No / To assess clinical outcomes and cost-effectiveness of using a two-layer cohesive compression bandage (TLCCB; Coban 2) compared with a two-layer compression system (TLCS; Ktwo) and a four-layer compression system (FLCS; Profore) in treating venous leg ulcers (VLUs) in clinical practice in the UK, from the perspective of the National Health Service (NHS). METHOD: This was a retrospective analysis of the case records of VLU patients, randomly extracted from The Health Improvement Network (THIN) database (a nationally representative database of clinical practice among patients registered with general practitioners in the UK), who were treated with either TLCCB (n=250), TLCS (n=250) or FLCS (n=175). Clinical outcomes and health-care resource use (and costs) over six months after starting treatment with each compression system were estimated. Differences in outcomes and resource use between treatments were adjusted for differences in baseline covariates. RESULTS: Patients' mean age was 75 years old and 57% were female. The mean time with a VLU was 6-7 months and the mean initial wound size was 77-85 cm2. The overall VLU healing rate, irrespective of bandage type, was 44% over the six months' study period. In the TLCCB group, 51% of wounds had healed by six months compared with 40% (p=0.03) and 28% (p=0.001) in the TLCS and FLCS groups, respectively. The mean time to healing was 2.5 months. Patients in the TLCCB group experienced better health-related quality of life (HRQoL) over six months (0.374 quality-adjusted life years (QALYs) per patient), compared with the TLCS (0.368 QALYs per patient) and FLCS (0.353 QALYs per patient). The mean six-monthly NHS management cost was pound2,413, pound2,707 and pound2,648 per patient in the TLCCB, TLCS and FLCS groups, respectively. CONCLUSION: Despite the systems studied reporting similar compression levels when tested in controlled studies, real-world evidence demonstrates that initiating treatment with TLCCB, compared with the other two compression systems, affords a more cost-effective use of NHS-funded resources in clinical practice, since it resulted in an increased healing rate, better HRQoL and a reduction in NHS management cost. The evidence also highlighted the lack of continuity between clinicians managing a wound, the inconsistent nature of the administered treatments and the lack of specialist involvement, all of which may impact on healing. DECLARATION OF INTEREST: This study was supported by an unrestricted research grant from 3M Health Care, UK. 3M Health Care had no influence on the study design, the collection, analysis, and interpretation of data, or on the writing of, and decision to submit for publication, the manuscript.

No / Increasing pressure on health care budgets highlights the need for clinicians to understand the true costs of wound care, in order to be able to defend services against indiscriminate cost cutting. Our aim was to develop and test a straightforward method of measuring treatment costs, which is feasible in routine practice. The method was tested in a prospective study of leg ulcer patients attending three specialist clinics in the UK. A set of ulcer-related health state descriptors were defined on the basis that they represented distinct and clinically relevant descriptions of wound condition ['healed', 'progressing'; 'static''deteriorating; 'severe' (ulcer with serious complications)]. A standardised data-collection instrument was used to record information for all patients attending the clinic during the study period regarding (i) the health state of the ulcer; (ii) treatment received during the clinic visit and (iii) treatment planned between clinic visits. Information on resource use was used to estimate weekly treatment costs by ulcer state. Information was collected at 827 independent weekly observations from the three study centres. Treatment costs increased markedly with ulcer severity: an ulcer which was 'deteriorating' or 'severe' cost between twice and six times as much per week as an ulcer which was progressing normally towards healing. Higher costs were driven primarily by more frequent clinic visits and by the costs of hospitalisation for ulcers with severe complications. This exercise has demonstrated that the proposed methodology is easy to apply, and produces information which is of value in monitoring healing and in potentially reducing treatment costs.

