No / Knowledge of clinically and cost-effective wound management is an obvious requirement for surgeons, yet wound care education rarely features within the medical curriculum. As a result surgical trainees are often poorly placed to join in multidisciplinary wound management and may feel threatened when asked to manage wound complications. A vast range of dressing products exists yet robust evidence of the function and effectiveness of individual products is often lacking. An understanding of wound pathophysiology, a defined treatment goal and regular wound assessment combined with knowledge of basic wound dressing categories will provide guidance on product selection for different clinical situations and wound types.

published_or_final_version / Transport Policy and Planning / Master / Master of Arts in Transport Policy and Planning

In vitro fertilization (IVF) is used to help infertile couples achieve a live birth. Clinical studies have suggested that multiple, consecutive cycles of IVF can increase live birth rate significantly. Others have documented improved live birth rates from the use of new laboratory techniques for preimplantation genetic screening (PGS). This genetic screening technique seeks to determine the ploidy of the embryo prior to implantation into the woman. To date, no study has examined the cost-effectiveness of using IVF in conjunction with PGS compared to that of IVF alone for 3 consecutive cycles in achieving a live birth. This study compared the incremental cost-effectiveness ratios (ICER) from each intervention arm based on the clinical probabilities for each outcome and this study was grounded in the protection motivation theory. Costs were obtained from secondary sources, such as the literature and government databases. The model was constructed using a decision-analytical approach that allowed for z test statistical analysis of the outcomes, where the ICER is the dependent variable and the independent variables are the 2 interventions. The robustness of the model was tested through univariate and probabilistic sensitivity analysis and stratified by age groups. The results showed that PGS with IVF was cost-effective for women aged under 40 and women aged 40-42, but not for women over 42. Based on a willingness-to-pay threshold of $100,000, IVF with PGS was the most cost-effective strategy in all age groups. The positive social change implication of this study is such that understanding the costs associated with a new technology to achieve a live birth is significant for society to help guide clinical treatment of these patients.

published_or_final_version / Public Administration / Master / Master of Public Administration

This study was an investigation into the cost-effectiveness of using re-usable instrumentation in laparoscopic surgery. The model used for the study was the laparoscopic cholecystectomy which is the commonest laparoscopic procedure performed by the general surgeons. The study was done at KZNGOV Hospital in Kwazulu Natal, one of the largest tertiary hospitals in the province. The research done was both qualitative and quantitative. An exploratory study was conducted initially by drawing up the case study, and then quantitative and qualitative research was conducted to evaluate the use of re-usable instrumentation in laparoscopic surgery. In order to conduct a more focused design, the three most commonly used laparoscopic instruments were evaluated. These were the trocars (sizes 11.0mm and 5.0mm), the endoshears / scissors and the clip applicators. The study aimed to assess whether the use of the re-usable instruments was more cost-effective, whether their use in minimal access surgery was feasible, and whether the use of re-usable instrumentation compromised patient well-being. Information for the case study was obtained from the hospital notes of the patients who had a laparoscopic cholecystectomy at KZNGOV Hospital, and from interviews with experienced surgeons. The study found that the re-usable instrumentation used at KZNGOV Hospital had no adverse effects on the patients. The Department of Surgery and the theatre committee at this hospital have chosen an excellent and cost-effective protocol for laparoscopic surgery, and the choice of instrumentation cannot be faulted. Analysis of the results showed a large cost saving obtained by using the re-usable laparoscopic instrumentation, with no adverse patient outcomes. / Thesis (MBA)-University of KwaZulu-Natal, Durban, 2003.

Leucodepletion, the removal of leucocytes from blood products improves the safety of blood transfusion by reducing adverse events associated with the incidental non-therapeutic transfusion of leucocytes. Leucodepletion has been shown to have clinical benefit for immuno-suppressed patients who require transfusion. The selective leucodepletion of blood products by bed side filtration for these patients has been widely practiced. This study investigated the economic consequences in Queensland of moving from a policy of selective leucodepletion to one of universal leucodepletion, that is providing all transfused patients with blood products leucodepleted during the manufacturing process. Using an analytic decision model a cost-effectiveness analysis was conducted. An ICER of $16.3M per life year gained was derived. Sensitivity analysis found this result to be robust to uncertainty in the parameters used in the model. This result argues against moving to a policy of universal leucodepletion. However during the course of the study the policy decision for universal leucodepletion was made and implemented in Queensland in October 2008. This study has concluded that cost-effectiveness is not an influential factor in policy decisions regarding quality and safety initiatives in the Australian blood sector.

