Stroke,which is the second leading cause of mortality worldwide and the third leading cause of death and disability combined,[1]necessitates cost-effective rehabilitation interventions.Acupuncture is a traditional Chi...Stroke,which is the second leading cause of mortality worldwide and the third leading cause of death and disability combined,[1]necessitates cost-effective rehabilitation interventions.Acupuncture is a traditional Chinese medicine therapy that is increasingly recognized as a complementary stroke therapy.展开更多
With the continuous application of new technologies in reconnaissance and attack, false camouflage plays a more important role in improving the survivability of targets, and the number of decoys plays a crucial role i...With the continuous application of new technologies in reconnaissance and attack, false camouflage plays a more important role in improving the survivability of targets, and the number of decoys plays a crucial role in the camouflaging effect. Based on the concept of cost-effectiveness ratio, according to the newly formulated Johnson criterion and the view of discovery and destruction, this paper proposes to take the identification probability as the probability of being destroyed and uses mathematical formulas to calculate the cost of a single use decoy. On this basis, a cost-effectiveness ratio model is established, with the product of the increase in the survival probability of the target and the cost of the target as the benefit, and the sum of the product of the probability of being destroyed and the cost of the decoy and the cost of a single use as the consumption cost. The model is calculated and analyzed, and the number of decoys that conform to the actual situation is obtained.展开更多
The United States （U.S.） is facing a national opioid epidemic, and medical systems are in need of non- pharmacologic strategies that can be employed to decrease the public＇s opioid dependence. Acupuncture has emerg...The United States （U.S.） is facing a national opioid epidemic, and medical systems are in need of non- pharmacologic strategies that can be employed to decrease the public＇s opioid dependence. Acupuncture has emerged as a powerful, evidence-based, safe, cost-effective, and available treatment modality suitable to meeting this need. Acupuncture has been shown to be effective for the management of numerous types of pain conditions, and mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives. Further, acupuncture＇s cost-effectiveness can dramatically decrease health care expenditures, both from the standpoint of treating acute pain and through avoiding addiction to opioids that requires costly care, destroys quality of life, and can lead to fatal overdose. Numerous federal regulatory agencies have advised or mandated that healthcare systems and providers offer non-pharmacologic treatment options for pain. Acupuncture stands out as the most evidence-based, immediately available choice to fulfil these calls. Acupuncture can safely, easily, and cost-effectively be incorporated into hospital settings as diverse as the emergency department, labor and delivery suites, andneonatal intensive care units to treat a variety of commonly seen pain conditions. Acupuncture is already being successfully and meaningfully utilized by the Veterans Administration and various branches of the U.S. Military, in some studies demonstrably decreasing the volume of opioids prescribed when included in care.展开更多
AIM: To compare XELOX and FOLFOX4 as colon cancer adjuvant chemotherapy based on MOSAIC and No. 16968 trails from Chinese cost-effectiveness perspective. METHODS: A decision-analytic Markov model was developed to comp...AIM: To compare XELOX and FOLFOX4 as colon cancer adjuvant chemotherapy based on MOSAIC and No. 16968 trails from Chinese cost-effectiveness perspective. METHODS: A decision-analytic Markov model was developed to compare the FOLFOX4 and XELOX regimens based MOSAIC and No. 16968 trial. Five states were included in our Markov model: well (state 1), minor toxicity (state 2), major toxicity (state 3), quitting adjuvant chemotherapy (state 4), and death due to adjuvant chemotherapy (state 5). Transitions among the 5 states were assumed to be Markovian. Costs were calculated from the perspective of the Chinese health-care payer. The utility data were taken from published studies. Sensitivity analyses were used to explore the impact of uncertainty factors in this cost-effectiveness analysis. RESULTS: Total direct costs of FOLFOX4 and XELOX per patient were $ 19884.96 +/- 4280.30 and $ 18113.25 +/- 3122.20, respectively. The total fees related to adverse events per patient during the entire treatment were $ 204.75 +/- 16.80 for the XELOX group, and $ 873.72 +/- 27.60 for the FOLFOX4 group, and the costs for travel and absenteeism per patient were $ 18495.00 for the XELOX group and $ 21,352.68 for the FOLFOX4 group. The base-case analysis showed that FOLFOX4 was estimated to produce an additional 0.06 in quality adjusted life years (QALYs) at an additional cost of $ 3950.47 when compared to the XELOX regimen over the model time horizon. The cost per QALY gained was $ 8047.30 in the XELOX group, which was $ 900.98 less than in the FOLFOX4 group ($ 8948.28). The one way sensitivity analysis demonstrated that the utility for the well state and minor toxicity state greatly influenced the incremental cost-effectiveness ratio of FOLFOX4. CONCLUSION: In term of cost-comparison, XELOX is expected to dominate FOLFOX4 regimes; Therefore, XELOX provides a more cost-effective adjuvant chemotherapy for colon cancer patients in China. c 2014 Baishideng Publishing Group Inc. All rights reserved.展开更多
Objective: Zoledronic acid (ZOL) is a nitrogen-containing bisphosphonate that induces osteoclast apoptosis and inhibits bone resorption. Adding ZOL to neoadjuvant chemotherapy has been shown to have potential anticanc...Objective: Zoledronic acid (ZOL) is a nitrogen-containing bisphosphonate that induces osteoclast apoptosis and inhibits bone resorption. Adding ZOL to neoadjuvant chemotherapy has been shown to have potential anticancer benefits in women with HER2-negative breast cancer. The objective of the present study was to investigate ZOL’s cost-effectiveness from the perspective of health care payers in Japan. Methods: A Markov model was developed to evaluate the costs and effectiveness associated with ZOL + chemotherapy (CTZ) and chemotherapy (CT) alone over a 10-year time horizon. Monthly transition probabilities were estimated according to JONIE1 (Japan Organization of Neoadjuvant Innovative Expert) Study data and an extrapolated Weibull model. Health outcomes were measured in quality-adjusted life years (QALYs). Costs were calculated using year-2018 Japanese yen (JPY) (1.00 US dollars (USD) = 110.4 JPY). Model robustness was addressed through one-way and probabilistic sensitivity analysis. The costs and QALYs were discounted at a rate of 2% per year. Results: In the base case, the use of CTZ was associated with a gain of 3.94 QALYs. The incremental cost per QALY of the CTZ gain was 681,056.1 JPY (6168.99 USD) per QALY. Conclusion: It is convincing that neoadjuvant CTZ for patients with breast cancer would be expected to have statistically significant clinical efficacy. Addition of ZOL to CT might be a cost-effective option compared with CT alone.展开更多