Aufgabenstellung: Die Europäische Kommission strebt an, die Zahl der Getöteten im Straßenverkehr in der EU bis zum Jahr 2010 zu halbieren, unter anderem durch Einsatz von Telemedizin in der präklinischen Notfallrettung. Ziel dieser Arbeit ist die Untersuchung der Kosten-Wirksamkeit von Telemedizinsystemen für die präklinische Notfallrettung bei Verkehrsunfällen in Deutschland. Methodik: Aus Sicht der Gesellschaft und der Krankenkassen werden drei Varianten eines Telemedizinsystems mit dem Status Quo in Deutschland, das heißt dem "Nicht-Einsatz von Telemedizin" in der präklinischen Notfallrettung, verglichen. Die Analyse erfolgt auf Basis retrospektiv erhobener Daten für einen Zeithorizont von zehn Jahren. Berücksichtigt werden Systemkosten, Kosten der Personenschäden und Strukturkosten des Rettungsdienstes. Diese werden diskontiert und nicht inflationsbereinigt. Der Nutzen wird mittels gewonnener Lebensjahre durch die Verkürzung des therapiefreien Intervalls und die Verbesserung der Laienhilfe gemessen. Aufgrund der Uneinheitlichkeit der Daten werden Annahmen und Abschätzungen getroffen. Ergebnis: Im Basisergebnis ist der Kosten-Wirksamkeits-Quotient für die Variante "Telemedizin für Laienhelfer" (299.366 Euro pro gewonnenes Lebensjahr) höher als für die Variante "Automatische Unfallmeldung" (247.977 Euro pro gewonnenes Lebensjahr). Den besten Kosten-Wirksamkeits-Quotient erzielt die Vollausstattung mit 239.524 Euro pro gewonnenem Lebensjahr. Im Rahmen von multivariaten Sensitivitätsanalysen (best und worst case scenario) wird festgestellt, dass eine Senkung der Systemkosten die Gesamtkosten überproportional reduziert und dass durch eine schnelle Marktdurchdringung der Kosten-Wirksamkeits-Quotient des Telemedizinsystems deutlich verbessert werden kann. Fazit: Für alle drei Varianten des Telemedizinsystems werden hohe Kosten pro gewonnenes Lebensjahr erwartet. Eine Einführung dieser Systeme erscheint nur in einer abgestimmten europäischen Vorgehensweise realistisch. / Objective: Since the European Commission set a goal of reducing the number of road accident deaths across the EU by 2010 to one half, the use of telemedicine for pre-clinical traffic accident emergency rescue is very high on the agenda. The purpose of this study is to assess the cost-effectiveness of telemedical devices for pre-clinical traffic accident emergency rescue in Germany. Methods: Three telemedical devices are compared from the perspective of society and health insurance with baseline assumptions in Germany, i.e. the non-application of telemedicine in pre-clinical emergency rescues. The analysis is based on retrospective statistical data covering a period of ten years. Costs resulting from telemedical device, personal injury, wasted journeys and erroneous dispatching of rescue services are discounted and not adjusted for inflation. The outcome is measured in terms of "life years gained" by reducing therapy-free intervals and improvements in first-aid provided by laypersons. Due to the uncertainty of data, certain assumptions and estimates are necessary. Results: In the base case scenario the cost-effectiveness ratio of the device "Telemedicine for laypersons" (Euro 299,366 per life year gained) would be higher than of the "Automatic Accident Alert" (Euro 247,977 per life year gained). The full equipment device has the best cost-effectiveness ratio (Euro 239,524 per life year gained). Multi-way sensitivity-analysis with best and worst case scenarios show that decreasing costs of telemedical device would disproportionately reduce total costs, and that rapid market penetration would largely increase the cost-effectiveness ratio of the devices. Conclusion: The net costs per life year gained in the application of the three telemedical devices are estimated as quite high. The implementation of the devices seems only realistic as part of a larger European co-ordinated initiative.

