 2). The Project strategies were affordable and of comparable cost-effectiveness to those of other developing countries. The results also provide strong support for the existing policy of scaling up DOTS in China.

  6. Cost-effectiveness of available treatment options for patients suffering from severe COPD in the UK: a fully incremental analysis

    Directory of Open Access Journals (Sweden)

    Hertel N

    2012-03-01

    Full Text Available Nadine Hertel1, Robert W Kotchie1, Yevgeniy Samyshkin1, Matthew Radford1, Samantha Humphreys2, Kevin Jameson21IMS Consulting Group, London, UK; 2MSD Ltd, Hoddesdon, UKPurpose: Frequent exacerbations which are both costly and potentially life-threatening are a major concern to patients with chronic obstructive pulmonary disease (COPD, despite the availability of several treatment options. This study aimed to assess the lifetime costs and outcomes associated with alternative treatment regimens for patients with severe COPD in the UK setting.Patients and methods: A Markov cohort model was developed to predict lifetime costs, outcomes, and cost-effectiveness of various combinations of a long-acting muscarinic antagonist (LAMA, a long-acting beta agonist (LABA, an inhaled corticosteroid (ICS, and roflumilast in a fully incremental analysis. Patients willing and able to take ICS, and those refusing or intolerant to ICS were analyzed separately. Efficacy was expressed as relative rate ratios of COPD exacerbation associated with alternative treatment regimens, taken from a mixed treatment comparison. The analysis was conducted from the UK National Health Service (NHS perspective. Parameter uncertainty was explored using one-way and probabilistic sensitivity analysis.Results: Based on the results of the fully incremental analysis a cost-effectiveness frontier was determined, indicating those treatment regimens which represent the most cost-effective use of NHS resources. For ICS-tolerant patients the cost-effectiveness frontier suggested LAMA as initial treatment. Where patients continue to exacerbate and additional therapy is required, LAMA + LABA/ICS can be a cost-effective option, followed by LAMA + LABA/ICS + roflumilast (incremental cost-effectiveness ratio [ICER] versus LAMA + LABA/ICS: £16,566 per quality-adjusted life-year [QALY] gained. The ICER in ICS-intolerant patients, comparing LAMA + LABA + roflumilast versus LAMA + LABA, was £13

  7. [Cost-effectiveness and affordability of strategy for preventing mother-to-child transmission of hepatitis B in China].

    Science.gov (United States)

    Lin, Y; Zhang, S X; Yang, P C; Cai, Y L; Zou, Y H

    2017-07-10

    Objective: To evaluate the cost effectiveness of nationwide prevention of mother to child transmission (PMTCT) strategy for hepatitis B, and estimate the willing to pay and budget impacts on the PMTCT. Methods: The decision analytic Markov model for the PMTCT was constructed and a birth cohort of Chinese infants born in 2013 was used to calculate the cost-effectiveness of the PMTCT among them compared with those receiving no intervention. The parameters in the model were obtained from literatures of national surveys or Meta-analysis. The costs, cases of HBV-related diseases and quality-adjusted life-years (QALYs) were obtained from the societal and payer perspectives, respectively. The incremental cost-effectiveness ratio (ICER) was used as measures of strategy optimization. One-way and probability sensitivity analysis were performed to explore the uncertainty of the primary results. In addition, cost-effectiveness acceptability curve and cost-effectiveness affordability curves were drawn to illustrate the cost effectiveness threshold and financial budget of the PMTCT strategy. Results: The lifetime cost for PMTCT strategy was 4 063.5 yuan (RMB) per carrier, which was 37 829.7 yuan (RMB) lower compared with those receiving no intervention. Due to the strategy, a total of 24.516 1 QALYs per person would be gained, which was higher than that in those receiving no intervention. From societal perspective, the ICER was -59 136.6 yuan (RMB) per additional QALYs gained, indicating that the PMTCT is cost effective. The results were reliable indicated by one-way, multi-way and probability sensitivity analyses. By the CEAC, the willing to pay was much lower than the cost-effectiveness threshold. From the affordability curve of the PMTCT strategy, the annual budget ranged from 590.4 million yuan (RMB) to 688.8 million yuan (RMB), which was lower than the financial ability. Based on the results of cost-effectiveness affordability curves, the higher annual budget was determined

  8. HIV surveillance systems in the Asia Pacific region

    Directory of Open Access Journals (Sweden)

    Bob Verbruggen

    2012-09-01

    Full Text Available In 2011, the United Nations Joint Programme on HIV/AIDS (UNAIDS Regional Support Team for Asia-Pacific conducted a stock-taking process of available strategic information in the Asia Pacific region. This paper summarizes the progress of HIV surveillance for 20 countries in the region, covering population size estimates of key populations at higher risk, HIV case reporting, HIV sentinel surveillance and probability surveys of behavioural and biological markers. Information on surveillance activities was obtained from publically available surveillance reports and protocols, supplemented by personal communication with the UNAIDS monitoring and evaluation advisers and surveillance experts in country. Key findings include substantial efforts in broadening the number and types of HIV surveillance components included in national HIV surveillance systems and adopting approaches to make surveillance more cost-efficient, such as integrating routine programme monitoring data and passive surveillance case reporting systems. More investment in regularly analysing and applying surveillance data to programme strengthening at the subnational level is needed but will require additional capacity-building and resources. The ability to triangulate multiple sources of surveillance data into a more comprehensive view of the HIV epidemic will be enhanced if more investment is made in better documentation and dissemination of surveillance activities and findings.

  9. Assessing the cost-effectiveness of new pharmaceuticals in epilepsy in adults: the results of a probabilistic decision model.

    Science.gov (United States)

    Hawkins, Neil; Epstein, David; Drummond, Michael; Wilby, Jennifer; Kainth, Anita; Chadwick, David; Sculpher, Mark

    2005-01-01

    Epilepsy currently affects more than 400,000 people in the United Kingdom and 2.3 million in the United States. Drug therapy is the mainstay of treatment for patients with epilepsy, but therapies vary widely in their mechanism of action and acquisition cost. This article describes a decision model developed for the National Institute for Clinical Excellence in the United Kingdom. It compares the long-term cost-effectiveness of drugs licensed in adults for use in 3 situations: monotherapy for newly diagnosed patients, monotherapy for refractory patients, and combination therapy for refractory patients. The analysis separately considers the treatment of partial and generalized seizures. The full range of pharmaceutical therapies feasibly used in the UK health system was included in the analysis. The analysis showed that, on the basis of existing evidence, for newly diagnosed patients with partial seizures, carbamazepine and valproate are likely to be the most cost-effective mono-therapies. Carbamazepine is likely to be the most cost-effective 2nd-line monotherapy for refractory patients, and oxcarbazepine would probably be the most cost-effective adjunctive therapy for refractory patients if the willingness to pay for additional health benefits is greater than 18,000 pounds per quality-adjusted life year (QALY). For patients with generalized seizures, valproate is most likely to be cost-effective for newly diagnosed patients. For refractory patients, adjunctive topiramate is more cost-effective than monotherapy alone if the willingness to pay for additional health benefits is greater than 35,000 pounds per QALY. There is, however, considerable uncertainty regarding these results. Some of the methodological features of the study will be of value in designing cost-effectiveness analyses of other therapies for chronic conditions. These include the methods used to deal with the absence of head-to-head trial data and the need to reflect time dependency in Markov

  10. Cost-effectiveness of drug-eluting stents versus bare-metal stents in patients undergoing percutaneous coronary intervention

    Science.gov (United States)

    Baschet, Louise; Bourguignon, Sandrine; Marque, Sébastien; Durand-Zaleski, Isabelle; Teiger, Emmanuel; Wilquin, Fanny; Levesque, Karine