Ammonium is an important nutrient in primary production; however, high ammonium loads can cause eutrophication of natural waterways, contributing to undesirable changes in water quality and ecosystem structure. While ...Ammonium is an important nutrient in primary production; however, high ammonium loads can cause eutrophication of natural waterways, contributing to undesirable changes in water quality and ecosystem structure. While ammonium pollution comes from diffuse agricultural sources, making control difficult, industrial or municipal point sources such as wastewater treatment plants also contribute significantly to overall ammonium pollution.These latter sources can be targeted more readily to control ammonium release into water systems. To assist policy makers and researchers in understanding the diversity of treatment options and the best option for their circumstance, this paper produces a comprehensive review of existing treatment options for ammonium removal with a particular focus on those technologies which offer the highest rates of removal and cost-effectiveness. Ion exchange and adsorption material methods are simple to apply, cost-effective, environmentally friendly technologies which are quite efficient at removing ammonium from treated water. The review presents a list of adsorbents from the literature, their adsorption capacities and other parameters needed for ammonium removal. Further, the preparation of adsorbents with high ammonium removal capacities and new adsorbents is discussed in the context of their relative cost, removal efficiencies, and limitations. Efficient, cost-effective, and environmental friendly adsorbents for the removal of ammonium on a large scale for commercial or water treatment plants are provided. In addition, future perspectives on removing ammonium using adsorbents are presented.展开更多
Aim: To assess whether the use of direct real- time polymerase chain reaction (PCR) on smear-positive sputa can be cost-effective, by speciating mycobacteria earlier than current methods and thereby preventing unneces...Aim: To assess whether the use of direct real- time polymerase chain reaction (PCR) on smear-positive sputa can be cost-effective, by speciating mycobacteria earlier than current methods and thereby preventing unnecessary screening tests as part of the contact tracing process. Methods: A retrospective study of all patients with smear-positive sputa in a Liverpool teach-ing hospital between 2004 and 2007. All the PCRs performed on these patients were re-viewed and compared them with their myco-bacterial culture results. Unit costs for PCR, chest X-ray (CXR), tuberculin skin test (TST), interferon-gamma (IFN-γ) and medical/nursing time were conservatively estimated at ￡50, ￡11, ￡10, ￡40 and ￡30 respectively. The total PCR costs were compared with the costs of unnec-essary follow up of patients, negative for My-cobacterium tuberculosis (MTB) by PCR, sub-sequently confirmed to be MTB culture nega-tive. Results: 203 smear-positive patients under-went direct PCR testing. 126 (62%) patients grew Mycobacterium tuberculosis (MTB), 74 (37%) had environmental mycobacterial infection (EMI) and 3 (1%) were culture negative. Of the 126 patients’ culture positive MTB patients, 123 were PCR positive and 3 PCR negative. Of the 77 pa-tients that were culture negative for MTB, 75 were PCR negative and 2 PCR positive The sensitivity, specificity, positive and negative predictive values for direct PCR versus MTB culture were 98%, 96%, 98% and 97% respec-tively. Total costs of all PCRs performed amounted to ￡10,150. The cost of contact pro-cedures for PCR-negative and MTB culture- negative index cases was estimated at ￡19,650. This equated to a total saving of ￡9,500 in contact tracing costs. Conclusions: Direct PCR examination testing of smear-positive patients can be cost-effective in areas where there is a high incidence of EMI.展开更多
AIM:To study the cost-effectiveness of high-resolution microendoscopy(HRME)in an esophageal squamous cell carcinoma(ESCC)screening program in China.METHODS:A decision analytic Markov model of ESCC was developed.Separa...AIM:To study the cost-effectiveness of high-resolution microendoscopy(HRME)in an esophageal squamous cell carcinoma(ESCC)screening program in China.METHODS:A decision analytic Markov model of ESCC was developed.Separate model analyses were conducted for cohorts consisting of an averagerisk population or a high-risk population in China.Hypothetical 50-year-old individuals were followed until age 80 or death.We compared three different strategies for both cohorts:(1)no screening;(2)standard endoscopic screening with Lugol’s iodine staining;and(3)endoscopic screening with Lugol’s iodine staining and an HRME.Model parameters were estimated from the literature as well as from GLOBOCAN,the Cancer Incidence and Mortality Worldwide cancer database.Health states in the model included non-neoplasia,mild dysplasia,moderate dysplasia,high-grade dysplasia,intramucosal carcinoma,operable cancer,inoperable cancer,and death.Separate ESCC incidence transition rates were generated for the average-risk and high-risk populations.Costs in Chinese currency were converted to international dollars(I$)and were adjusted to 2012dollars using the Consumer Price Index.RESULTS:The main outcome measurements for this study were quality-adjusted life years(QALYs)and incremental cost-effectiveness ratio(ICER).For the average-risk population,the HRME screening strategy produced 0.043 more QALYs than the no screening strategy at an additional cost of I$646,resulting in an ICER of I$11808 per QALY gained.Standard endoscopic screening was weakly dominated.Among the high-risk population,when the HRME screening strategy was compared with the standard screening strategy,the ICER was I$8173 per QALY.For both the high-risk and average-risk screening populations,the HRME screening strategy appeared to be the most cost-effective strategy,producing ICERs below the willingness-topay threshold,I$23500 per QALY.One-way sensitivity analysis showed that,for the average-risk population,higher specificity of Lugol’s iodine(>40%)and lower specificity of HRME(<70%)could make Lugol’s iodine screening cost-effective.For the high-risk population,the results of the model were not substantially affected by varying the follow-up rate after Lugol’s iodine screening,Lugol’s iodine test characteristics(sensitivity and specificity),or HRME specificity.CONCLUSION:The incorporation of HRME into an ESCC screening program could be cost-effective in China.Larger studies of HRME performance are needed to confirm these findings.展开更多