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Background: In the ‘Arimidex’, Tamoxifen Alone or in Combination (ATAC) trial, the aromatase inhibitor (AI) anastrozole had a ignificantly better efficacy and safety profile than tamoxifen as initial adjuvant therapy for hormone receptor-positive (HR+) early breast cancer (EBC) in postmenopausal patients. To compare the combined long-term clinical and economic benefits, we carried out a cost-effectiveness analysis (CEA) of anastrozole versus tamoxifen based on the data of the 100- month analysis of the ATAC trial from the perspective of the German public health insurance. Patients and Methods: A Markov model with a 25-year time horizon was developed using the 100-month analysis of the ATAC trial as well as data obtained from published literature and expert opinion. Results: Adjuvant treatment of EBC with anastrozole achieved an additional 0.32 quality-adjusted life-years (QALYs) gained per patient compared with tamoxifen, at an additional cost of D 6819 per patient. Thus, the incremental cost effectiveness of anastrozole versus tamoxifen at 25 years was D 21,069 ($ 30,717) per QALY gained. Conclusions: This is the first CEA of an AI that is based on extended follow-up data, taking into account the carryover effect of anastrozole, which maintains the efficacy benefits beyond therapy completion after 5 years. Adjuvant treatment with anastrozole for postmenopausal women with HR+ EBC is a cost-effective alternative to tamoxifen. / Hintergrund: Bei der adjuvanten Therapie von postmenopausalen Patientinnen mit Hormonrezeptor-positivem (HR+) Mammakarzinom belegen die ATAC-100-Monatsdaten (ATAC-Studie: ‘Arimidex’, Tamoxifen Alone or in Combination) einen signifikanten Vorteil von Anastrozol gegenüber Tamoxifen in Bezug auf Rezidivrisiko und Verträglichkeit. Es wurde eine Kosten-Nutzwert-Analyse von Anastrozol im Vergleich zu Tamoxifen aus der Sicht des deutschen Gesundheitssystems durchgeführt. Material und Methoden: Als Berechnungsbasis wurde ein Markov- Modell zur Abschätzung der Kosteneffektivität entwickelt. Der Modellierungszeitraum umfasste 25 Jahre. Die Daten wurden anhand der ATAC-100-Monatsdaten, vorliegender Literatur und durch ein interdisziplinäres Expertenteam ermittelt. Ergebnisse: Eine adjuvante Therapie mit Anastrozol erzielte 0,32 quality-adjusted life-years (QALYs) pro Patientin mehr, verglichen mit einer adjuvanten Tamoxifentherapie. Die zusätzlichen Kosten der Therapie mit Anastrozol lagen bei 6819 D pro Patientin. Im Vergleich mit Tamoxifen erzielte Anastrozol einen ICER (Incremental Cost-Effectiveness Ratio) von 21 069 D (30 717 $)/QALY über den gesamten Modellierungszeitraum. Schlussfolgerung: Diese Kosten- Nutzwert-Analyse eines Aromatasehemmers basiert erstmals auf einer Datenanalyse, die auch das Follow-Up und den sogenannten Carryover- Effekt nach einer abgeschlossenen 5-Jahres-Therapie beinhaltet. Anastrozol ist auch nach dieser Analyse aus der Sicht des deutschen Gesundheitssystems eine kosteneffektive Therapieoption für postmenopausale Patientinnen mit einem HR+ frühen Mammakarzinom. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Background: In the ‘Arimidex’, Tamoxifen Alone or in Combination (ATAC) trial, the aromatase inhibitor (AI) anastrozole had a ignificantly better efficacy and safety profile than tamoxifen as initial adjuvant therapy for hormone receptor-positive (HR+) early breast cancer (EBC) in postmenopausal patients. To compare the combined long-term clinical and economic benefits, we carried out a cost-effectiveness analysis (CEA) of anastrozole versus tamoxifen based on the data of the 100- month analysis of the ATAC trial from the perspective of the German public health insurance. Patients and Methods: A Markov model with a 25-year time horizon was developed using the 100-month analysis of the ATAC trial as well as data obtained from published literature and expert opinion. Results: Adjuvant treatment of EBC with anastrozole achieved an additional 0.32 quality-adjusted life-years (QALYs) gained per patient compared with