    2016-01-01

    Objective To determine the cost-effectiveness of drug-eluting stents (DES) compared with bare-metal stents (BMS) in patients requiring a percutaneous coronary intervention in France, using a recent meta-analysis including second-generation DES. Methods A cost-effectiveness analysis was performed in the French National Health Insurance setting. Effectiveness settings were taken from a meta-analysis of 117 762 patient-years with 76 randomised trials. The main effectiveness criterion was major cardiac event-free survival. Effectiveness and costs were modelled over a 5-year horizon using a three-state Markov model. Incremental cost-effectiveness ratios and a cost-effectiveness acceptability curve were calculated for a range of thresholds for willingness to pay per year without major cardiac event gain. Deterministic and probabilistic sensitivity analyses were performed. Results Base case results demonstrated that DES are dominant over BMS, with an increase in event-free survival and a cost-reduction of €184, primarily due to a diminution of second revascularisations, and an absence of myocardial infarction and stent thrombosis. These results are robust for uncertainty on one-way deterministic and probabilistic sensitivity analyses. Using a cost-effectiveness threshold of €7000 per major cardiac event-free year gained, DES has a >95% probability of being cost-effective versus BMS. Conclusions Following DES price decrease, new-generation DES development and taking into account recent meta-analyses results, the DES can now be considered cost-effective regardless of selective indication in France, according to European recommendations. PMID:27621830

  11. The cost-effectiveness of increasing alcohol taxes: a modelling study

    Directory of Open Access Journals (Sweden)

    de Wit G

    2008-11-01

    Full Text Available Abstract Background Excessive alcohol use increases risks of chronic diseases such as coronary heart disease and several types of cancer, with associated losses of quality of life and life-years. Alcohol taxes can be considered as a public health instrument as they are known to be able to decrease alcohol consumption. In this paper, we estimate the cost-effectiveness of an alcohol tax increase for the entire Dutch population from a health-care perspective focusing on health benefits and health-care costs in alcohol users. Methods The chronic disease model of the National Institute for Public Health and the Environment was used to extrapolate from decreased alcohol consumption due to tax increases to effects on health-care costs, life-years gained and quality-adjusted life-years gained, A Dutch scenario in which tax increases for beer are planned, and a Swedish scenario representing one of the highest alcohol taxes in Europe, were compared with current practice in the Netherlands. To estimate cost-effectiveness ratios, yearly differences in model outcomes between intervention and current practice scenarios were discounted and added over the time horizon of 100 years to find net present values for incremental life-years gained, quality-adjusted life-years gained, and health-care costs. Results In the Swedish scenario, many more quality-adjusted life-years were gained than in the Dutch scenario, but both scenarios had almost equal incremental cost-effectiveness ratios: €5100 per quality-adjusted life-year and €5300 per quality-adjusted life-year, respectively. Conclusion Focusing on health-care costs and health consequences for drinkers, an alcohol tax increase is a cost-effective policy instrument.

  12. Cost effectiveness of epidural steroid injections to manage chronic lower back pain.

    Science.gov (United States)

    Whynes, David K; McCahon, Robert A; Ravenscroft, Andrew; Hardman, Jonathan

    2012-09-27

    The efficacy of epidural steroid injections in the management of chronic low back pain is disputed, yet the technique remains popular amongst physicians and patients alike. This study assesses the cost effectiveness of injections administered in a routine outpatient setting in England. Patients attending the Nottingham University Hospitals' Pain Clinic received two injections of methylprednisolone plus levobupivacaine at different dosages, separated by at least 12 weeks. Prior to each injection, and every week thereafter for 12 weeks, participants completed the EQ-5D health-related quality of life instrument. For each patient for each injection, total health state utility gain relative to baseline was calculated. The cost of the procedure was modelled from observed clinical practice. Cost effectiveness was calculated as procedure cost relative to utility gain. 39 patients provided records. Over a 13-week period commencing with injection, mean quality adjusted life year (QALY) gains per patient for the two dosages were 0.028 (SD 0.063) and 0.021 (SD 0.057). The difference in QALYs gained by dosage was insignificant (paired t-test, CIs -0.019 - 0.033). Based on modelled resource use and data from other studies, the mean cost of an injection was estimated at £219 (SD 83). The cost utility ratio of the two injections amounted to £8,975 per QALY gained (CIs 5,480 - 22,915). However, at costs equivalent to the tariff price typically paid to providers by health care purchasers, the ratio increased to £27,459 (CIs 16,779 - 70,091). When provided in an outpatient setting, epidural steroid injections are a short term, but nevertheless cost effective, means of managing chronic low back pain. However, designation of the procedure as a day case requires the National Health Service to reimburse providers at a price which pushes the procedure to the margin of cost effectiveness. ISRCTN 43299460.

  13. [Cost-effectiveness analysis of universal screening for thyroid disease in pregnant women in Spain].

    Science.gov (United States)

    Donnay Candil, Sergio; Balsa Barro, José Antonio; Álvarez Hernández, Julia; Crespo Palomo, Carlos; Pérez-Alcántara, Ferrán; Polanco Sánchez, Carlos

    2015-01-01

    To assess the cost-effectiveness of universal screening for thyroid disease in pregnant women in Spain as compared to high risk screening and no screening. A decision-analytic model comparing the incremental cost per quality-adjusted life year (QALY) of universal screening versus high risk screening and versus no screening. was used for the pregnancy and postpartum period. Probabilities from randomized controlled trials were considered for adverse obstetrical outcomes. A Markov model was used to assess the lifetime period after the first postpartum year and account for development of overt hypothyroidism. The main assumptions in the model and use of resources were assessed by local clinical experts. The analysis considered direct healthcare costs only. Universal screening gained .011 QALYs over high risk screening and .014 QALYS over no screening. Total direct costs per patient were €5,786 for universal screening, €5,791 for high risk screening, and €5,781 for no screening. Universal screening was dominant compared to risk-based screening and a very cost-effective alternative as compared to no screening. Use of universal screening instead of high risk screening would result in €2,653,854 annual savings for the Spanish National Health System. Universal screening for thyroid disease in pregnant women in the first trimester is dominant in Spain as compared to risk-based screening, and is cost-effective as compared to no screening (incremental cost-effectiveness ratio of €374 per QALY). Moreover, it allows diagnosing and treating cases of clinical and subclinical hypothyroidism that may not be detected when only high-risk women are screened. Copyright © 2014 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

  14. Cost and cost-effectiveness of tuberculosis treatment shortening: a model-based analysis.

    Science.gov (United States)

    Gomez, G B; Dowdy, D W; Bastos, M L; Zwerling, A; Sweeney, S; Foster, N; Trajman, A; Islam, M A; Kapiga, S; Sinanovic, E; Knight, G M; White, R G; Wells, W A; Cobelens, F G; Vassall, A

    2016-12-01

    Despite improvements in treatment success rates for tuberculosis (TB), current six-month regimen duration remains a challenge for many National TB Programmes, health systems, and patients. There is increasing investment in the development of shortened regimens with a number of candidates in phase 3 trials. We developed an individual-based decision analytic model to assess the cost-effectiveness of a hypothetical four-month regimen for first-line treatment of TB, assuming non-inferiority to current regimens of six-month duration. The model was populated using extensive, empirically-collected data to estimate the economic impact on both health systems and patients of regimen shortening for first-line TB treatment in South Africa, Brazil, Bangladesh, and Tanzania. We explicitly considered 'real world' constraints such as sub-optimal guideline adherence. From a societal perspective, a shortened regimen, priced at USD1 per day, could be a cost-saving option in South Africa, Brazil, and Tanzania, but would not be cost-effective in Bangladesh when compared to one gross domestic product (GDP) per capita. Incorporating 'real world' constraints reduces cost-effectiveness. Patient-incurred costs could be reduced in all settings. From a health service perspective, increased drug costs need to be balanced against decreased delivery costs. The new regimen would remain a cost-effective option, when compared to each countries' GDP per capita, even if new drugs cost up to USD7.5 and USD53.8 per day in South Africa and Brazil; this threshold was above USD1 in Tanzania and under USD1 in Bangladesh. Reducing the duration of first-line TB treatment has the potential for substantial economic gains from a patient perspective. The potential economic gains for health services may also be important, but will be context-specific and dependent on the appropriate pricing of any new regimen.

