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1.
Prev Vet Med ; 230: 106284, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-39089162

RESUMEN

BACKGROUND: As low probability events, United States producers, value chain actors, and veterinary services (VS) have limited experience with identifying foreign animal disease (FAD), which can allow FADs to spread undetected. Point-of-care (POC) diagnostic testing may help reduce the time from detecting an initial suspect case to implementing actionable interventions compared to the current approach of only using laboratory diagnostic testing for disease diagnosis and confirmation. To evaluate the value of the reduced response time, we compare the associated costs between the two diagnostic approaches while accounting for the uncertainty surrounding the size of a FAD event. METHODS: We apply a state-contingent approach (SCA) to model the uncertainty surrounding a FAD through alternative events, where the event defines the scale of outbreak size and its duration. We apply this approach within a cost-benefit framework (CBA) to determine the economic value from the two testing investment strategies to help explain the policymaker's response (and costs) to alternative FAD events while also considering the cost impacts on the producers from each event. RESULTS: Compared to the current laboratory strategy, a POC strategy that reduces response time by 0.5-days (swine, cattle scenarios) and 1.5-days (poultry scenario) may provide cost-saving to both producers and public response efforts. The benefit-cost analysis further suggests that despite the higher fixed costs to adopt the POC strategy, the swine and cattle sectors may benefit while the benefits may not be as pronounced in the poultry sector. DISCUSSION: POC testing that can reduce the time between detection and response during a FAD event may be a sound strategy for public expenditure and provide cost-savings for producers, especially when minimal fixed costs are incurred. However, to fully determine the value of POC testing, the consequences (costs) associated with potential actions if something goes wrong, (e.g. false positive results), should be considered in future studies.


Asunto(s)
Análisis Costo-Beneficio , Pruebas en el Punto de Atención , Animales , Estados Unidos , Bovinos , Pruebas en el Punto de Atención/economía , Porcinos , Enfermedades de los Porcinos/diagnóstico , Enfermedades de los Porcinos/economía , Enfermedades Transmisibles Importadas/veterinaria , Enfermedades Transmisibles Importadas/diagnóstico , Enfermedades Transmisibles Importadas/prevención & control , Enfermedades Transmisibles Importadas/economía , Enfermedades de los Bovinos/diagnóstico , Enfermedades de los Bovinos/economía , Enfermedades de las Aves de Corral/diagnóstico , Enfermedades de las Aves de Corral/economía , Sistemas de Atención de Punto/economía , Aves de Corral , Brotes de Enfermedades/veterinaria , Brotes de Enfermedades/prevención & control , Brotes de Enfermedades/economía , Factores de Tiempo
2.
Int J Vet Sci Med ; 12(1): 48-59, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39010895

RESUMEN

Non-typhoidal salmonellosis (NTS) is significant and an economic burden in Nigeria. To determine whether investment in NTS control is economically justifiable, Outbreak Costing Tool (OCT) was used to estimate the robust funding of public and animal health systems for epidemio-surveillance and control of multisectoral NTS outbreaks in Nigeria. Health, production, and economic data were collected and used to populate the tool for evaluation. The multisectoral NTS burden for the year 2020 in Nigeria was US$ 930,887,379.00. Approximately 4,835 technical officers, and 3,700 non-technical staff (n = 8,535) were needed with an investment of >2.2 million work hours. The investment cost for NTS control was US$ 53,854,660.87. The non-labour-related cost was 89.21% of the total intervention costs. The overall intervention's investment was 374.15% of the estimated national and subnational systems' annual budget for diarrhoeal diseases, and the outbreak response period attracted the highest costs (53%) of the total intervention. In conclusion, intervention against NTS was beneficial (benefit - cost ratio: 17.29), hence justifying the need for multisectoral surveillance-response against NTS in Nigeria. Complex sectoral silos must give way to coordinated collaborations to optimize benefits; and over-centralization of health interventions' associated delays must be removed through decentralized sub-national-focused framework that empowers rapid investigation, response, control, data collection, and analyses. It should assist anticipatory planning, and outbreak investigation and reduce critical response time. Anticipatory planning tools, when applied pre-emptively, can benefit budgeting, identify gaps, and assist in the delivery of cost-saving and effective measures against infectious disease.