This study aims to explore the ability of a multi-criteria decision making with analytical hierarchy process (MCDM-AHP) model to emulate the results of a cost benefit analysis (CBA) model in the context of offshore wind farm siting within the Swedish exclusive economic zone (EEZ). The research question addressed is whether the MCDM-AHP analysis produces similar results to the CBA analysis. In addition to this, the strengths and weaknesses of each model is explored. The MCDM-AHP model employs the spatial criteria in a more basic manner compared to the CBA model, simplifying the evaluation process while still explaining 89.5% of the variation in the CBA model and defining similar areas as suitable. Thus, it can be concluded that the MCDM-AHP model adequately emulates the CBA model within the context of offshore wind farm siting within the Swedish EEZ. However, it is crucial to note that the two models produce outputs on different scales. While the CBA model provides levelized cost of energy (LCOE) values that can be thresholded for investment viability comparisons, the suitability score generated by the MCDM-AHP model remains a relative and arbitrary score within the model. Both models entail uncertainties, limiting their usage beyond making general assumptions or identifying areas of interest. The findings reveal that the CBA model demonstrates greater robustness when confronted with changes in spatial input parameters compared to the MCDM-AHP model. This discrepancy is attributed to the iterative computation process and consideration of flat cost inputs in the CBA model, whereas the MCDM-AHP model represents a linear combination of various spatial parameters. However, the calculated LCOE values in the CBA model are highly sensitive to changes in modeling assumptions regarding external parameters, resulting in significant linear variations. The LCOE values obtained from the CBA model baseline case fall within a range of 52.1 - 98.9 EUR/MWh, which aligns with similar studies, validating the CBA model. Nonetheless, caution should be exercised when considering these results as an accurate representation of the real world due to inherent uncertainties in cost inputs and the LCOE measure. The strengths of the MCDM-AHP model lie in its robustness when the order of relative importance remains stable for key spatial evaluators. It is sensitive to significant changes in water depth and wind speed, which heavily influence its output. The model's simplicity allows for a quick overview of the problem, but it requires assumptions that introduce uncertainties. Validation of the MCDM-AHP model using existing and planned offshore wind farms within the Swedish EEZ was possible but limited by the arbitrary scale and limited validation areas. The comparison between the two models could be enhanced with more comprehensive spatial and economic data for an in-depth CBA model, which could serve as a ground truth for the MCDM-AHP model. Nevertheless, the comparison made in this study considers the CBA model to be closer to the truth, acknowledging the underlying assumptions that should be considered during evaluation. In conclusion, within the context of offshore wind farm siting, the MCDM-AHP model produces outputs that are similar to the CBA model.

Les nouvelles technologies médicales contribuent aux dépenses en santé qui ne cessent de croître, alors que les budgets se trouvent limités. L’évaluation économique des technologies devraient permettre d’identifier quelles sont celles qui sont les plus rentables. Malgré cela, plusieurs technologies dont le rapport coût-efficacité reste plutôt limite ou défavorable sont utilisées en médecine moderne et remboursées par notre système public de santé. Ce mémoire se concentre sur deux technologies en santé cardiovasculaire dont le rapport coût-efficacité est plutôt limite mais qui sont fréquemment utilisées au Canada; les tuteurs médicamentés ou pharmaco-actifs et les défibrillateurs cardiaques implantables (DCI). Nous avons fait une évaluation contingente de ces technologies dans le but d’examiner si ce type d’évaluation économique complémentaire pouvait procurer un point de vue nouveau sur la valeur économique et sociétaire des ces technologies. Les résultats de ces deux évaluations indiquent que les patients accordent une grande importance aux bénéfices que procurent ces deux technologies. Nos résultats soutiennent les politiques de santé actuelles de rembourser de façon libérale ces deux technologies. / Technological innovations have greatly contributed to the rising costs in healthcare, while budgets have remained limited. Economic evaluations of technologies should identify which technologies are cost-effective. However, several technologies used in modern medicine are either borderline cost-effective or even not cost-effective according to many studies. This thesis focuses on two technologies in cardiovascular medicine which are considered borderline cost-effective; drug-eluting stents and implantable cardioverter defibrillators. We conducted a contingent valuation of these technologies in hopes of determining if this alternative type of economic evaluation could give a novel point of view on the economic and societal value of these technologies. Results indicated that patients greatly valued benefits provided by these two technologies. Our result support our public healthcare system policies’ of liberal reimbursement of these two technologies.