BACKGROUND: Transcatheter arterial chemoembolization(TACE) and TACE in combination with sorafenib(TACEsorafenib) have shown a significant survival benefit for the treatment of unresectable hepatocellular carcinoma(HCC...BACKGROUND: Transcatheter arterial chemoembolization(TACE) and TACE in combination with sorafenib(TACEsorafenib) have shown a significant survival benefit for the treatment of unresectable hepatocellular carcinoma(HCC). Adopting either as a first-line therapy carries major cost and resource implications. The objective of this study was to estimate the relative cost-effectiveness of TACE against TACE-sorafenib for unresectable HCC using a decision analytic model.METHODS: A Markov cohort model was developed to compare TACE and TACE-sorafenib. Transition probabilities and utilities were obtained from systematic literature reviews, and costs were obtained from West China Hospital, Sichuan University, China. Survival benefits were reported in quality-adjusted life-years(QALYs). The incremental cost-effectiveness ratio(ICER) was calculated. Sensitive analysis was performed by varying potentially modifiable parameters of the model.RESULTS: The base-case analysis showed that TACE cost $26 951 and yielded survival of 0.71 QALYs, and TACE-sorafenib cost $44 542 and yielded survival of 1.02 QALYs in the entire treatment. The ICER of TACE-sorafenib versus TACE was $56 745 per QALY gained, which was above threshold for cost-effectiveness in China. Sensitivity analysis revealed that the major driver of ICER was the cost post TACE-sorafenib therapy with stable state.CONCLUSION: TACE is a more cost-effective strategy than TACE-sorafenib for the treatment of unresectable HCC.展开更多
Objective:To develop a rapid,cost effective RT-PCR method for the mass scale diagnosis of such diseases at the vireraia stage to find out the actual disease burden in that area.Methods:For this purpose,cases with the ...Objective:To develop a rapid,cost effective RT-PCR method for the mass scale diagnosis of such diseases at the vireraia stage to find out the actual disease burden in that area.Methods:For this purpose,cases with the history of only short febrile illness were considered.Thus 157 samples with the history of dengue/chikungunya like illness and only 58 samples with a history of acute encephalitis syndrome(AES)were selected.Results:Out of 157 samples,42 and 74 were detected as dengue and chikungunya,respectively and out of 58 AES cases only 23 could be detected as Japanese encephalitis by this RT-PCR method.Conclusions:This cost effective RT-PCR method can detect the total positive cases that remain undetected by EL1SA method.Moreover,this method is capable to detect the viral RNA from patients'sera even after the appearance of IgM antibody at one fifth costs as compared with the other commercially available kits.展开更多
A cost-effective ultra-dense wavelength-division-multiplexed passive optical network(UD-WDM PON) with speed of 12.5 Gbit/s and channel spacing of 12.5 GHz is proposed and demonstrated. The distributed feedback(DFB) la...A cost-effective ultra-dense wavelength-division-multiplexed passive optical network(UD-WDM PON) with speed of 12.5 Gbit/s and channel spacing of 12.5 GHz is proposed and demonstrated. The distributed feedback(DFB) lasers modulated in 4-level pulse amplitude modulation(4-PAM) format are used for downstream links, and the reflective semiconductor optical amplifiers(RSOAs) together with an optical frequency comb modulated in quadrature phase shift keying(QPSK) format are used for upstream links. We can achieve the error-free transmission of the upstream signals with speed of 12.5 Gbit/s even after 20 km single-mode fiber(SMF). The power penalty obtained by using the frequency comb generator instead of a tunable laser is around 0.5 d B. By using 11 DFB lasers and a set of intensity and phase modulators, it is possible to provide the seed light for 297 optical network units(ONUs) within the C-band.展开更多
Mesh hernia repair is one of the commonest open techniques of inguinal hernia repair.The main limiting factor in the use of new meshes is the cost.We carried out a prospective randomized double blind study and compris...Mesh hernia repair is one of the commonest open techniques of inguinal hernia repair.The main limiting factor in the use of new meshes is the cost.We carried out a prospective randomized double blind study and comprising of a hundred patients with 100 inguinal hernias admitted consecutively for elective surgery,divided into the polypropylene mesh(PPM)group and the mosquito net mesh(MNM)group each containing fifty patients.All cases were completed successfully and results revealed no difference in two groups.The results of the present study,in consistent with the published literature,reveal that the cheap indigenous mosquito mesh,which has similar properties of an imported mesh,can be safely used for tension-free inguinal hernia repair in adults.Further trials with a larger number of patients and longer follow-ups are justified and recommended.展开更多
Anthrax is an infection caused by bacteria and it affects both human and animal populations. The disease can be categorized under zoonotic diseases and humans can contract infections through contact with infected anim...Anthrax is an infection caused by bacteria and it affects both human and animal populations. The disease can be categorized under zoonotic diseases and humans can contract infections through contact with infected animals, ingest contaminated dairy and animal products. In this paper, we developed a mathematical model for anthrax transmission dynamics in both human and animal populations with optimal control. The qualitative solution of the model behaviour was analyzed by determining Rhv, equilibrium points and sensitivity analysis. A vaccination class was incorporated into the model with waning immunity. Local and global stability of the model’s equilibria was found to be locally asymptotically stable whenever Rhv Rhv. It was revealed that reducing animal and human interaction rate, would decrease Rhv. We extended the model to optimal control in order to find the best control strategy in reducing anthrax infections. It showed that the effective strategy in combating the anthrax epidemics is vaccination of animals and prevention of humans.展开更多
AIM To review the early and more recent studies of Bivalirudin, to assess the safety, effectiveness, and cost benefits of this drug.METHODS Literature search of MEDLINE and Pub Med databases from 1990 to 2017 using ke...AIM To review the early and more recent studies of Bivalirudin, to assess the safety, effectiveness, and cost benefits of this drug.METHODS Literature search of MEDLINE and Pub Med databases from 1990 to 2017 using keywords as "bivalirubin" and "angiomax", combined with the words "safety", "effectiveness", "efficiency", "side effects", "toxicity", "adverse effect", and "adverse drug reaction".RESULTS A total of 66 publications were reviewed. The changes in clinical practice and differences in clinical protocols make it difficult to do direct comparisons of studies among each other. However, most trials showed decreased bleeding complications with bivalirudin, although ischemic complications and mortality were mostly comparable, with some favor towards bivalirudin.CONCLUSION Bivalirudin and heparin are both acceptable options according to current ACA/AHA guidelines. Authors conclude however, that that due to bivalirudin safer bleeding profile, it should be the preferred medication for anticoagulation.展开更多