3.
Proc Natl Acad Sci U S A ; 121(22): e2320338121, 2024 May 28.
Artículo en Inglés | MEDLINE | ID: mdl-38768355

RESUMEN

Electric school buses have been proposed as an alternative to reduce the health and climate impacts of the current U.S. school bus fleet, of which a substantial share are highly polluting old diesel vehicles. However, the climate and health benefits of electric school buses are not well known. As they are substantially more costly than diesel buses, assessing their benefits is needed to inform policy decisions. We assess the health benefits of electric school buses in the United States from reduced adult mortality and childhood asthma onset risks due to exposure to ambient fine particulate matter (PM2.5). We also evaluate climate benefits from reduced greenhouse-gas emissions. We find that replacing the average diesel bus in the U.S. fleet in 2017 with an electric bus yields $84,200 in total benefits. Climate benefits amount to $40,400/bus, whereas health benefits amount to $43,800/bus due to 4.42*10-3 fewer PM2.5-attributable deaths ($40,000 of total) and 7.42*10-3 fewer PM2.5-attributable new childhood asthma cases ($3,700 of total). However, health benefits of electric buses vary substantially by driving location and model year (MY) of the diesel buses they replace. Replacing old, MY 2005 diesel buses in large cities yields $207,200/bus in health benefits and is likely cost-beneficial, although other policies that accelerate fleet turnover in these areas deserve consideration. Electric school buses driven in rural areas achieve small health benefits from reduced exposure to ambient PM2.5. Further research assessing benefits of reduced exposure to in-cabin air pollution among children riding buses would be valuable to inform policy decisions.


Asunto(s)
Contaminación del Aire , Vehículos a Motor , Material Particulado , Instituciones Académicas , Emisiones de Vehículos , Humanos , Estados Unidos , Emisiones de Vehículos/prevención & control , Material Particulado/efectos adversos , Asma/epidemiología , Asma/etiología , Asma/mortalidad , Niño , Contaminantes Atmosféricos/efectos adversos , Contaminantes Atmosféricos/análisis , Exposición a Riesgos Ambientales/efectos adversos , Electricidad , Adulto
4.
One Health ; 18: 100699, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38496339

RESUMEN

Antimicrobials are a core aspect of most livestock production systems, especially in low-and middle-income countries. They underpin the efficient use of scarce feed resources and stabilize returns on capital and labor inputs. Antimicrobial use (AMU) contributes to the production of healthy animals, yet AMU in livestock is linked to antimicrobial resistance (AMR) in animals, humans and the environment. The Vietnamese Platform for Antimicrobial Reduction in Chicken Production was implemented during 2016-2019 and was one of Southeast Asia's first interventions focused on AMU reductions in livestock production. The project targeted small-scale commercial poultry farms in the Mekong Delta region of Vietnam using a "randomized before-and-after controlled" study design. It provided farmers with a locally adapted support service (farmer training plan, advisory visits, biosecurity, and antimicrobial replacement products) to help them reduce their reliance on antimicrobials. A partial budget analysis was performed comparing the control group (status-quo) and intervention group (alternative). The median net farm-level benefit of the intervention strategies with the project's support was VND 6.78 million (interquartile range (IR) VND -71.9-89 million) per farm. Without project support the benefit was reduced to VND 5.1 million (IR VND -69.1-87.2 million) to VND 5.3 million (IR -VND 68.9-87.5 million) depending on the antimicrobial alternative product used. At the project level with a focus on AMU and its reduction, subsequently influence on the resistance reduction, our results showed that achieving resistance reduction benefits with the current knowledge and technologies required investment of at least VND 9.1 million (US$ 395.10) per farm during the project's lifetime. The results highlight the positive net profit for the majority of enrolled farms and a reasonable investments from the project. The recommendation focuses on the implementation of policies on financial support, legislation, and information as potential solutions to facilitate the application of intervention strategies to reduce AMU in poultry production.