Para avaliar os benefícios da comunicação rápida ao clínico do diagnóstico de vírus respiratórios, foi analisado a viabilidade econômica de 2 testes, com o tempo de entrega de resultado em 2 horas para teste rápido e 48 horas para Biologia Molecular. As amostras coletadas foram processadas utilizando técnicas convencionais e os testes disponíveis no mercado local. Foram escolhidos dois testes rápidos pelo método de imunocromatografia para quatro parâmetros analíticos: Influenza A, Influenza H1N1, Influenza B e Vírus Sincicial Respiratório (RSV) e em Biologia Molecular um teste de RT-PCR multiplex com 25 patógenos entre vírus e bactérias. O tipo de amostra utilizada foi swab e lavado de nasofaringe. A população escolhida para o estudo foi paciente adulto, em tratamento de câncer, que necessita de uma resposta rápida já que a maioria se encontra com comprometimento do sistema imune por doença ou por tratamento. O estudo foi transversal, realizado entre os anos de 2012 e 2013, para avaliar a viabilidade econômica da introdução de testes de diagnóstico da infecção respiratória aguda de etiologia viral a partir de amostras de nasofaringe em pacientes com câncer atendidos no Centro de Atendimento de Oncologia Intercorrência (CAIO ), do Instituto do Câncer do Estado de São Paulo (ICESP), hospital público que atende exclusivamente Sistema Único de Saúde (SUS) e Hospital A.C. Camargo, que atende tanto a pacientes do SUS como da rede privada. O estudo incluiu 152 pacientes em tratamento para qualquer tipo de câncer, predominantemente do sexo feminino (81 mulheres e 70 homens) com idades entre 18-86 anos. Para participar do estudo o paciente era consultado e o critério para escolha do paciente foi ser portador de câncer, com história de febre (ainda que referida) acompanhada de tosse ou dor de garganta, tosse e sintomas respiratórios agudos, atendidos por protocolo padronizado que inclui avaliação na admissão, seguimento e manejo antimicrobiano. Para a avaliação econômica os pacientes foram classificados de acordo com o estado geral de saúde, se apresentavam bom estado de estado de saúde poderiam receber alta e faziam uso da medicação em casa evitando 5 dias de internação se recebessem algum resultado para Influenza ou RSV, no entanto os pacientes que apresentavam outro vírus, resultado negativo ou o estado geral era ruim permaneciam internados por 7 dias em observação e cuidados com medicação adequada. Foram realizadas análises econômicas em dois âmbitos: o sistema de saúde publico e o privado considerando o fator diminuição de dias de internação. A analise de Custo-benefício foi eficiente no Sistema privado mas inadequada para o SUS assim como, qualquer outra medida monetária já que os valores de reembolso do SUS estão defasados do custo de qualquer internação. A análise de Custo-efetividade que olha para outros fatores além do monetário foi efetiva nos dois sistemas que enfrentam falta de leitos além da condição de saúde do paciente de evitar a ingestão desnecessária de antibióticos, evitar os gastos do acompanhante, perda de dias de trabalho e estudo. Não houve correspondência de resultados dos testes rápidos com o multiplex de Biologia Molecular / To evaluate the benefits of the rapid communication of the respiratory viruses\' diagnosis to the doctor, the economic feasibility of two tests was analyzed, with the result delivery time within 2-hours for the rapid test and 48 hours for Molecular Biology. The samples were processed using conventional techniques and the available tests in the local market. Two rapid tests were selected by the immunochromatography method for four analytical parameters: Influenza A, Influenza A H1N1, Influenza B, and Respiratory Syncytial Virus (RSV) and in Molecular Biology a multiplex RT-PCR assay with 25 pathogens between viruses and bacteria. The type of sample used was swab and nasopharyngeal wash. The population chosen for the study was of adult patients undergoing cancer treatment, which requires a rapid response since most have a compromised immune system due to the disease or treatment. The study, conducted between 2012 and 2013, was cross-sectional to evaluate the economic feasibility of introducing diagnostic tests for acute respiratory infection of viral etiology from nasopharyngeal samples of patients with cancer attended at the Oncology Intercurrence Care Center (CAIO), at the Cancer Institute of the São Paulo State (ICESP), at public hospital that attends exclusively the Unified Health System (SUS) and at AC Camargo hospital, which attends SUS patients as well as the private health system. The study included 152 patients undergoing treatment for any type of cancer, predominantly female (81 women and 70 men) between 18 and 86 years. To participate in the study, the