In today’s world, Cloud Computing (CC) enables the users to accesscomputing resources and services over cloud without any need to own the infrastructure. Cloud Computing is a concept in which a network of devices, lo...In today’s world, Cloud Computing (CC) enables the users to accesscomputing resources and services over cloud without any need to own the infrastructure. Cloud Computing is a concept in which a network of devices, located inremote locations, is integrated to perform operations like data collection, processing, data profiling and data storage. In this context, resource allocation and taskscheduling are important processes which must be managed based on the requirements of a user. In order to allocate the resources effectively, hybrid cloud isemployed since it is a capable solution to process large-scale consumer applications in a pay-by-use manner. Hence, the model is to be designed as a profit-driven framework to reduce cost and make span. With this motivation, the currentresearch work develops a Cost-Effective Optimal Task Scheduling Model(CEOTS). A novel algorithm called Target-based Cost Derivation (TCD) modelis used in the proposed work for hybrid clouds. Moreover, the algorithm workson the basis of multi-intentional task completion process with optimal resourceallocation. The model was successfully simulated to validate its effectivenessbased on factors such as processing time, make span and efficient utilization ofvirtual machines. The results infer that the proposed model outperformed theexisting works and can be relied in future for real-time applications.展开更多
AIM: To analyze the cost-effectiveness of the diagnosis of solitary pulmonary nodule(SPN) in China. METHODS: Decision analysis models were constructed to assess the cost-effectiveness of four strategies for the manage...AIM: To analyze the cost-effectiveness of the diagnosis of solitary pulmonary nodule(SPN) in China. METHODS: Decision analysis models were constructed to assess the cost-effectiveness of four strategies for the management of SPN: computed tomography(CT) alone, CT plus CT-guided automated cutting needle biopsy(ACNB), CT plus positron emission tomography/computed tomography(PET/CT), CT plus diffusionweighted magnetic resonance imaging(DWI) plus PET/CT. RESULTS: The prevalence of lung cancer among SPN discovered in the clinical setting was approximately 50%. The CT plus ACNB strategy had higher diagnostic accuracies(87% vs 81%), with a cost saving of $1945 RMB per patient, and reducing unnecessary thoracotomy by 16.5%; this was associated with a 4.5% missed diagnosis rate. CT plus DWI plus PET/CT strategy also had higher accuracies(95% vs 81%), with a cost saving of $590 RMB per patient, and reducing unneces-sary thoracotomy by 13.5%; this was accompanied by 0.3% missed diagnosis rate. CT plus PET strategy is cost effective at a prevalence rate of 0-34%, but there was a larger prevalence range of lung cancer for CT plus ACNB strategy(from 0 to 0.6) and CT plus DWI plus PET/CT strategy(from 0 to 0.64). CONCLUSION: CT plus DWI plus PET/CT strategy was cost-effective, and had a higher accuracy accompanied by a lower missed diagnosis rate than CT plus ACNB strategy.展开更多
Objective: To review our open partial nephrectomy (OPN) experience and compare to known robotic partial nephrectomy (RPN) data to determine whether length of stay (LOS) and morbidity are significant drivers in the sur...Objective: To review our open partial nephrectomy (OPN) experience and compare to known robotic partial nephrectomy (RPN) data to determine whether length of stay (LOS) and morbidity are significant drivers in the surgical approach employed for partial nephrectomy. Methods: We reviewed our OPN experience during the last 3 years examining age, tumor size, LOS, pathology, blood loss, complications, recurences, and deaths. Results: Seventy-five patients underwent OPN during this period. Mean age was 59 years, tumor size 2.8 cm, percent malignant 75%, estimated blood loss 350 cc. With a median follow-up of 18 months, there was one urinoma managed by drain-age, one pseudo aneurysm that required embolization and one pulmonary embolism that required anticoagulation. There were no readmissions, no tumor recurences, and no deaths. Our major complication rate was 4% as compared to other trials that re-ported major complication rates between 1% - 9% for RPN and between 3% - 24% for OPN. In the first half of the experience (n = 37), median LOS was 57 hours. Using a pathway encouraging early ambulation and smaller incisions in the second half of the experience (n = 38), median LOS was 35 hours. This is much shorter than reported RPN LOS of 62 - 67 hours and OPN LOS of 108 - 142 hours. Conclusion: OPN can be performed safely and effectively with one night hospital stay. This provides a more cost-effective approach to partial nephrectomy with similar or better complication rates and calls into question the main value drivers of RPN.展开更多
Background and Objective: A multitude of large cohort studies have collected data on incidence and covariates/risk factors of various chronic diseases. However, approaches for utilization of these large data and trans...Background and Objective: A multitude of large cohort studies have collected data on incidence and covariates/risk factors of various chronic diseases. However, approaches for utilization of these large data and translation of the valuable results to inform and guide clinical disease prevention practice are not well developed. In this paper, we proposed, based on large cohort study data, a novel conceptual cost-effective disease prevention design strategy for a target group when it is not affordable to include everyone in the target group for intervention. Methods and Results: Data from American Indian participants (n = 3516;2056 women) aged 45 - 74 years in the Strong Heart Study, the diabetes risk prediction model from the study, a utility function, and regression models were used. A conceptual cost-effective disease prevention design strategy based on large cohort data was initiated. The application of the proposed strategy for diabetes prevention was illustrated. Discussion: The strategy may provide reasonable solutions to address cost-effective prevention design issues. These issues include complex associations of a disease with its significant risk factors, cost-effectively selecting individuals at high risk of developing disease to undergo intervention, individual differences in health conditions, choosing intervention risk factors and setting their appropriate, attainable, gradual and adaptive goal levels for different subgroups, and assessing effectiveness of the prevention program. Conclusions: The strategy and methods shown in the illustrative example can also be analogously adopted and applied to other diseases preventions. The proposed strategy provides a way to translate and apply epidemiological study results to clinical disease prevention practice.展开更多
基金supported by the social development project of the National Social Science Fund Project(No.17BTQ063)National Natural Science Foundation of China(72174094).