  15. Cost-Effectiveness of Radiation and Chemotherapy for High-Risk Low-Grade Glioma.

    Science.gov (United States)

    Qian, Yushen; Maruyama, Satoshi; Kim, Haju; Pollom, Erqi L; Kumar, Kiran A; Chin, Alexander L; Harris, Jeremy P; Chang, Daniel T; Pitt, Allison; Bendavid, Eran; Owens, Douglas K; Durkee, Ben Y; Soltys, Scott G

    2017-06-28

    The addition of PCV (procarbazine, lomustine, vincristine) chemotherapy to radiotherapy (RT) for patients with high-risk (≥ 40 years old or sub-totally resected) low-grade glioma (LGG) results in an absolute median survival benefit of over 5 years. We evaluated the cost-effectiveness of this treatment strategy. A decision tree with an integrated three-state Markov model was created to follow patients with high risk LGG after surgery treated with RT vs. RT+PCV. Patients existed in one of 3 health states: stable, progressive, and dead. Survival and freedom from progression were modeled to reflect the results of RTOG 9802 using time-dependent transition probabilities. Health utility values and costs of care were derived from the literature and national registry databases. Analysis was conducted from the healthcare perspective. Deterministic and probabilistic sensitivity analysis explored uncertainty in model parameters. Modeled outcomes demonstrated agreement with clinical data in expected benefit of addition of PCV to RT. The addition of PCV to RT yielded an incremental benefit of 4.77 quality-adjusted life-years (QALYs) (9.94 for RT+PCV vs. 5.17 for RT alone) at an incremental cost of $48,635 ($188,234 for RT+PCV vs. $139,598 for RT alone), resulting in an incremental cost-effectiveness ratio of $10,186 per QALY gained. Probabilistic sensitivity analysis demonstrates that within modeled distributions of parameters, RT+PCV has 99.96% probability of being cost-effectiveness at a willingness-to-pay threshold of $100,000 per QALY. The addition of PCV to RT is a cost-effective treatment strategy for patients with high-risk LGG.

  16. Cost-effectiveness of psychological and pharmacological interventions for generalized anxiety disorder and panic disorder.

    Science.gov (United States)

    Heuzenroeder, Louise; Donnelly, Marie; Haby, Michelle M; Mihalopoulos, Cathrine; Rossell, Ruth; Carter, Rob; Andrews, Gavin; Vos, Theo

    2004-08-01

    To assess from a health sector perspective the incremental cost-effectiveness of interventions for generalized anxiety disorder (cognitive behavioural therapy [CBT] and serotonin and noradrenaline reuptake inhibitors [SNRIs]) and panic disorder (CBT, selective serotonin reuptake inhibitors [SSRIs] and tricyclic antidepressants [TCAs]). The health benefit is measured as a reduction in disability-adjusted life years (DALYs), based on effect size calculations from meta-analyses of randomised controlled trials. An assessment on second stage filter criteria ("equity", "strength of evidence", "feasibility" and "acceptability to stakeholders") is also undertaken to incorporate additional factors that impact on resource allocation decisions. Costs and benefits are calculated for a period of one year for the eligible population (prevalent cases of generalized anxiety disorder/panic disorder identified in the National Survey of Mental Health and Wellbeing, extrapolated to the Australian population in the year 2000 for those aged 18 years and older). Simulation modelling techniques are used to present 95% uncertainty intervals (UI) around the incremental cost-effectiveness ratios (ICERs). Compared to current practice, CBT by a psychologist on a public salary is the most cost-effective intervention for both generalized anxiety disorder (A$6900/DALY saved; 95% UI A$4000 to A$12 000) and panic disorder (A$6800/DALY saved; 95% UI A$2900 to A$15 000). Cognitive behavioural therapy results in a greater total health benefit than the drug interventions for both anxiety disorders, although equity and feasibility concerns for CBT interventions are also greater. Cognitive behavioural therapy is the most effective and cost-effective intervention for generalized anxiety disorder and panic disorder. However, its implementation would require policy change to enable more widespread access to a sufficient number of trained therapists for the treatment of anxiety disorders.

  17. Cost effectiveness of targeted HIV prevention interventions for female sex workers in India.

    Science.gov (United States)

    Prinja, Shankar; Bahuguna, Pankaj; Rudra, Shalini; Gupta, Indrani; Kaur, Manmeet; Mehendale, S M; Chatterjee, Susmita; Panda, Samiran; Kumar, Rajesh

    2011-06-01

    To ascertain the cost effectiveness of targeted interventions for female sex workers (FSW) under the National AIDS Control Programme in India. A compartmental mathematical Markov state model was used over a 20-year time horizon (1995-2015) to estimate the cost effectiveness of FSW targeted interventions, with a health system perspective. The incremental costs and effects of FSW targeted interventions were compared against a baseline scenario of mass media for the general population alone. The incremental cost-effectiveness ratio was computed at a 3% discount rate using HIV infections averted and disability-adjusted life-years (DALY) as benefit measures. It was assumed that the transmission of the HIV virus moves from a high-risk group (FSW) to the client population and finally to the general population (partners of clients). Targeted interventions for FSW result in a reduction of 47% (1.6 million) prevalent and 36% (2.7 million) cumulative HIV cases, respectively, in 2015. Adult HIV prevalence in India, with and without (mass media only) FSW interventions, would be 0.25% and 0.48% in 2015. Indian government and development partners spend an average US $104 (INR4680) per HIV infection averted and US $10.7 (INR483) per DALY averted. Discounting at 3%, FSW targeted interventions cost US $105.5 (INR4748) and US $10.9 (INR490) per HIV case and DALY averted, respectively. At the current gross domestic product in India, targeted intervention is a cost-effective strategy for HIV prevention in India.

  18. The Cost-Effectiveness of Anemia Treatment for Persons with Chronic Kidney Disease.

    Directory of Open Access Journals (Sweden)

    Benjamin O Yarnoff

    Full Text Available Although major guidelines uniformly recommend iron supplementation and erythropoietin stimulating agents (ESAs for managing chronic anemia in persons with chronic kidney disease (CKD, there are differences in the recommended hemoglobin (Hb treatment target and no guidelines consider the costs or cost-effectiveness of treatment. In this study, we explored the most cost-effective Hb target for anemia treatment in persons with CKD stages 3-4.The CKD Health Policy Model was populated with a synthetic cohort of persons over age 30 with prevalent CKD stages 3-4 (i.e., not on dialysis and anemia created from the 1999-2010 National Health and Nutrition Examination Survey. Incremental cost-effectiveness ratios (ICERs, computed as incremental cost divided by incremental quality adjusted life years (QALYs, were assessed for Hb targets of 10 g/dl to 13 g/dl at 0.5 g/dl increments. Targeting a Hb of 10 g/dl resulted in an ICER of $32,111 compared with no treatment and targeting a Hb of 10.5 g/dl resulted in an ICER of $32,475 compared with a Hb target of 10 g/dl. QALYs increased to 4.63 for a Hb target of 10 g/dl and to 4.75 for a target of 10.5 g/dl or 11 g/dl. Any treatment target above 11 g/dl increased medical costs and decreased QALYs.In persons over age 30 with CKD stages 3-4, anemia treatment is most cost-effective when targeting a Hb level of 10.5 g/dl. This study provides important information for framing guidelines related to treatment of anemia in persons with CKD.