5.
Traffic Inj Prev ; 25(3): 544-552, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38436613

RESUMEN

OBJECTIVES: Cable median barriers (CMBs) are installed on freeway medians to prevent cross-median crashes and reduce the severity of median-related crashes. Though CMBs are effective in preventing cross-median crashes, they are also known to increase the number of property damage-only (PDO) crashes. The higher frequency of PDO crashes could result in increased CMB maintenance and repair expenses. The aim of this study is to evaluate the safety impact and economic justification of CMBs in Louisiana. METHODS: Initially, a flowchart was developed using Louisiana crash data to identify targeted crashes, such as median-related and cross-median crashes. This was followed by a 3-year observational before-and-after crash analysis with an emphasis on head-on collisions and crashes involving large trucks. Using a 4-step improved prediction method, crash modification factors were then developed to quantitatively assess the impact of CMBs on crash outcomes, accounting for and adjusting to changes in the annual average daily traffic (AADT) and relevant crash frequencies before and after CMB implementation. Finally, an exhaustive benefit-cost analysis was conducted to determine the cost-effectiveness of CMBs. RESULTS: The results revealed that CMBs significantly reduced cross-median crashes of all severities. However, an increase in PDO crashes was observed in both total and median-related crashes. Large truck cross-median crashes and head-on collisions also decreased significantly after CMB implementation. Testing Level 4 (TL-4) CMBs were found to be more effective in preventing vehicles from crossing the median and in reducing crashes of higher severity levels. The benefit-cost ratios, calculated using economic crash unit costs for both total and targeted crashes, were greater than 1. Notably, the estimated benefit-cost ratios were considerably higher, demonstrating that CMBs are cost-effective countermeasures for enhancing traffic safety. CONCLUSION: This study contributes to the understanding of CMB performance from both traffic safety and economic perspectives. The findings may assist transportation agencies in making decisions regarding the management of CMB systems. Based on the comprehensive analysis of CMBs on Louisiana freeways, this project has revealed that CMBs are an effective and economically justified crash countermeasure. Thus, further implementation of CMBs is recommended until better alternatives are available.


Asunto(s)
Accidentes de Tránsito , Planificación Ambiental , Humanos , Accidentes de Tránsito/prevención & control , Análisis Costo-Beneficio , Vehículos a Motor , Transportes
6.
Water Res ; 239: 120058, 2023 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-37182309

RESUMEN

Benefit cost analysis (BCA) is frequently used to evaluate potable water infrastructure (PWI) investments. However, a limitation raised by BCA researchers is the narrow view of analysts in identifying investment impacts. In this paper, we propose a systems-thinking framework, supported by data from the literature, interviews, and macroeconomic data, to provide analysts with a more systematic and comprehensive view of investment impacts. The framework, once built, can be applied to any PWI investment question, to identify the prominent impacts that an analyst should consider taking forward through the quantification stages of the BCA process. We validate our method for identifying impacts using data from New Zealand. Our method identifies impacts that are typically not valued in BCA of PWI investments, but that are a common impact of many types of PWI investment decision. Household costs, for example, score in the Top 10 investment outcomes, but are only typically valued in ex post analyses of outbreaks. These impacts warrant attention in future benefit cost analyses. An additional contribution is the development a new betweenness importance rating, which we call flow betweenness, to evaluate each impact's prominence within the PWI socio-economic system.