文摘Stroke,which is the second leading cause of mortality worldwide and the third leading cause of death and disability combined,[1]necessitates cost-effective rehabilitation interventions.Acupuncture is a traditional Chinese medicine therapy that is increasingly recognized as a complementary stroke therapy.
文摘With the continuous application of new technologies in reconnaissance and attack, false camouflage plays a more important role in improving the survivability of targets, and the number of decoys plays a crucial role in the camouflaging effect. Based on the concept of cost-effectiveness ratio, according to the newly formulated Johnson criterion and the view of discovery and destruction, this paper proposes to take the identification probability as the probability of being destroyed and uses mathematical formulas to calculate the cost of a single use decoy. On this basis, a cost-effectiveness ratio model is established, with the product of the increase in the survival probability of the target and the cost of the target as the benefit, and the sum of the product of the probability of being destroyed and the cost of the decoy and the cost of a single use as the consumption cost. The model is calculated and analyzed, and the number of decoys that conform to the actual situation is obtained.
文摘The United States （U.S.） is facing a national opioid epidemic, and medical systems are in need of non- pharmacologic strategies that can be employed to decrease the public＇s opioid dependence. Acupuncture has emerged as a powerful, evidence-based, safe, cost-effective, and available treatment modality suitable to meeting this need. Acupuncture has been shown to be effective for the management of numerous types of pain conditions, and mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives. Further, acupuncture＇s cost-effectiveness can dramatically decrease health care expenditures, both from the standpoint of treating acute pain and through avoiding addiction to opioids that requires costly care, destroys quality of life, and can lead to fatal overdose. Numerous federal regulatory agencies have advised or mandated that healthcare systems and providers offer non-pharmacologic treatment options for pain. Acupuncture stands out as the most evidence-based, immediately available choice to fulfil these calls. Acupuncture can safely, easily, and cost-effectively be incorporated into hospital settings as diverse as the emergency department, labor and delivery suites, andneonatal intensive care units to treat a variety of commonly seen pain conditions. Acupuncture is already being successfully and meaningfully utilized by the Veterans Administration and various branches of the U.S. Military, in some studies demonstrably decreasing the volume of opioids prescribed when included in care.
基金Supported by National Natural Science Foundation of China,No.81071862
文摘AIM: To compare XELOX and FOLFOX4 as colon cancer adjuvant chemotherapy based on MOSAIC and No. 16968 trails from Chinese cost-effectiveness perspective. METHODS: A decision-analytic Markov model was developed to compare the FOLFOX4 and XELOX regimens based MOSAIC and No. 16968 trial. Five states were included in our Markov model: well (state 1), minor toxicity (state 2), major toxicity (state 3), quitting adjuvant chemotherapy (state 4), and death due to adjuvant chemotherapy (state 5). Transitions among the 5 states were assumed to be Markovian. Costs were calculated from the perspective of the Chinese health-care payer. The utility data were taken from published studies. Sensitivity analyses were used to explore the impact of uncertainty factors in this cost-effectiveness analysis. RESULTS: Total direct costs of FOLFOX4 and XELOX per patient were $ 19884.96 +/- 4280.30 and $ 18113.25 +/- 3122.20, respectively. The total fees related to adverse events per patient during the entire treatment were $ 204.75 +/- 16.80 for the XELOX group, and $ 873.72 +/- 27.60 for the FOLFOX4 group, and the costs for travel and absenteeism per patient were $ 18495.00 for the XELOX group and $ 21,352.68 for the FOLFOX4 group. The base-case analysis showed that FOLFOX4 was estimated to produce an additional 0.06 in quality adjusted life years (QALYs) at an additional cost of $ 3950.47 when compared to the XELOX regimen over the model time horizon. The cost per QALY gained was $ 8047.30 in the XELOX group, which was $ 900.98 less than in the FOLFOX4 group ($ 8948.28). The one way sensitivity analysis demonstrated that the utility for the well state and minor toxicity state greatly influenced the incremental cost-effectiveness ratio of FOLFOX4. CONCLUSION: In term of cost-comparison, XELOX is expected to dominate FOLFOX4 regimes; Therefore, XELOX provides a more cost-effective adjuvant chemotherapy for colon cancer patients in China. c 2014 Baishideng Publishing Group Inc. All rights reserved.