  19. Obesity and Surgical Treatment – A Cost-Effectiveness Assessment for Sweden

    Directory of Open Access Journals (Sweden)

    Sixten Borg

    2014-07-01

    Full Text Available Background:The rising trend in the prevalence of obesity has during the past decades become a major public health concern in many countries, as obesity may lead to comorbidities and death. A frequent used marker for obesity is the Body Mass Index (BMI. The cost of treatment for obesity related diseases has become a heavy burden on national health care budget in many countries. While diet and exercise are the cornerstones of weight management, pharmaco­therapy is often needed to achieve and maintain desired weight loss.  In some cases of extreme obesity, bariatric surgery may be recommended. It is expected to increase by 50% in Sweden.Objective: The overall objective was to develop a cost-effectiveness model using the best available evidence to assess the cost-effectiveness of gastric bypass (GBP surgical treatments for obesity in adult patients, in comparison with conventional treatment (CT, in Sweden from a healthcare perspective. With the model we also seeked to identify the lower cut-off point using BMI criteria, for the surgical intervention to be cost-effective. Methods:A micro-simulation model with an underlying Markov methodology was developed, that simulates individual patients. It simulates the outcomes of the patients in terms of treatment costs, life years, and quality adjusted life years (QALY over his/her remaining lifetime. The costs are presented in SEK in the year 2006 price level (1 SEK ≈ 0.11 EUR ≈ 0.14 USD.Results: We estimated that the incremental cost per QALY gained will not exceed SEK 33,000 per QALY in patients with BMI < 35. In patients with BMI > 35 kg/m2, gastric bypass surgery has lower costs compared to conventional treatment. Conclusion: Gastric bypass surgery is a cost-effective intervention compared to conventional treatment consisting of watchful waiting, diet and exercise.

  20. Cost-effectiveness of preventive interventions to reduce alcohol consumption in Denmark.

    Directory of Open Access Journals (Sweden)

    Astrid Ledgaard Holm

    Full Text Available INTRODUCTION: Excessive alcohol consumption increases the risk of many diseases and injuries, and the Global Burden of Disease 2010 study estimated that 6% of the burden of disease in Denmark is due to alcohol consumption. Alcohol consumption thus places a considerable economic burden on society. METHODS: We analysed the cost-effectiveness of six interventions aimed at preventing alcohol abuse in the adult Danish population: 30% increased taxation, increased minimum legal drinking age, advertisement bans, limited hours of retail sales, and brief and longer individual interventions. Potential health effects were evaluated as changes in incidence, prevalence and mortality of alcohol-related diseases and injuries. Net costs were calculated as the sum of intervention costs and cost offsets related to treatment of alcohol-related outcomes, based on health care costs from Danish national registers. Cost-effectiveness was evaluated by calculating incremental cost-effectiveness ratios (ICERs for each intervention. We also created an intervention pathway to determine the optimal sequence of interventions and their combined effects. RESULTS: Three of the analysed interventions (advertising bans, limited hours of retail sales and taxation were cost-saving, and the remaining three interventions were all cost-effective. Net costs varied from € -17 million per year for advertisement ban to € 8 million for longer individual intervention. Effectiveness varied from 115 disability-adjusted life years (DALY per year for minimum legal drinking age to 2,900 DALY for advertisement ban. The total annual effect if all interventions were implemented would be 7,300 DALY, with a net cost of € -30 million. CONCLUSION: Our results show that interventions targeting the whole population were more effective than individual-focused interventions. A ban on alcohol advertising, limited hours of retail sale and increased taxation had the highest probability of being cost

  1. 2007年全国克山病病情监测汇总分析%Analysis of the data of national Keshan disease surveillance in 2007

    Institute of Scientific and Technical Information of China (English)

    全国克山病监测协作组

    2008-01-01

    目的 掌握2007年全国克山病患病及发病情况,为制订克山病防治策略提供科学依据.方法 根据2007年克山病监测方案及《克山病诊断标准》(GB 17021-1997),对15个病区省(区、市)的24个监测点居民进行查体、描记心电图、疑似病例摄X线胸片等临床检查.采集监测点居民主食粮样和发样,检测含硒量.结果 24个监测点居民潜在型、慢型克山病检出率分别为2.4%(465/19280)、0.6%(119/19 280).按检出率区间估计,全国病区有235万例(216万~254万例)克山病病人,其中慢型48万例(39万~57万例).本次监测新检出潜在型克山病85例,慢型克山病9例.15个省(区、市)的22个监测点心电图检查的异常率为14.3%(2554/17 801).14个省(区、市)22个监测点X线胸片检查有心胸比例增大者占38.8%(285/734).11个省(区、市)17个监测点共采集发样566份,发硒平均水平为0.3848 mg/kg;15个监测点采集小麦254份.平均硒水平为0.0428 mg/kg;采集玉米213份.平均硒水平为0.0250 mg/kg.结论 克山病仍然是严重的地方性公共卫生问题.要坚持做好克山病监测工作,改进抽样方法,增强监测的代表性;建议加大监测的投入.开展概率抽样,进行总体推断.以适应克山病新形势下的要求.%Objective To study prevalence and incidence of Keshan Disease (KD) in China in 2007, and provide scientific basis for control strategies on KD. Methods Based on the Scheme of KD Surveillance and the Standard of Diagnosis of KD(GB 17021-1997), the residents in 24 surveillance sites of 15 provinces were surveyed by physical examination, electrocardiogram(ECM) and X-ray. The hair and food potentially related to KD were sampled for determination of selenium levels. Besults The prevalence of latent and chronic KD in 24 surveillance sites was 2.4%(465/19280) and 0.6%(119/19 280), respectively, and the number of KD patients in China was estimated to be 2.16 to 2.54 millions. Of them, 390 to 570

  2. Cost-Effectiveness of Complementary Therapies in the United Kingdom—A Systematic Review†

    Directory of Open Access Journals (Sweden)

    Peter H. Canter

    2006-01-01

    Full Text Available Objectives: The aim of this review is to systematically summarize and assess all prospective, controlled, cost-effectiveness studies of complementary therapies carried out in the UK. Data sources: Medline (via PubMed, Embase, CINAHL, Amed (Alternative and Allied Medicine Database, British Library Medical Information Centre, The Cochrane Library, National Health Service Economic Evaluation Database (via Cochrane and Health Technology Assessments up to October 2005. Review methods: Articles describing prospective, controlled, cost-effectiveness studies of any type of complementary therapy for any medical condition carried out in the UK were included. Data extracted included the main outcomes for health benefit and cost. These data were extracted independently by two authors, described narratively and also presented as a table. Results: Six cost-effectiveness studies of complementary medicine in the UK were identified: four different types of spinal manipulation for back pain, one type of acupuncture for chronic headache and one type of acupuncture for chronic back pain. Four of the six studies compared the complementary therapy with usual conventional treatment in pragmatic, randomized clinical trials without sham or placebo arms. Main outcome measures of effectiveness favored the complementary therapies but in the case of spinal manipulation (four studies and acupuncture (one study for back pain, effect sizes were small and of uncertain clinical relevance. The same four studies included a cost-utility analyses in which the incremental cost per quality adjusted life year (QALY was less than £10 000. The complementary therapy represented an additional health care cost in five of the six studies. Conclusions: Prospective, controlled, cost-effectiveness studies of complementary therapies have been carried out in the UK only for spinal manipulation (four studies and acupuncture (two studies. The limited data available indicate that the use of these

  3. Rope Climbing Robot with Surveillance Capability

    Directory of Open Access Journals (Sweden)

    Kanza Zafar

    2013-08-01

    Full Text Available In the past different engineers and researcher developed robots capable of climbing for various purposes. In this paper we have developed a robot capable of rope climbing in both horizontal and vertical direction. Furthermore, the robot has the ability to perform surveillance using a camera mounted on top of the robot. The quality of the transmitted video from the camera to the computer is clear and stable. Hence the developed robot is a good choice for surveillance purposes. In addition, it can be used to traverse floors of a building. It uses an IR sensor to sense strips attached at each floor. Once the strips are sensed, a dropping mechanism is activated in which a specific object is dropped to the targeted floor or location. The robot can work in automatic mode or manual through RF signals from an RF transmitter. Finally the robot is cost effective compared to many other developed robots for rope climbing.