Asunto(s)
Agua Potable , Análisis Costo-Beneficio , Inversiones en Salud , Abastecimiento de Agua , Nueva Zelanda
7.
Pest Manag Sci ; 79(10): 3712-3720, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37184331

RESUMEN

BACKGROUND: Tuta absoluta (Meyrick) is a major pest of tomato produced in glasshouses and open field, causing severe damages to crops, reducing the quality of tomato fruits. The current maintenance of the pest populations below the economic threshold is not achieved by natural and classical control, thus requiring the continuous application of biological control agents (BCAs), under an augmentative or inoculative approach. The present study aims to develop an economic and financial model to evaluate the commercial viability of a continuous mass production of Macrolophus pygmaeus (Rambur), a BCA commonly used against the tomato moth, Tuta absoluta, in protected culture. The estimations for our model were based on two approaches: the farm-level impact analysis and the benefit-cost analysis. RESULTS: The results of the farm-level analysis show that the adoption of a more sustainable biological control approach is profitable for farmers and the benefit-cost analysis provides evidence that the investment on a new factory dedicated to the mass rearing of M. pygmaeus to control tomato moth populations generates a positive net present value (NPV) of 7.2 million euros, corresponding to an internal rate of return (IRR) of 28.4% per year. CONCLUSION: Our results are in line with (i) the more recent European Commission proposals for a new Regulation on sustainable use of plant protection products, which includes the reduction of 50% the use and risk of chemical pesticides by 2030 and (ii) most of the existing literature which conclude that new projects on BCA production are worth investments. © 2023 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

8.
Appl Math Comput ; 447: 127905, 2023 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-36818690

RESUMEN

A complex dynamic interplay exists between epidemic transmission and vaccination, which is significantly influenced by human behavioral responses. We construct a research framework combining both the function modeling of the cumulative global COVID-19 information and limited individuals' information processing capacity employing the Gompertz model for growing processes. Meanwhile, we built a function representing the decision to get vaccinated following benefit-cost analysis considered the choices made by people in each scenario have an influence from altruism, free-riding and immunity escaping capacity. Through the mean-field calculation analysis and using a fourth-order Runge-Kutta method with constant step size, we obtain plots from numerical simulations. We found that only when the total number of infectious individuals proves sufficient to reach and exceed a certain level will the individuals face a better trade-off in determining whether to get vaccinated against the diseases based on that information. Besides, authoritative media have a higher decisive influence and efforts should be focused on extending the duration of vaccine protection, which is beneficial to inhibit the outbreaks of epidemics. Our work elucidates that reducing the negative payoff brought about by the free-riding behavior for individuals or improving the positive payoff from the altruistic motivation helps to control the disease in cultures that value social benefits, vaccination willingness is generally stronger. We also note that at a high risk of infection, the decision of vaccination is highly correlated with global epidemic information concerning COVID-19 infection, while at times of lower risk, it depends on the game theoretic vaccine strategy. The findings demonstrate that improving health literacy, ensuring open and transparent information on vaccine safety and efficacy as a public health priority can be an effective strategy for mitigating inequalities in health education, as well as alleviating the phenomenon that immunity escaping abilities is more likely to panic by populations with high levels of education. In addition, prosocial nudges are great ways to bridge these immunity gaps that can contribute to implementing government public health control measures, creating a positive feedback loop.

9.
Risk Anal ; 43(10): 2053-2068, 2023 10.
Artículo en Inglés | MEDLINE | ID: mdl-36649917

RESUMEN

In 2021, the Biden Administration issued mandates requiring COVID-19 vaccinations for U.S. federal employees and contractors and for some healthcare and private sector workers. These mandates have been challenged in court; some have been halted or delayed. However, their costs and benefits have not been rigorously appraised. This study helps fill that gap. We estimate the direct costs and health-related benefits that would have accrued if these vaccination requirements had been implemented as intended. Compared with the January 2022 vaccination rates, we find that the mandates could have led to 15 million additional vaccinated individuals, increasing the overall proportion of the fully vaccinated U.S. population from 64% to 68%. The associated net benefits depend on the subsequent evolution of the pandemic-information unavailable ex ante to analysts or policymakers. In scenarios involving the emergence of a novel, more transmissible variant, against which vaccination and previous infection offer moderate protection, the estimated net benefits are potentially large. They reach almost $20,000 per additional vaccinated individual, with more than 20,000 total deaths averted over the 6-month period assessed. In scenarios involving a fading pandemic, existing vaccination-acquired or infection-acquired immunity provides sufficient protection, and the mandates' benefits are unlikely to exceed their costs. Thus, mandates may be most useful when the consequences of inaction are catastrophic. However, we do not compare the effects of mandates with alternative policies for increasing vaccination rates or for promoting other protective measures, which may receive stronger public support and be less likely to be overturned by litigation.