tamoxifen, at an additional cost of D 6819 per patient. Thus, the incremental cost effectiveness of anastrozole versus tamoxifen at 25 years was D 21,069 ($ 30,717) per QALY gained. Conclusions: This is the first CEA of an AI that is based on extended follow-up data, taking into account the carryover effect of anastrozole, which maintains the efficacy benefits beyond therapy completion after 5 years. Adjuvant treatment with anastrozole for postmenopausal women with HR+ EBC is a cost-effective alternative to tamoxifen. / Hintergrund: Bei der adjuvanten Therapie von postmenopausalen Patientinnen mit Hormonrezeptor-positivem (HR+) Mammakarzinom belegen die ATAC-100-Monatsdaten (ATAC-Studie: ‘Arimidex’, Tamoxifen Alone or in Combination) einen signifikanten Vorteil von Anastrozol gegenüber Tamoxifen in Bezug auf Rezidivrisiko und Verträglichkeit. Es wurde eine Kosten-Nutzwert-Analyse von Anastrozol im Vergleich zu Tamoxifen aus der Sicht des deutschen Gesundheitssystems durchgeführt. Material und Methoden: Als Berechnungsbasis wurde ein Markov- Modell zur Abschätzung der Kosteneffektivität entwickelt. Der Modellierungszeitraum umfasste 25 Jahre. Die Daten wurden anhand der ATAC-100-Monatsdaten, vorliegender Literatur und durch ein interdisziplinäres Expertenteam ermittelt. Ergebnisse: Eine adjuvante Therapie mit Anastrozol erzielte 0,32 quality-adjusted life-years (QALYs) pro Patientin mehr, verglichen mit einer adjuvanten Tamoxifentherapie. Die zusätzlichen Kosten der Therapie mit Anastrozol lagen bei 6819 D pro Patientin. Im Vergleich mit Tamoxifen erzielte Anastrozol einen ICER (Incremental Cost-Effectiveness Ratio) von 21 069 D (30 717 $)/QALY über den gesamten Modellierungszeitraum. Schlussfolgerung: Diese Kosten- Nutzwert-Analyse eines Aromatasehemmers basiert erstmals auf einer Datenanalyse, die auch das Follow-Up und den sogenannten Carryover- Effekt nach einer abgeschlossenen 5-Jahres-Therapie beinhaltet. Anastrozol ist auch nach dieser Analyse aus der Sicht des deutschen Gesundheitssystems eine kosteneffektive Therapieoption für postmenopausale Patientinnen mit einem HR+ frühen Mammakarzinom. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Thesis (MSocialWork) -- University of Stellenbosch, 2002. / ENGLISH ABSTRACT: Since 1988 it became practice for welfare organisations to submit an evaluation of their welfare programme as part of their application for state funding for the next year. Included in this evaluation is a section on the cost efficiency of the programme. After the first democratic election in 1994 a number of processes were started to develop new welfare policies for the country. In all of these processes cost efficiency is seen as a principle, but in spite of this, so it seems from the documents, is the evaluation of cost efficiency still a problem. The question therefore arises: What is the present status of the evaluation of the cost efficiency of social services after twelve years of program evaluation? Only a few studies on the methodology of the evaluation of cost efficiency within the South African context were found through the literature study. An exploratory study was therefore undertaken to determine what the reasons could be why so little progress was made with cost effiency evaluation. The empirical study focussed on residential facilities for older persons and was done within one welfare organisation in the Western- and Southern Cape. A sample of twenty managers was randomly selected and fifteen respondents returned the questionaire. It is a potential danger that managers of residential facilities for older persons could see the evaluation of the services rendered as just another administrative task, because of the very strong link between evaluation and the application for state funding. The researcher therefore wanted to ascertain what the attitude of the managers is towards the evaluation of their services, and especially the evaluation of the cost-efficiency thereof. It was found that the managers are positive towards program evaluation and the evaluation of cost efficiency, but