  4. Cost-effectiveness of automated external defibrillators on airlines.

    Science.gov (United States)

    Groeneveld, P W; Kwong, J L; Liu, Y; Rodriguez, A J; Jones, M P; Sanders, G D; Garber, A M

    2001-09-26

    Installation of automated external defibrillators (AEDs) on passenger aircraft has been shown to improve survival of cardiac arrest in that setting, but the cost-effectiveness of such measures has not been proven. To examine the costs and effectiveness of several different options for AED deployment in the US commercial air transportation system. Decision and cost-effectiveness analysis of a strategy of full deployment on all aircraft as well as several strategies of partial deployment only on larger aircraft, compared with a baseline strategy of no AEDs on aircraft (but training flight attendants in basic life support) for a hypothetical cohort of persons experiencing cardiac arrest aboard US commercial aircraft. Estimates for costs and outcomes were obtained from the medical literature, the Federal Aviation Administration, the Air Transport Association of America, a population-based cohort of Medicare patients, AED manufacturers, and the Bureau of Labor Statistics. Quality-adjusted survival after cardiac arrest; costs of AED deployment on aircraft and of medical care for cardiac arrest survivors. Adding AEDs on passenger aircraft with more than 200 passengers would cost $35 300 per quality-adjusted life-year (QALY) gained. Additional AEDs on aircraft with capacities between 100 and 200 persons would cost an additional $40 800 per added QALY compared with deployment on large-capacity aircraft only, and full deployment on all passenger aircraft would cost an additional $94 700 per QALY gained compared with limited deployment on aircraft with capacity greater than 100. Sensitivity analyses indicated that the quality of life, annual mortality rate, and the effectiveness of AEDs in improving survival were the most influential factors in the model. In 85% of Monte Carlo simulations, AED placement on large-capacity aircraft produced cost-effectiveness ratios of less than $50 000 per QALY. The cost-effectiveness of placing AEDs on commercial aircraft compares favorably

  5. Cost-effectiveness of Bariatric Surgery in Adolescents With Obesity.

    Science.gov (United States)

    Klebanoff, Matthew J; Chhatwal, Jagpreet; Nudel, Jacob D; Corey, Kathleen E; Kaplan, Lee M; Hur, Chin

    2017-02-01

    Severe obesity affects 4% to 6% of US youth and is increasing in prevalence. Bariatric surgery for the treatment of adolescents with severe obesity is becoming more common, but data on cost-effectiveness are limited. To assess the cost-effectiveness of bariatric surgery for adolescents with obesity using recently published results from the Teen-Longitudinal Assessment of Bariatric Surgery study. A state-transition model was constructed to compare 2 strategies: no surgery and bariatric surgery. In the no surgery strategy, patients remained at their initial body mass index (calculated as weight in kilograms divided by height in meters squared) over time. In the bariatric surgery strategy, patients were subjected to risks of perioperative mortality and complications as well as initial morbidity but also experienced longer-term quality-of-life improvements associated with weight loss. Cohort demographic information-of the 228 patients included, the mean (SD) age was 17 (1.6) years, the mean (range) body mass index was 53 (34-88), and 171 (75.0%) were female-surgery-related outcomes, and base case time horizon (3 years) were based on data from the Teen-Longitudinal Assessment of Bariatric Surgery study. One-way and probabilistic sensitivity analyses were performed. Quality-adjusted life-years (QALYs), total costs (in US dollars adjusted to 2015-year values using the Consumer Price Index), and incremental cost-effectiveness ratios (ICERs). A willingness-to-pay threshold of $100 000 per QALY was used to assess cost-effectiveness. After 3 years, surgery led to a gain of 0.199 QALYs compared with no surgery at an incremental cost of $30 747, yielding an unfavorable ICER of $154 684 per QALY. When the clinical study results were extrapolated to 4 years, the ICER decreased to $114 078 per QALY and became cost-effective by 5 years with an ICER of $91 032 per QALY. Outcomes were robust in most 1-way and probabilistic sensitivity analyses. Bariatric surgery incurs

  6. Cost-effectiveness of malaria microscopy and rapid diagnostic tests versus presumptive diagnosis

    DEFF Research Database (Denmark)

    Batwala, Vincent; Magnussen, Pascal; Hansen, Kristian S.;

    2011-01-01

    ABSTRACT: BACKGROUND: Current Uganda National Malaria treatment guidelines recommend parasitological confirmation either by microscopy or rapid diagnostic test (RDT) before treatment with artemether-lumefantrine (AL). However, the cost-effectiveness of these strategies has not been assessed...... at rural operational primary care centres. METHODS: Three health centres (HCs) were randomized to three diagnostic arms (microscopy, RDT and presumptive diagnosis) in a district of low and another of high malaria transmission intensities in Uganda. Some 22,052 patients presenting with fever at outpatients...

  7. Incidence and risk factors for injuries to the anterior cruciate ligament in National Collegiate Athletic Association football: data from the 2004-2005 through 2008-2009 National Collegiate Athletic Association Injury Surveillance System.

    Science.gov (United States)

    Dragoo, Jason L; Braun, Hillary J; Durham, Jennah L; Chen, Michael R; Harris, Alex H S

    2012-05-01

    Injuries to the anterior cruciate ligament (ACL) are common in athletic populations, particularly in athletes participating in football, soccer, and skiing. The purpose of this study was to analyze the National Collegiate Athletic Association (NCAA) Injury Surveillance System (ISS) men's football ACL injury database from the playing seasons of 2004-2005 through 2008-2009 to determine the incidence and epidemiology of complete injury to the ACL in NCAA football athletes. Descriptive epidemiology study. The NCAA ISS men's football database was reviewed from the 2004-2005 through 2008-2009 seasons using the specific injury code, "Anterior cruciate ligament (ACL) complete tear." The injury rate was computed for competition and practice exposures. Ninety-five percent confidence intervals (CIs) for the incident rates were calculated using assumptions of a Poisson distribution. Pairwise, 2-sample tests of equality of proportions with a continuity correction were used to estimate the associations of risk factors such as event type, playing surface, season segment, and football subdivision. Descriptive data were also described. The ACL injury rate during games (8.06 per 10,000 athlete-exposures [AEs] 95% CI, 6.80-9.42) was significantly greater than the rate during practice (0.8 per 10,000 AEs 95% CI, 0.68-0.93). Players were 10.09 (95% CI, 8.08-12.59) times more likely to sustain an ACL injury in competition when compared with practices. When practice exposures were analyzed separately, the injury rate was significantly greater during scrimmages (3.99 per 10,000 AEs 95% CI, 2.29-5.94) compared with regular practices (0.83 per 10,000 AEs 95% CI, 0.69-0.97) and walk-throughs (0 per 10,000 AEs 95% CI, 0-0.14). There was an incidence rate of 1.73 ACL injuries per 10,000 AEs (95% CI, 1.47-2.0) on artificial playing surfaces compared with a rate of 1.24 per 10,000 AEs (95% CI, 1.05-1.45) on natural grass. The rate of ACL injury on artificial surfaces is 1.39 (95% CI, 1

  8. Evaluation of multivariate surveillance

    OpenAIRE

    Frisén,Marianne; Andersson, Eva; Schiöler, Linus

    2009-01-01

    Multivariate surveillance is of interest in many areas such as industrial production, bioterrorism detection, spatial surveillance, and financial transaction strategies. Some of the suggested approaches to multivariate surveillance have been multivariate counterparts to the univariate Shewhart, EWMA, and CUSUM methods. Our emphasis is on the special challenges of evaluating multivariate surveillance methods. Some new measures are suggested and the properties of several measures are demonstrat...