Asunto(s)
Vacunas contra la COVID-19 , COVID-19 , Humanos , Análisis Costo-Beneficio , COVID-19/prevención & control , Vacunación , Pandemias
10.
Value Health ; 26(5): 666-675, 2023 05.
Artículo en Inglés | MEDLINE | ID: mdl-36328326

RESUMEN

OBJECTIVES: This study aimed to evaluate the health and economic impact of diphtheria, tetanus, whole-cell pertussis vaccine (DTwP) and diphtheria-tetanus-acellular pertussis vaccine (DTaP) vaccination on pertussis prevention and control in China during the 40 years from 1978 to 2017. METHODS: We conducted cost-benefit analyses with a decision tree model populated with historical vaccination coverage levels and pertussis incidence and mortality data from before 1978 and during 1978 to 2017. We modeled 40 birth cohorts from birth until death. Costs and benefits were estimated from direct cost and societal perspectives (direct and indirect costs). Costs and benefits were adjusted to 2017 US dollars (USD), and future values were discounted at a 3% annual rate. We calculated net benefit values (net savings) and benefit-cost ratios of pertussis vaccination of children younger than 5 years. We conducted sensitivity analyses by varying key parameters within plausible ranges. RESULTS: Without DTwP and DTaP vaccination, there would be an estimated 115.76 million pertussis cases and 426 650 pertussis deaths in the 40 cohorts. With DTwP/DTaP vaccination, pertussis cases and deaths were decreased by an estimated 92.57% and 97.43%, saving 46 987.81 million USD in direct costs and 82 013.37 million USD from societal perspective. Pertussis vaccination program costs were 2168.76 million USD and 3961.28 million USD from direct cost and societal perspectives. Benefit-cost ratios were 21.67:1 from the direct cost perspective and 20.70:1 from the societal perspective. Sensitivity analyses showed the results to be robust. CONCLUSIONS: Over the lifetime of 40 birth cohorts, China's immunization program is preventing 93% of pertussis cases and 97% of pertussis deaths, resulting in substantial savings to the healthcare system and society.


Asunto(s)
Vacunas contra Difteria, Tétanos y Tos Ferina Acelular , Tos Ferina , Niño , Humanos , Tos Ferina/epidemiología , Tos Ferina/prevención & control , Análisis Costo-Beneficio , Vacunación , China/epidemiología
11.
J Environ Manage ; 326(Pt A): 116679, 2023 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-36403320

RESUMEN

Despite significant drop in pollinator abundance, no studies exist on the benefits and costs of pollinator conservation in the public domain. An in-person survey was conducted at three large, public US universities to estimate benefits to become Bee Campus USA certified. We test whether different types of reminders on existing student sustainability fees affect Willingness to Pay. Costs of achieving this certification per university were obtained. Net Present Value demonstrates that the net benefits to each school are largely positive, except under the most restrictive assumption. Information reminders of existing fees lead to little change in support of pollinator conservation.


Asunto(s)
Crianza de Animales Domésticos , Certificación , Análisis Costo-Beneficio , Animales , Abejas , Certificación/economía , Sector Público , Universidades/economía , Crianza de Animales Domésticos/economía , Crianza de Animales Domésticos/legislación & jurisprudencia , Polinización
12.
Heliyon ; 8(8): e10295, 2022 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-36072260