文摘Objective: Zoledronic acid (ZOL) is a nitrogen-containing bisphosphonate that induces osteoclast apoptosis and inhibits bone resorption. Adding ZOL to neoadjuvant chemotherapy has been shown to have potential anticancer benefits in women with HER2-negative breast cancer. The objective of the present study was to investigate ZOL’s cost-effectiveness from the perspective of health care payers in Japan. Methods: A Markov model was developed to evaluate the costs and effectiveness associated with ZOL + chemotherapy (CTZ) and chemotherapy (CT) alone over a 10-year time horizon. Monthly transition probabilities were estimated according to JONIE1 (Japan Organization of Neoadjuvant Innovative Expert) Study data and an extrapolated Weibull model. Health outcomes were measured in quality-adjusted life years (QALYs). Costs were calculated using year-2018 Japanese yen (JPY) (1.00 US dollars (USD) = 110.4 JPY). Model robustness was addressed through one-way and probabilistic sensitivity analysis. The costs and QALYs were discounted at a rate of 2% per year. Results: In the base case, the use of CTZ was associated with a gain of 3.94 QALYs. The incremental cost per QALY of the CTZ gain was 681,056.1 JPY (6168.99 USD) per QALY. Conclusion: It is convincing that neoadjuvant CTZ for patients with breast cancer would be expected to have statistically significant clinical efficacy. Addition of ZOL to CT might be a cost-effective option compared with CT alone.
基金the School of Environment,Griffith University,for providing Ph.D.scholarship and funding for J.H
文摘Ammonium is an important nutrient in primary production; however, high ammonium loads can cause eutrophication of natural waterways, contributing to undesirable changes in water quality and ecosystem structure. While ammonium pollution comes from diffuse agricultural sources, making control difficult, industrial or municipal point sources such as wastewater treatment plants also contribute significantly to overall ammonium pollution.These latter sources can be targeted more readily to control ammonium release into water systems. To assist policy makers and researchers in understanding the diversity of treatment options and the best option for their circumstance, this paper produces a comprehensive review of existing treatment options for ammonium removal with a particular focus on those technologies which offer the highest rates of removal and cost-effectiveness. Ion exchange and adsorption material methods are simple to apply, cost-effective, environmentally friendly technologies which are quite efficient at removing ammonium from treated water. The review presents a list of adsorbents from the literature, their adsorption capacities and other parameters needed for ammonium removal. Further, the preparation of adsorbents with high ammonium removal capacities and new adsorbents is discussed in the context of their relative cost, removal efficiencies, and limitations. Efficient, cost-effective, and environmental friendly adsorbents for the removal of ammonium on a large scale for commercial or water treatment plants are provided. In addition, future perspectives on removing ammonium using adsorbents are presented.
文摘Aim: To assess whether the use of direct real- time polymerase chain reaction (PCR) on smear-positive sputa can be cost-effective, by speciating mycobacteria earlier than current methods and thereby preventing unnecessary screening tests as part of the contact tracing process. Methods: A retrospective study of all patients with smear-positive sputa in a Liverpool teach-ing hospital between 2004 and 2007. All the PCRs performed on these patients were re-viewed and compared them with their myco-bacterial culture results. Unit costs for PCR, chest X-ray (CXR), tuberculin skin test (TST), interferon-gamma (IFN-γ) and medical/nursing time were conservatively estimated at ￡50, ￡11, ￡10, ￡40 and ￡30 respectively. The total PCR costs were compared with the costs of unnec-essary follow up of patients, negative for My-cobacterium tuberculosis (MTB) by PCR, sub-sequently confirmed to be MTB culture nega-tive. Results: 203 smear-positive patients under-went direct PCR testing. 126 (62%) patients grew Mycobacterium tuberculosis (MTB), 74 (37%) had environmental mycobacterial infection (EMI) and 3 (1%) were culture negative. Of the 126 patients’ culture positive MTB patients, 123 were PCR positive and 3 PCR negative. Of the 77 pa-tients that were culture negative for MTB, 75 were PCR negative and 2 PCR positive The sensitivity, specificity, positive and negative predictive values for direct PCR versus MTB culture were 98%, 96%, 98% and 97% respec-tively. Total costs of all PCRs performed amounted to ￡10,150. The cost of contact pro-cedures for PCR-negative and MTB culture- negative index cases was estimated at ￡19,650. This equated to a total saving of ￡9,500 in contact tracing costs. Conclusions: Direct PCR examination testing of smear-positive patients can be cost-effective in areas where there is a high incidence of EMI.
基金Supported by National Institutes of Health,United States,No.R01-CA140574 and No.U01-CA152926(to Hur C)No.R21-CA156704 and No.R01-CA181275(to Anandasabapathy S)and No.K25-CA133141(to Kong CY)
文摘AIM:To study the cost-effectiveness of high-resolution microendoscopy(HRME)in an esophageal squamous cell carcinoma(ESCC)screening program in China.METHODS:A decision analytic Markov model of ESCC was developed.Separate model analyses were conducted for cohorts consisting of an averagerisk population or a high-risk population in China.Hypothetical 50-year-old individuals were followed until age 80 or death.We compared three different strategies for both cohorts:(1)no screening;(2)standard endoscopic screening with Lugol’s iodine staining;and(3)endoscopic screening with Lugol’s iodine staining and an HRME.Model parameters were estimated from the literature as well as from GLOBOCAN,the Cancer Incidence and Mortality Worldwide cancer database.Health states in the model included non-neoplasia,mild dysplasia,moderate dysplasia,high-grade dysplasia,intramucosal carcinoma,operable cancer,inoperable cancer,and death.Separate ESCC incidence transition rates were generated for the average-risk and high-risk populations.Costs in Chinese currency were converted to international dollars(I$)and were adjusted to 2012dollars using the Consumer Price Index.RESULTS:The main outcome measurements for this study were quality-adjusted life years(QALYs)and incremental cost-effectiveness ratio(ICER).For the average-risk population,the HRME screening strategy produced 0.043 more QALYs than the no screening strategy at an additional cost of I$646,resulting in an ICER of I$11808 per QALY gained.Standard endoscopic screening was weakly dominated.Among the high-risk population,when the HRME screening strategy was compared with the standard screening strategy,the ICER was I$8173 per QALY.For both the high-risk and average-risk screening populations,the HRME screening strategy appeared to be the most cost-effective strategy,producing ICERs below the willingness-topay threshold,I$23500 per QALY.One-way sensitivity analysis showed that,for the average-risk population,higher specificity of Lugol’s iodine(>40%)and lower specificity of HRME(<70%)could make Lugol’s iodine screening cost-effective.For the high-risk population,the results of the model were not substantially affected by varying the follow-up rate after Lugol’s iodine screening,Lugol’s iodine test characteristics(sensitivity and specificity),or HRME specificity.CONCLUSION:The incorporation of HRME into an ESCC screening program could be cost-effective in China.Larger studies of HRME performance are needed to confirm these findings.