  9. Surveillance strategies for Classical Swine Fever in wild boar – a comprehensive evaluation study to ensure powerful surveillance

    Science.gov (United States)

    Schulz, Katja; Peyre, Marisa; Staubach, Christoph; Schauer, Birgit; Schulz, Jana; Calba, Clémentine; Häsler, Barbara; Conraths, Franz J.

    2017-01-01

    Surveillance of Classical Swine Fever (CSF) should not only focus on livestock, but must also include wild boar. To prevent disease transmission into commercial pig herds, it is therefore vital to have knowledge about the disease status in wild boar. In the present study, we performed a comprehensive evaluation of alternative surveillance strategies for Classical Swine Fever (CSF) in wild boar and compared them with the currently implemented conventional approach. The evaluation protocol was designed using the EVA tool, a decision support tool to help in the development of an economic and epidemiological evaluation protocol for surveillance. To evaluate the effectiveness of the surveillance strategies, we investigated their sensitivity and timeliness. Acceptability was analysed and finally, the cost-effectiveness of the surveillance strategies was determined. We developed 69 surveillance strategies for comparative evaluation between the existing approach and the novel proposed strategies. Sampling only within sub-adults resulted in a better acceptability and timeliness than the currently implemented strategy. Strategies that were completely based on passive surveillance performance did not achieve the desired detection probability of 95%. In conclusion, the results of the study suggest that risk-based approaches can be an option to design more effective CSF surveillance strategies in wild boar. PMID:28266576

  10. Surveillance strategies for Classical Swine Fever in wild boar - a comprehensive evaluation study to ensure powerful surveillance.

    Science.gov (United States)

    Schulz, Katja; Peyre, Marisa; Staubach, Christoph; Schauer, Birgit; Schulz, Jana; Calba, Clémentine; Häsler, Barbara; Conraths, Franz J

    2017-03-07

    Surveillance of Classical Swine Fever (CSF) should not only focus on livestock, but must also include wild boar. To prevent disease transmission into commercial pig herds, it is therefore vital to have knowledge about the disease status in wild boar. In the present study, we performed a comprehensive evaluation of alternative surveillance strategies for Classical Swine Fever (CSF) in wild boar and compared them with the currently implemented conventional approach. The evaluation protocol was designed using the EVA tool, a decision support tool to help in the development of an economic and epidemiological evaluation protocol for surveillance. To evaluate the effectiveness of the surveillance strategies, we investigated their sensitivity and timeliness. Acceptability was analysed and finally, the cost-effectiveness of the surveillance strategies was determined. We developed 69 surveillance strategies for comparative evaluation between the existing approach and the novel proposed strategies. Sampling only within sub-adults resulted in a better acceptability and timeliness than the currently implemented strategy. Strategies that were completely based on passive surveillance performance did not achieve the desired detection probability of 95%. In conclusion, the results of the study suggest that risk-based approaches can be an option to design more effective CSF surveillance strategies in wild boar.

  11. GEIS Surveillance Network Program

    Science.gov (United States)

    2013-10-01

    resistance surveillance, diarrhea etiology and antimicrobial resistance surveillance, sexually transmitted illness surveillance, and capacity building...vomiting, diarrhea , joint pains, general malaise. Of the samples analyzed, only 53.7% had an associated etiology: Malaria (47.0%, EBV (39.7...immunity to the disease. Many adults in those situations are reservoirs, facilitating continuing disease transmission to those without immunity. In Kenya

  12. SOA-surveillance Nederland

    NARCIS (Netherlands)

    Rijlaarsdam J; Bosman A; Laar MJW van de; CIE

    2000-01-01

    In May 1999 a working group was started to evaluate the current surveillance systems for sexually transmitted diseases (STD) and to make suggestions for a renewed effective and efficient STD surveillance system in the Netherlands. The surveillance system has to provide insight into the prevalence an

  13. SOA-surveillance Nederland

    NARCIS (Netherlands)

    Rijlaarsdam J; Bosman A; Laar MJW van de; CIE

    2000-01-01

    In May 1999 a working group was started to evaluate the current surveillance systems for sexually transmitted diseases (STD) and to make suggestions for a renewed effective and efficient STD surveillance system in the Netherlands. The surveillance system has to provide insight into the prevalence

  14. Cost-effectiveness of telemonitoring of diabetic foot ulcer patients

    DEFF Research Database (Denmark)

    Fasterholdt, Iben; Gerstrøm, Marie; Rasmussen, Benjamin Schnack Brandt

    2017-01-01

    This study compared the cost-effectiveness of telemonitoring with standard monitoring for patients with diabetic foot ulcers. The economic evaluation was nested within a pragmatic randomised controlled trial. A total of 374 patients were randomised to either telemonitoring or standard monitoring....... Telemonitoring consisted of two tele-consultations in the patient's own home and one consultation at the outpatient clinic; standard monitoring consisted of three outpatient clinic consultations. Total healthcare costs were estimated over a 6-month period at individual patient level, from a healthcare sector...... perspective. The bootstrap method was used to calculate the incremental cost-effectiveness ratio, and one-way sensitivity analyses were performed. Telemonitoring costs were found to be €2039 less per patient compared to standard monitoring; however, this difference was not statistically significant...

  15. Cost-effectiveness of telemonitoring of diabetic foot ulcer patients.

    Science.gov (United States)

    Fasterholdt, Iben; Gerstrøm, Marie; Rasmussen, Benjamin Schnack Brandt; Yderstræde, Knud Bonnet; Kidholm, Kristian; Pedersen, Kjeld Møller

    2016-09-16

    This study compared the cost-effectiveness of telemonitoring with standard monitoring for patients with diabetic foot ulcers. The economic evaluation was nested within a pragmatic randomised controlled trial. A total of 374 patients were randomised to either telemonitoring or standard monitoring. Telemonitoring consisted of two tele-consultations in the patient's own home and one consultation at the outpatient clinic; standard monitoring consisted of three outpatient clinic consultations. Total healthcare costs were estimated over a 6-month period at individual patient level, from a healthcare sector perspective. The bootstrap method was used to calculate the incremental cost-effectiveness ratio, and one-way sensitivity analyses were performed. Telemonitoring costs were found to be €2039 less per patient compared to standard monitoring; however, this difference was not statistically significant. Amputation rate was similar in the two groups. In conclusion, a telemonitoring service in this form had similar costs and effects as standard monitoring. © The Author(s) 2016.

  16. [Cost-effectiveness of breast cancer screening policies in Mexico].

    Science.gov (United States)

    Valencia-Mendoza, Atanacio; Sánchez-González, Gilberto; Bautista-Arredondo, Sergio; Torres-Mejía, Gabriela; Bertozzi, Stefano M

    2009-01-01

    Generate cost-effectiveness information to allow policy makers optimize breast cancer (BC) policy in Mexico. We constructed a Markov model that incorporates four interrelated processes of the disease: the natural history; detection using mammography; treatment; and other competing-causes mortality, according to which 13 different strategies were modeled. Strategies (starting age, % of coverage, frequency in years)= (48, 25, 2), (40, 50, 2) and (40, 50, 1) constituted the optimal method for expanding the BC program, yielding 75.3, 116.4 and 171.1 thousand pesos per life-year saved, respectively. The strategies included in the optimal method for expanding the program produce a cost per life-year saved of less than two times the GNP per capita and hence are cost-effective according to WHO Commission on Macroeconomics and Health criteria.