RESUMEN

Waste generation rates have increased with rapid population and economic growth worldwide, especially in tourism cities. Nan Province and Luang Prabang (LPB) are twin cities that have been popular tourist destinations. The impact of unmanaged waste threatens the socioeconomic environment in both places. Three waste management scenarios were developed to achieve net-zero greenhouse gas (GHG) emissions from the municipal solid waste (MSW) sector in Nan and LPB by 2030. Sensitivity and benefit-cost (B/C) analyses were performed, and alternative scenarios were proposed. With the use of available waste management technology, all developed scenarios in both locations could achieve net-zero emissions within the difference contexts of the city such as waste composition. From this study, on-site waste sorting is the key for waste management to achieve net-zero emissions. Sensitivity analysis revealed that, with an average carbon price of 28.42 USD/tCO2e, all scenarios in Nan and LPB were feasible, except for scenario 2 (off-site waste sorting) in LPB. This study found that it would be challenging but achievable to reach the net-zero emissions target. The challenge includes the increased on-site waste separation rate and raising public awareness concerning municipal solid waste management as well as its importance for effective waste management. These developed scenarios show a pathway for the waste sector to achieve net-zero emissions by 2030 with available waste management technology in Nan and Luang Prabang, and the possibilities for other locations facing similar situations.

13.
Vaccine X ; 12: 100197, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-35915644

RESUMEN

This research estimated the optimal size and composition of the portfolio, and its benefit-cost ratio, of COVID-19 vaccines that Colombia should negotiate as a price-taking country. The Advance Market Commitments (AMC) mathematical model was applied using the parameters from the Colombian context and from a literature review. The findings indicate that the optimal portfolio of Colombia should include 13 vaccines, mainly from two platforms: i) RNA and ii) inactivated virus. The benefit-cost ratio was always greater than one in the baseline scenario and after performing many sensitivity analyses on parameters such as the percentage of the population at risk, the price per treatment, and the herd immunity threshold, among others. In a context of high uncertainty, the best decision - with high benefit - is to anticipate the negotiation processes with the providers of COVID-19 vaccines, which will generate positive economic and health impacts.

14.
J Health Econ ; 84: 102643, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-35688094

RESUMEN

The social value of decreasing health risks can be evaluated using benefit-cost analysis (BCA), cost-effectiveness analysis (CEA), or a social-welfare function (SWF). These frameworks can produce different social preference rankings of interventions depending on how their health effects and costs are distributed in a population. This paper derives social values of marginal decreases in the probability of illness, its severity (decrease in health status), lethality (conditional mortality risk), and cost under BCA, CEA, and three benchmark SWFs: utilitarian, ex ante prioritarian, and ex post prioritarian. The sensitivity of the social values of improvements in health and decreases in cost to individual circumstances are diverse. In contrast, the conditions under which a decrease in risk, severity, or lethality is socially preferred to a decrease in another of these dimensions are identical for BCA, CEA, the utilitarian and ex ante prioritarian SWFs, but can differ for the ex post prioritarian SWF.


Asunto(s)
Cuidados Paliativos , Bienestar Social , Análisis Costo-Beneficio , Estado de Salud , Humanos
15.
Waste Manag Res ; 40(12): 1766-1776, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-35723614

RESUMEN

The numerous amount of electronic waste (e-waste) has not been managed effectively resulting informal dismantling sites are being expanded in Thailand. The government attempts to improve the efficiency of an integrated e-waste management system, but baseline data of e-waste stream in informal sectors are insufficient. This research aimed to investigate the inflow and outflow of the materials throughout the informal e-waste dismantling processes at the well-known second-largest community in Buriram province during 2017-2018. To describe the quantities of dismantled materials, a material flow analysis was performed. The overall amount of e-waste taken to the community was estimated to be in the range of 1593-12,943 tonnes year-1. Valuable materials could be recovered at more than 90% (by mass) from fans, refrigerators, washing machines, microwaves and air conditioners. The amount of e-waste residue that the local administrative organization had to handle was up to 1144 tonnes year-1. The quantitative data retrieved from this study could provide a satisfactory equation for estimating the amount of separated valuable and non-valuable materials. Recyclable materials from dismantling have an economic incentive, e-waste dismantlers in a small and large household group that can earn approximately 798 and 1262 USD month-1 income, respectively. The notable e-waste characterization and quantification of recovered materials would be useful for improving the potential circular flow of e-waste in Thailand.