the majority of them responded that the lack of guidelines and manuals is a deficiency. The lack of proper measuring instruments was also stressed. The research also shown that the managers conceptualize cost efficiency mainly in terms of costs and not as a relation between the outcomes of the programme and the costs thereof. The managers of residential facilities uses the evaluation document that was send out by the department, because it forms part of the application for state funding. This means that the level of program evaluation is actually determined by the department. It was found that this document focused mainly on the measuring of inputs and outputs and not so much of the evaluation of the outcomes of the programme. Based on the results of the study the researcher proposed guidelines to promote the evaluation of the cost efficiency of social services. / AFRIKAANSE OPSOMMING: Dit is sedert 1988 praktyk dat vrywillige welsynsorganisasies jaarliks 'n evaluering van hulle maatskaplikewelsynsprogram moet indien as deel van die aansoek om staatsubsidie vir die volgende jaar. By hierdie evaluering van die maatskaplikewelsynsprogramme is die evaluering van die kostedoeltreffendheid van die program ingesluit. Na die eerste demokratiese verkiesing in 1994 het verskeie prosesse aan die gang gekom om nuwe maatskaplikewelsynsbeleid vir Suid-Afrika te ontwikkel. In al die dokumente wat deur die prosesse ontwikkel is, word die kostedoeltreffendheid van maatskaplikewelsynsdienste as 'n belangrike beginsel gestel. Tog blyk dit, uit die verslae van sommige van die prosesse, dat die evaluering van kostedoeltreffendheid 'n probleem blyk te wees. Die vraag ontstaan dan tereg: Wat is die huidige stand van die evaluering van die kostedoeltreffendheid van maatskaplikewelsynsprogramme twaalf jaar sedert die implementering van programevaluering? Uit die literatuurstudie het dit geblyk dat daar min studies in Suid-Afrika bestaan wat handel oor die metodiek van kostedoeltreffendheidsevaluering van maatskaplikewelsynsprogramme. Verkennende navorsing is onderneem om vas te stel waarom daar oënskynlik min vordering gemaak is met die evaluering van kostedoeltreffendheid van maatskaplikewelsynsprogramme. Die empiriese studie het gefokus op residensiële fasiliteite vir ouer persone en die navorsing is uitgevoer by een welsynsorganisasie in die Wes- en Suid-Kaap. 'n Steekproef van twintig bestuurders is op ewekansige wyse geselekteer en vyftien respondente het die vraelys teruggestuur. Die gevaar bestaan dat, vanweë die sterk verband tussen die evaluering van die program en die aansoek vir subsidie, die evaluering van die maatskaplikewelsynsprogram bloot net as nog 'n administratiewe taak gesien kan word. Daarom wou die navorser vasstel wat die bestuurders van residensiële versorgingsprogramme vir ouer persone se houding jeens programevaluering en die evaluering van die kostedoeltreffendheid van die program is. In die studie is bevind dat die bestuurders positief jeens programevaluering en die evaluering van die kostedoeltreffendheid van die programme is, maar die oorgrote meerderheid bestuurders het aangedui dat hulle dit as 'n leemte sien dat daar min riglyne of handleidings bestaan. Die gebrek aan meetinstrumente is ook beklemtoon. Uit die studie het dit verder geblyk dat die bestuurders die konsep kostedoeltreffendheid hoofsaaklik in terme van koste verstaan, en nie in terme van 'n verhouding van die uitkomste van die program tot die koste daarvan nie. Die bestuurders van residensiële fasiliteite voltooi jaarliks die evalueringsdokument van die betrokke staatsdepartement, omdat dit deel vorm van die aansoekprosedure vir staatsubsidie. Hierdie dokument bepaal derhalwe die vlak van programevaluering. Dit het uit die studie geblyk dat die dokument wat gebruik word grootliks fokus op die meting van insette en uitsette en nie soseer op die uitkomste van die welsynsprogramme nie. Gebaseer op die bevindinge van die navorsing is riglyne voorgestel wat sal meewerk om die evaluering van die kostedoeltreffendheid van maatskaplike dienste te bevorder.