  17. An fMRI study on sunk cost effect.

    Science.gov (United States)

    Zeng, Jianmin; Zhang, Qinglin; Chen, Changming; Yu, Rongjun; Gong, Qiyong

    2013-06-26

    Sunk cost effect (also called escalation of commitment, etc) is a pervasive, interesting and famous decision bias, which has been intensively discussed in psychology, economics, management, political science, zoology, etc. To date, little has been known about the neural basis of this phenomenon. We investigated it by using functional magnetic resonance imaging (fMRI) to monitor healthy subjects' brain activities when they made decisions in a task wherein sunk cost and incremental cost were systematically manipulated. Higher sunk cost only increased activity of some brain areas (mainly lateral frontal and parietal cortices, which are involved in risk-taking), whereas lower incremental cost mainly increased activity of some brain areas (including striatum and medial prefrontal cortex, which are sensitive to rewards). No overlapping brain areas were found to respond to both sunk cost and incremental cost. These results favor certainty effect over self-justification or diminishing sensitivity as account of sunk cost effect.

  18. Cost-effectiveness analysis in Chagas' disease vectors control interventions

    Directory of Open Access Journals (Sweden)

    A. M. Oliveira Filho

    1989-01-01

    Full Text Available After a large scale field trial performed in central Brazil envisaging the control of Chagas' disease vectors in an endemic area colonized by Triatoma infestans and T. sordida the cost-effectiveness analysis for each insecticide/formulation was performed. It considered the operational costs and the prices of insecticides and formulations, related to the activity and persistence of each one. The end point was considered to be less than 90% of domicilliary unitis (house + annexes free of infestation. The results showed good cost-effectiveness for a slow-release emulsifiable suspension (SRES based on PVA and containing malathion as active ingredient, as well as for the pyrethroids tested in this assay-cyfluthrin, cypermethrin, deltamethrin and permethrin.

  19. Power and sample size in cost-effectiveness analysis.

    Science.gov (United States)

    Laska, E M; Meisner, M; Siegel, C

    1999-01-01

    For resource allocation under a constrained budget, optimal decision rules for mutually exclusive programs require that the treatment with the highest incremental cost-effectiveness ratio (ICER) below a willingness-to-pay (WTP) criterion be funded. This is equivalent to determining the treatment with the smallest net health cost. The designer of a cost-effectiveness study needs to select a sample size so that the power to reject the null hypothesis, the equality of the net health costs of two treatments, is high. A recently published formula derived under normal distribution theory overstates sample-size requirements. Using net health costs, the authors present simple methods for power analysis based on conventional normal and on nonparametric statistical theory.

  20. Cost-effectiveness of Voriconasole in treatment of invasive aspregillosis

    Directory of Open Access Journals (Sweden)

    N. N. Climko

    2009-01-01

    Full Text Available Invasive aspergillosis (IA is widespread infectious implication in immunodeficient patients, characterized by severe clinical manifestations and high mortality. This article presents the first case of pharmacoeconomical analysis of Voriconasole in treatment of IA compared with alternative therapies in Russia. Using mathematic modeling methods, we evalued total costs (including costs of IA treatment, clinical effectiveness and IA-related mortality in each therapy group. Obtained results showed the dominating of Voriconasole because of its high effectiveness and lower costs compared with caspofungine or amphotericine B. Total costs of therapy with Voricinasole were up to 30% lower compared with caspofungine and up to 70% lower compared with amphotericine B. Performed univariate sensitivity analysis showed that cost-effectiveness of anti-IA treatment depends mostly on clinical effectiveness of antimycotics rather than drug costs. Thus, treatment with Voriconasole is cost-effective in IA patients.

  1. Above Bonneville Passage and Propagation Cost Effectiveness Analysis.

    Energy Technology Data Exchange (ETDEWEB)

    Paulsen, C.M.; Hyman, J.B.; Wernstedt, K.

    1993-05-01

    We have developed several models to evaluate the cost-effectiveness of alternative strategies to mitigate hydrosystem impacts on salmon and steelhead, and applied these models to areas of the Columbia River Basin. Our latest application evaluates the cost-effectiveness of proposed strategies that target mainstem survival (e.g., predator control, increases in water velocity) and subbasin propagation (e.g., habitat improvements, screening, hatchery production increases) for chinook salmon and steelhead stocks, in the portion of the Columbia Basin bounded by Bonneville, Chief Joseph, Dworshak, and Hells Canyon darns. At its core the analysis primarily considers financial cost and biological effectiveness, but we have included other attributes which may be of concern to the region.

  2. Methodological considerations in the analysis of cost effectiveness in dentistry.

    Science.gov (United States)

    Antczak-Bouckoms, A A; Tulloch, J F; White, B A; Capilouto, E I

    1989-01-01

    Cost-effectiveness analysis is a technique applied with increasing frequency to help make rational decisions in health care resource allocation. This article reviews the ten general principles of cost-effectiveness analysis outlined by the Office of Technology Assessment of the US Congress and describes a model for such analyses used widely in medicine, but only recently applied in dentistry. The imperative for the formulation of the best current information on both the effectiveness of dental practices and their costs is made more urgent because of the now universally recognized belief that resources available to meet the demands for health care are limited. Today's environment requires critical allocation decisions within categorical health problems, across diseases, or relative to other health problems. If important health benefits or cost savings are to be realized, then these analytic approaches must become widely understood, accepted, and appropriately applied by key decision makers in the dental health sector.

  3. Selecting cost-effective areas for restoration of ecosystem services.

    Science.gov (United States)

    Adame, M F; Hermoso, V; Perhans, K; Lovelock, C E; Herrera-Silveira, J A

    2015-04-01

    Selection of areas for restoration should be based on cost-effectiveness analysis to attain the maximum benefit with a limited budget and overcome the traditional ad hoc allocation of funds for restoration projects. Restoration projects need to be planned on the basis of ecological knowledge and economic and social constraints. We devised a novel approach for selecting cost-effective areas for restoration on the basis of biodiversity and potential provision of 3 ecosystem services: carbon storage, water depuration, and coastal protection. We used Marxan, a spatial prioritization tool, to balance the provision of ecosystem services against the cost of restoration. We tested this approach in a mangrove ecosystem in the Caribbean. Our approach efficiently selected restoration areas that at low cost were compatible with biodiversity targets and that maximized the provision of one or more ecosystem services. Choosing areas for restoration of mangroves on the basis carbon storage potential, largely guaranteed the restoration of biodiversity and other ecosystem services.

  4. Hanford Site Environmental Surveillance Master Sampling Schedule

    Energy Technology Data Exchange (ETDEWEB)

    Bisping, Lynn E.

    2002-01-16

    Environmental surveillance of the Hanford Site and surrounding areas is conducted by Pacific Northwest National Laboratory (PNNL) for the U.S. Department of Energy (DOE). Sampling is conducted to evaluate levels of radioactive and nonradioactive pollutants in the Hanford environs. The document contains the CY 2002 schedules for the routine collection of samples for the Surface Environmental Surveillance Project (SESP) and Drinking Water Monitoring Project.