Asunto(s)
Residuos Electrónicos , Artículos Domésticos , Administración de Residuos , Residuos Electrónicos/análisis , Tailandia , Reciclaje
16.
Dose Response ; 20(1): 15593258221086475, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35498373

RESUMEN

In this contribution, we propose that 'sound' government policy should be characterised by a proportionate, integral vision with due consideration to tradeoffs between social costs and benefits. This principle also applies to government policy regarding the protection of workers from exposure to chemicals. It should be taken into account that having a job is a huge health benefit. Less educated people are statistically likely to enjoy ten additional healthy years, if employed. Although there is no debate about the risks of exposure to high doses of chemicals, there is most certainly debate on the magnitude, nature and possible cumulative effects of low-dose exposure to chemicals. These are established by model-based assumptions. The current advisory structure in which the Health Council of the Netherlands restricts its focus to the immediate health benefits for workers on the basis of risk avoidance models, and the Social and Economic Council of the Netherlands which focuses primarily on policy costs for trade and industry, is hardly a sound basis for well-considered decision making. The challenge for the scientific experts is to provide political administrators with an insightful social cost-benefit analysis, including all the concomitant uncertainties.

17.
Front Pediatr ; 10: 788589, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35592841

RESUMEN

Background: Congenital hypothyroidism (CH) is one of the most common preventable causes of mental retardation. Implementing newborn screening (NBS) in >52 countries enabled early detection and to initiate treatment of neonates with CH. India is yet to implement a national NBS program even though an estimated 5-15% of sick newborns suffer from genetic and metabolic disorders. Recent pilot studies confirm that the CH incidence rates range from 1 in 500 to 1 in 3,400 live births. Our objective was to estimate overall incidence rates of congenital hypothyroidism and to evaluate the costs and benefits of implementing universal NBS for CH in India. Methods: We used the best available epidemiological and cost data to synthesize incidence rates and screening costs for CH in India. We conducted a meta-analysis of country-specific published literature and included 14 studies to calculate baseline CH incidence rates. We used two models to estimate intellectual disability in unscreened cohorts. Disability-adjusted life years (DALY) were calculated to quantify burden of disease utilizing disability weights. Direct costs including screening, confirmatory tests, and treatment costs were obtained from public and private market sources. Economic benefits were calculated from lost DALY using human capital approach and value of statistical life methods, utilizing gross national income (GNI) per capita data and value of statistical life year (VSLY), respectively. Cost discounting was used to estimate the present value of future benefits over lifetime of affected newborns. Results: The incidence rate of CH in India is 72 (95% CI: 58, 85) cases per 100,000 live births. Based on this data, 1 in 1,388 (95% CI: 1166, 1714) infants were diagnosed with CH in India for the year 2018. The estimated annual incidence ranged from 14,000 to 20,730 cases, and those at risk for intellectual disability ranged from 5,397 to 13,929 cases. Estimated discounted and undiscounted lost DALYs were 57,640 and 410,000, respectively. Direct annual costs for universal screening for CH in India is around USD187 million. Based on current incidence and expected severity of sequelae, economic losses ranged from USD 159 million to 1.1 billion. Benefit-cost ratios ranged from 1.8 to 6. Conclusions: Universal NBS for CH is one of the healthcare interventions that is beneficial to prevent morbidity and cost saving. The cumulative economic benefits, derived from prevention of intellectual disability, assuming cost effectiveness threshold of three times of gross domestic product per capita, far outweigh the direct and indirect costs of screening, treatment, and surveillance throughout the life of the affected individuals. Our analysis strongly supports the argument for investing in NBS that provides good value for money and would yield substantial financial gains for the country.