文摘BACKGROUND: Transcatheter arterial chemoembolization(TACE) and TACE in combination with sorafenib(TACEsorafenib) have shown a significant survival benefit for the treatment of unresectable hepatocellular carcinoma(HCC). Adopting either as a first-line therapy carries major cost and resource implications. The objective of this study was to estimate the relative cost-effectiveness of TACE against TACE-sorafenib for unresectable HCC using a decision analytic model.METHODS: A Markov cohort model was developed to compare TACE and TACE-sorafenib. Transition probabilities and utilities were obtained from systematic literature reviews, and costs were obtained from West China Hospital, Sichuan University, China. Survival benefits were reported in quality-adjusted life-years(QALYs). The incremental cost-effectiveness ratio(ICER) was calculated. Sensitive analysis was performed by varying potentially modifiable parameters of the model.RESULTS: The base-case analysis showed that TACE cost $26 951 and yielded survival of 0.71 QALYs, and TACE-sorafenib cost $44 542 and yielded survival of 1.02 QALYs in the entire treatment. The ICER of TACE-sorafenib versus TACE was $56 745 per QALY gained, which was above threshold for cost-effectiveness in China. Sensitivity analysis revealed that the major driver of ICER was the cost post TACE-sorafenib therapy with stable state.CONCLUSION: TACE is a more cost-effective strategy than TACE-sorafenib for the treatment of unresectable HCC.
基金supported by the Department of Science and Technology,Goverment of West Bengal.India[grant No.705(Sanc.)ST/P/S&T/9G-27/2007]
文摘Objective:To develop a rapid,cost effective RT-PCR method for the mass scale diagnosis of such diseases at the vireraia stage to find out the actual disease burden in that area.Methods:For this purpose,cases with the history of only short febrile illness were considered.Thus 157 samples with the history of dengue/chikungunya like illness and only 58 samples with a history of acute encephalitis syndrome(AES)were selected.Results:Out of 157 samples,42 and 74 were detected as dengue and chikungunya,respectively and out of 58 AES cases only 23 could be detected as Japanese encephalitis by this RT-PCR method.Conclusions:This cost effective RT-PCR method can detect the total positive cases that remain undetected by EL1SA method.Moreover,this method is capable to detect the viral RNA from patients'sera even after the appearance of IgM antibody at one fifth costs as compared with the other commercially available kits.
基金supported by the National Natural Science Foundation of China(No.61475015)
文摘A cost-effective ultra-dense wavelength-division-multiplexed passive optical network(UD-WDM PON) with speed of 12.5 Gbit/s and channel spacing of 12.5 GHz is proposed and demonstrated. The distributed feedback(DFB) lasers modulated in 4-level pulse amplitude modulation(4-PAM) format are used for downstream links, and the reflective semiconductor optical amplifiers(RSOAs) together with an optical frequency comb modulated in quadrature phase shift keying(QPSK) format are used for upstream links. We can achieve the error-free transmission of the upstream signals with speed of 12.5 Gbit/s even after 20 km single-mode fiber(SMF). The power penalty obtained by using the frequency comb generator instead of a tunable laser is around 0.5 d B. By using 11 DFB lasers and a set of intensity and phase modulators, it is possible to provide the seed light for 297 optical network units(ONUs) within the C-band.
文摘Mesh hernia repair is one of the commonest open techniques of inguinal hernia repair.The main limiting factor in the use of new meshes is the cost.We carried out a prospective randomized double blind study and comprising of a hundred patients with 100 inguinal hernias admitted consecutively for elective surgery,divided into the polypropylene mesh(PPM)group and the mosquito net mesh(MNM)group each containing fifty patients.All cases were completed successfully and results revealed no difference in two groups.The results of the present study,in consistent with the published literature,reveal that the cheap indigenous mosquito mesh,which has similar properties of an imported mesh,can be safely used for tension-free inguinal hernia repair in adults.Further trials with a larger number of patients and longer follow-ups are justified and recommended.
文摘Anthrax is an infection caused by bacteria and it affects both human and animal populations. The disease can be categorized under zoonotic diseases and humans can contract infections through contact with infected animals, ingest contaminated dairy and animal products. In this paper, we developed a mathematical model for anthrax transmission dynamics in both human and animal populations with optimal control. The qualitative solution of the model behaviour was analyzed by determining Rhv, equilibrium points and sensitivity analysis. A vaccination class was incorporated into the model with waning immunity. Local and global stability of the model’s equilibria was found to be locally asymptotically stable whenever Rhv Rhv. It was revealed that reducing animal and human interaction rate, would decrease Rhv. We extended the model to optimal control in order to find the best control strategy in reducing anthrax infections. It showed that the effective strategy in combating the anthrax epidemics is vaccination of animals and prevention of humans.