  5. Evaluating the cost-effectiveness of preventive zinc supplementation

    OpenAIRE

    Fink, Günther; Heitner, Jesse

    2014-01-01

    Background Even though the WHO currently recommends zinc for diarrhea management, no consensus has been reached with respect to routine distribution of zinc for preventive reasons. We reviewed the health impact of preventive zinc interventions, and evaluated the relative cost effectiveness of currently feasible interventions. Methods Using the latest relative risk estimates reported in the literature, we parameterized a health impact model, and calculated the expected benefits of zinc supplem...

  6. Evaluating the cost-effectiveness of preventive zinc supplementation

    OpenAIRE

    Fink, Günther; Heitner, Jesse

    2014-01-01

    Background: Even though the WHO currently recommends zinc for diarrhea management, no consensus has been reached with respect to routine distribution of zinc for preventive reasons. We reviewed the health impact of preventive zinc interventions, and evaluated the relative cost effectiveness of currently feasible interventions. Methods: Using the latest relative risk estimates reported in the literature, we parameterized a health impact model, and calculated the expected benefits of zinc suppl...

  7. Cost-effectiveness of early treatment for retinopathy of prematurity.

    Science.gov (United States)

    Kamholz, Karen L; Cole, Cynthia H; Gray, James E; Zupancic, John A F

    2009-01-01

    The Early Treatment for Retinopathy of Prematurity trial demonstrated that peripheral retinal ablation of eyes with high-risk prethreshold retinopathy of prematurity (early treatment) is associated with improved visual outcomes at 9 months' corrected gestational age compared with treatment at threshold disease (conventional management). However, early treatment increased the frequency of laser therapy, anesthesia with intubation, treatment-related systemic complications, and the need for repeat treatments. To determine the cost-effectiveness of an early treatment strategy for retinopathy of prematurity compared with conventional management. We developed a stochastic decision analytic model to assess the incremental cost of early treatment per eye with severe visual impairment prevented. We derived resource-use and efficacy estimates from the Early Treatment for Retinopathy of Prematurity trial's published outcome data. We used a third-party payer perspective. Our primary analysis focused on outcomes from birth through 9 months' corrected gestational age. A secondary analysis used a lifetime horizon. Parameter uncertainty was quantified by using probabilistic and deterministic sensitivity analyses. The incremental cost-effectiveness of early treatment was $14,200 per eye with severe visual impairment prevented. There was a 90% probability that the cost-effectiveness of early treatment would be less than $40,000 per eye with severe visual impairment prevented and a 0.5% probability that early treatment would be cost-saving (less costly and more effective). Limiting early treatment to more severely affected eyes (eyes with "type 1 retinopathy of prematurity" as defined by the Early Treatment for Retinopathy of Prematurity trial) had a cost-effectiveness of $6,200 per eye with severe visual impairment prevented. Analyses that considered long-term costs and outcomes found that early treatment was cost-saving. Early treatment of retinopathy of prematurity is both

  8. Modified Transverse Thoracosternotomy and Cost-Effective Reinforced Sternal Closure.

    Science.gov (United States)

    Costa, Joseph; Sonett, Joshua R; D'Ovidio, Frank

    2015-12-01

    The bilateral transverse thoracosternotomy clamshell incision provides excellent exposure to the mediastinal structures in double lung transplantation. The use of a modified transverse sternotomy and a figure of 8 configuration with one monofilament metal wire, along with two longitudinal wires across the sternal division, results in greater stability and equally distributed oblique tension. Our described technique was more cost effective and resulted in no incidence of dehiscence. We present our experience using a modified transverse sternotomy and reinforced sternal closure method.

  9. Cost effectiveness of routine duodenal biopsies in iron deficiency anemia

    Science.gov (United States)

    Broide, Efrat; Matalon, Shay; Kriger-Sharabi, Ofra; Richter, Vered; Shirin, Haim; Leshno, Moshe

    2016-01-01

    AIM To investigate the cost effectiveness of routine small bowel biopsies (SBBs) in patients with iron deficiency anemia (IDA) independent of their celiac disease (CD) serology test results. METHODS We used a state transition Markov model. Two strategies were compared: routine SBBs during esophagogastroduodenoscopy (EGD) in all patients with IDA regardless their celiac serology status (strategy A) vs SBBs only in IDA patients with positive serology (strategy B). The main outcomes were quality adjusted life years (QALY), average cost and the incremental cost effectiveness ratio (ICER). One way sensitivity analysis was performed on all variables and two way sensitivity analysis on selected variables were done. In order to validate the results, a Monte Carlo simulation of 100 sample trials with 10, and an acceptability curve were performed. RESULTS Strategy A of routine SBBs yielded 19.888 QALYs with a cost of $218.10 compared to 19.887 QALYs and $234.17 in strategy B. In terms of cost-effectiveness, strategy A was the dominant strategy, as long as the cost of SBBs stayed less than $67. In addition, the ICER of strategy A was preferable, providing the cost of biopsy stays under $77. Monte Carlo simulation demonstrated that strategy A yielded the same QALY but with lower costs than strategy B. CONCLUSION Our model suggests that EGD with routine SBBs is a cost-effective approach with improved QALYs in patients with IDA when the prevalence of CD is 5% or greater. SBBs should be a routine screening tool for CD among patients with IDA, regardless of their celiac antibody status. PMID:27678365

  10. Assessing cost-effectiveness in the management of multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Ceri J Phillips

    2009-11-01

    Full Text Available Ceri J Phillips, Ioan HumphreysInstitute for Health Research, School of Health Science, Swansea University, Swansea, Wales, UKAbstract: Multiple sclerosis (MS is one of the most common causes of neurological disability in young and middle-aged adults, with current prevalence rates estimated to be 30 per 100,000 populations. Women are approximately twice as susceptible as males, but males are more likely to have progressive disease. The onset of the disease normally occurs between 20 and 40 years of age, with a peak incidence during the late twenties and early thirties, resulting in many years of disability for a large proportion of patients, many of whom require wheelchairs and some nursing home or hospital care. The aim of this study is to update a previous review which considered the cost-effectiveness of disease-modifying drugs (DMDs, such as interferons and glatiramer acetate, with more up to date therapies, such as mitaxantrone hydrochloride and natalizumab in the treatment of MS. The development and availability of new agents has been accompanied byan increased optimism that treatment regimens for MS would be more effective; that the number, severity and duration of relapses would diminish; that disease progression would be delayed; and that disability accumulation would be reduced. However, doubts have been expressed about the effectiveness of these treatments, which has only served to compound the problems associated with endeavors to estimate the relative cost-effectiveness of such interventions.Keywords: multiple sclerosis, disease management, immunomodulatory drugs, cost-effectiveness, cost-effectiveness analysis, cost-utility analysis

  11. Cost Effective Evaluation of Companies’ Storytelling on the Web

    OpenAIRE

    Clemmensen, Torkil; Vendelø, Morten

    2004-01-01

    In this paper we present a cost effective and simple procedure for evaluating company web sites. Our assumption is that such sites are places for companies’ self-presentation and that customers are readers of these texts. Web site texts with narrative qualities, e.g. scenes, actors, acts, initiate the customers’ imagination and narrative mind and hence their decision making. These ideas are investigated in a qualitative study of two companies’ self-presentation as future work places for stude...

  12. Cost Effective Evaluation of Companies’ Storytelling on the Web

    OpenAIRE

    Clemmensen, Torkil; Vendelø, Morten

    2004-01-01

    Abstract: In this paper we present a cost effective and simple procedure for evaluating company web sites. Our assumption is that such sites are places for companies’ self-presentation and that customers are readers of these texts. Web site texts with narrative qualities, e.g. scenes, actors, acts, initiate the customers’ imagination and narrative mind and hence their decision making. These ideas are investigated in a qualitative study of two companies’ self-presentation as future work places...

  13. Cost-effectiveness of asthma therapy: a