18.
Prev Med ; 165(Pt B): 107079, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-35533885

RESUMEN

Higgins and colleagues' recently-completed randomized controlled trial and pooled data with 4 related trials of smoking cessation in pregnant women in Vermont (USA) showed that abstinence-contingent financial incentives (FI) increased abstinence over control conditions from early pregnancy through 24-weeks postpartum. Control conditions were best practices (BP) alone in the recent trial and payments provided independent of smoking status (noncontingently) in the others. This paper reports economic analyses of abstinence-contingent FI. Merging trial results with maternal and infant healthcare costs from all Vermont Medicaid deliveries in 2019, we computed incremental cost-effectiveness ratios (ICERs) for quality-adjusted life years (QALYs) and compared them to established thresholds. The healthcare sector cost (±standard error) of adding FI to BP averaged $634.76 ± $531.61 per participant. Based on this trial, the increased probability per BP + FI participant of smoking abstinence at 24-weeks postpartum was 3.17%, the cost per additional abstinent woman was $20,043, the incremental health gain was 0.0270 ± 0.0412 QALYs, the ICER was $23,511/QALY gained, and the probabilities that BP + FI was very cost-effective (ICER≤$65,910) and cost-effective (ICER≤$100,000) were 67.9% and 71.0%, respectively. Based on the pooled trials, the corresponding values were even more favorable-8.89%, $7138, 0.0758 ± 0.0178 QALYs, $8371/QALY, 98.6% and 99.3%, respectively. Each dollar invested in abstinence-contingent FI over control smoking-cessation programs yielded $4.20 in economic benefits in the recent trial and $11.90 in the pooled trials (very favorable benefit-cost ratios). Medicaid and commercial insurers may wish to consider covering financial incentives for smoking abstinence as a cost-effective service for pregnant beneficiaries who smoke. Trial Registration: ClinicalTrials.gov identifier: NCT02210832.


Asunto(s)
Cese del Hábito de Fumar , Humanos , Femenino , Embarazo , Cese del Hábito de Fumar/métodos , Motivación , Periodo Posparto , Años de Vida Ajustados por Calidad de Vida , Análisis Costo-Beneficio
19.
Econ Disaster Clim Chang ; 6(2): 213-233, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35372754

RESUMEN

The purpose of this paper is to develop an analytical framework for estimating the behavioral effects of disasters and their economic consequences. The reduction of these losses represents the benefits of pre-disaster mitigation and post-disaster recovery. We provide conceptualizations, definitions, classifications, and a formal welfare analysis of this category of economic consequences. We also examine methods used to measure behavioral reactions to fear for insight into improving their delineation. Because we are interested in a comprehensive assessment of behavioral effects, we also include resilience adjustments and extend our initial partial equilibrium analysis to the general equilibrium level. The analysis is intended to serve as the basis for the legitimate inclusion of behavioral consequences of disasters in benefit-cost analysis.

20.
Gates Open Res ; 6: 5, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35280345

RESUMEN

Background: Investments made by countries and donors to support polio eradication and the Global Polio Eradication Initiative (GPEI) over the past 35 years provided financial support for significant health interventions beyond the prevention of polio. Prior economic analyses that sought to quantify the economic benefits of some interventions encountered insufficient data and evidence associated with non-polio-specific activities. The 2022-2026 GPEI Strategic Plan explicitly identified integration and gender equity as funded mandates that must move forward in parallel with polio eradication, but these goals remain vaguely defined from a health economic perspective. Methods: To ensure unambiguous and full accounting for all financial investments in the GPEI, polio eradication, and other desirable objectives, we identify the health economic analysis methods and inputs needed to ensure transparent financial accountability and cost-effective use of funds. Results: Sufficient inputs and methods exist to characterize the health and economic benefits of polio-specific activities, but we identified the need for additional information and method development for some non-polio-specific and cost-sharing activities. Donors who seek to support non-polio-specific objectives as part of the GPEI may want to provide dedicated support financing for which it may be difficult to apply typical health economic criteria and to expect net health and/or net economic benefits. Conclusions: Given the mixture of funding sources provided to the GPEI, which includes support by governments and private donors, we recommend that the GPEI separately account for financial needs that represent necessities for polio eradication from those used for other stated objectives. An added layer of specificity that identifies all funds according to each activity, the accountable party and/or parties, and the associated measurable health or other outcome(s), will enable improved health economic analyses and reporting to donors who seek to track returns on their investments.

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