文摘AIM To review the early and more recent studies of Bivalirudin, to assess the safety, effectiveness, and cost benefits of this drug.METHODS Literature search of MEDLINE and Pub Med databases from 1990 to 2017 using keywords as "bivalirubin" and "angiomax", combined with the words "safety", "effectiveness", "efficiency", "side effects", "toxicity", "adverse effect", and "adverse drug reaction".RESULTS A total of 66 publications were reviewed. The changes in clinical practice and differences in clinical protocols make it difficult to do direct comparisons of studies among each other. However, most trials showed decreased bleeding complications with bivalirudin, although ischemic complications and mortality were mostly comparable, with some favor towards bivalirudin.CONCLUSION Bivalirudin and heparin are both acceptable options according to current ACA/AHA guidelines. Authors conclude however, that that due to bivalirudin safer bleeding profile, it should be the preferred medication for anticoagulation.
文摘In today’s world, Cloud Computing (CC) enables the users to accesscomputing resources and services over cloud without any need to own the infrastructure. Cloud Computing is a concept in which a network of devices, located inremote locations, is integrated to perform operations like data collection, processing, data profiling and data storage. In this context, resource allocation and taskscheduling are important processes which must be managed based on the requirements of a user. In order to allocate the resources effectively, hybrid cloud isemployed since it is a capable solution to process large-scale consumer applications in a pay-by-use manner. Hence, the model is to be designed as a profit-driven framework to reduce cost and make span. With this motivation, the currentresearch work develops a Cost-Effective Optimal Task Scheduling Model(CEOTS). A novel algorithm called Target-based Cost Derivation (TCD) modelis used in the proposed work for hybrid clouds. Moreover, the algorithm workson the basis of multi-intentional task completion process with optimal resourceallocation. The model was successfully simulated to validate its effectivenessbased on factors such as processing time, make span and efficient utilization ofvirtual machines. The results infer that the proposed model outperformed theexisting works and can be relied in future for real-time applications.
文摘AIM: To analyze the cost-effectiveness of the diagnosis of solitary pulmonary nodule(SPN) in China. METHODS: Decision analysis models were constructed to assess the cost-effectiveness of four strategies for the management of SPN: computed tomography(CT) alone, CT plus CT-guided automated cutting needle biopsy(ACNB), CT plus positron emission tomography/computed tomography(PET/CT), CT plus diffusionweighted magnetic resonance imaging(DWI) plus PET/CT. RESULTS: The prevalence of lung cancer among SPN discovered in the clinical setting was approximately 50%. The CT plus ACNB strategy had higher diagnostic accuracies(87% vs 81%), with a cost saving of $1945 RMB per patient, and reducing unnecessary thoracotomy by 16.5%; this was associated with a 4.5% missed diagnosis rate. CT plus DWI plus PET/CT strategy also had higher accuracies(95% vs 81%), with a cost saving of $590 RMB per patient, and reducing unneces-sary thoracotomy by 13.5%; this was accompanied by 0.3% missed diagnosis rate. CT plus PET strategy is cost effective at a prevalence rate of 0-34%, but there was a larger prevalence range of lung cancer for CT plus ACNB strategy(from 0 to 0.6) and CT plus DWI plus PET/CT strategy(from 0 to 0.64). CONCLUSION: CT plus DWI plus PET/CT strategy was cost-effective, and had a higher accuracy accompanied by a lower missed diagnosis rate than CT plus ACNB strategy.
文摘Objective: To review our open partial nephrectomy (OPN) experience and compare to known robotic partial nephrectomy (RPN) data to determine whether length of stay (LOS) and morbidity are significant drivers in the surgical approach employed for partial nephrectomy. Methods: We reviewed our OPN experience during the last 3 years examining age, tumor size, LOS, pathology, blood loss, complications, recurences, and deaths. Results: Seventy-five patients underwent OPN during this period. Mean age was 59 years, tumor size 2.8 cm, percent malignant 75%, estimated blood loss 350 cc. With a median follow-up of 18 months, there was one urinoma managed by drain-age, one pseudo aneurysm that required embolization and one pulmonary embolism that required anticoagulation. There were no readmissions, no tumor recurences, and no deaths. Our major complication rate was 4% as compared to other trials that re-ported major complication rates between 1% - 9% for RPN and between 3% - 24% for OPN. In the first half of the experience (n = 37), median LOS was 57 hours. Using a pathway encouraging early ambulation and smaller incisions in the second half of the experience (n = 38), median LOS was 35 hours. This is much shorter than reported RPN LOS of 62 - 67 hours and OPN LOS of 108 - 142 hours. Conclusion: OPN can be performed safely and effectively with one night hospital stay. This provides a more cost-effective approach to partial nephrectomy with similar or better complication rates and calls into question the main value drivers of RPN.
文摘Background and Objective: A multitude of large cohort studies have collected data on incidence and covariates/risk factors of various chronic diseases. However, approaches for utilization of these large data and translation of the valuable results to inform and guide clinical disease prevention practice are not well developed. In this paper, we proposed, based on large cohort study data, a novel conceptual cost-effective disease prevention design strategy for a target group when it is not affordable to include everyone in the target group for intervention. Methods and Results: Data from American Indian participants (n = 3516;2056 women) aged 45 - 74 years in the Strong Heart Study, the diabetes risk prediction model from the study, a utility function, and regression models were used. A conceptual cost-effective disease prevention design strategy based on large cohort data was initiated. The application of the proposed strategy for diabetes prevention was illustrated. Discussion: The strategy may provide reasonable solutions to address cost-effective prevention design issues. These issues include complex associations of a disease with its significant risk factors, cost-effectively selecting individuals at high risk of developing disease to undergo intervention, individual differences in health conditions, choosing intervention risk factors and setting their appropriate, attainable, gradual and adaptive goal levels for different subgroups, and assessing effectiveness of the prevention program. Conclusions: The strategy and methods shown in the illustrative example can also be analogously adopted and applied to other diseases preventions. The proposed strategy provides a way to translate and apply epidemiological study results to clinical disease prevention practice.