patients were consulted and the criteria for choosing a patient was to be a cancer patient with a history of fever (even if referred) accompanied by cough or sore throat, coughing and acute respiratory symptoms, attended by standardized protocol that includes an evaluation at the admission, tracking and antimicrobial management. For the economic evaluation, patients were classified according to the general health condition. If they were in a good health condition, they could receive medical discharge and make use of the medication at home avoiding five days of hospitalization when receiving a result for influenza or RSV. However, the patients with other viruses, negative results or with bad general condition remained hospitalized for seven days under observation and care with proper medication. Economic analyzes were carried out in two areas: the public health system and private health system considering the factor decreased length of hospital stay. The cost-benefit analysis was efficient in the private system but inadequate for the NHS as well as any other monetary measure since the SUS reimbursement values are too low when compared to the cost of any other hospital. The cost-effectiveness analysis that looks at other factors besides money was effective in both systems that were facing lack of beds in addition to the health condition of the patient to avoid unnecessary intake of antibiotics, avoid the costs of the accompanying person, loss of working and study days. There were no results correspondences of the rapid tests with the Molecular Biology multiplex

Chan Siu-Wah. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (leaves 173-200). / Abstracts in English and Chinese; appendix in Chinese. / Table of Contents --- p.i / Abstract --- p.v / 論文摘要 --- p.ix / Acknowledgments --- p.xii / Table of Figures --- p.xiii / Table of Tables --- p.xvii / Chapter Chapter 1. --- Introduction --- p.1 / Chapter Chapter 2. --- Literature Review --- p.3 / Chapter 2.1 --- Diabetes Mellitus (DM)： Overview --- p.3 / Chapter 2.1.1 --- Diagnosis and Diagnostic Criteria --- p.4 / Chapter 2.1.2 --- Classifications of Diabetes Mellitus --- p.8 / Chapter 2.1.3 --- Management of Type 2 Diabetes Mellitus --- p.15 / Chapter 2.2 --- Diabetes Mellitus Complications： Overview --- p.25 / Chapter 2.2.1 --- Microvascular Complications --- p.26 / Chapter 2.2.2 --- Macrovascular Complications --- p.31 / Chapter 2.3 --- Type 2 Diabetes Mellitus - A Rising Global Burden --- p.32 / Chapter 2.3.1 --- Prevalence of Type 2 Diabetes Mellitus --- p.32 / Chapter 2.3.2 --- Prevalence of Type 2 Diabetes Mellitus in Hong Kong --- p.36 / Chapter 2.3.3 --- Mortality and Morbidity of Type 2 Diabetes Mellitus in Hong Kong --- p.40 / Chapter 2.4 --- cost of Type 2 Diabetes Mellitus - Under-explored Area in Hong Kong and Asia --- p.46 / Chapter 2.4.1 --- Cost of Type 2 Diabetes Mellitus in the USA --- p.48 / Chapter 2.4.2 --- Cost of Type 2 Diabetes Mellitus in Europe --- p.57 / Chapter 2.4.3 --- Cost of Type 2 Diabetes Mellitus in Asia-Pacific --- p.61 / Chapter 2.5 --- Hong Kong Healthcare System --- p.65 / Chapter 2.5.1 --- Hospital Authority in Hong Kong (Public Healthcare Sector) --- p.67 / Chapter 2.5.2 --- Hong Kong Healthcare Financing System --- p.73 / Chapter 2.6 --- New Emerging Drug Treatment for Type 2 DM in Hong Kong Chinese - Rosiglitazone --- p.77 / Chapter 2.6.1 --- Clinical Efficacy and Tolerability of Rosiglitazone --- p.77 / Chapter 2.6.2 --- Cost-effectiveness of Rosiglitazone --- p.78 / Chapter Chapter 3. --- Hypothesis and Objectives --- p.81 / Chapter 3.1 --- Cost of Type 2 Diabetes Mellitus in Hong Kong Chinese --- p.81 / Chapter 3.1.1 --- Hypothesis --- p.81 / Chapter 3.1.2 --- Objectives --- p.81 / Chapter 3.2 --- Cost-effectiveness Analysis of Metformin + Rosiglitazone vs. Metformin + Glibenclamide for Type 2 DM Patient Whose Diabetes is not Adequately Controlled by Metformin Alone from a Payer's Perspective --- p.82 / Chapter 3.2.1 --- Hypothesis --- p.82 / Chapter 3.2.2 --- Objectives --- p.83 / Chapter Chapter 4. --- Cost of Type 2 Diabetes Mellitus in Hong Kong Chinese --- p.84 / Chapter 4.1 --- Subjects and Methods --- p.84 / Chapter 4.1.1 --- Subjects --- p.84 / Chapter 4.1.2 --- Methods --- p.85 / Chapter 4.1.3 --- Validity and Reliability of the Chinese Questionnaire --- p.96 / Chapter 4.2 --- Results --- p.96 / Chapter 4.2.1 --- Subjects' Characteristics --- p.96 / Chapter 4.2.3 --- Comorbidity --- p.102 / Chapter 4.2.4 --- Complications --- p.102 / Chapter 4.2.5 --- Costs of Type 2 DM --- p.104 / Chapter 4.3 --- Discussions --- p.123 / Chapter Chapter 5 --- Cost-effectiveness Analysis of Metformin + Rosiglitazone vs. Metformin + Glibenclamide for Type 2 DM Patient Whose Diabetes is not Adequately Controlled by Metformin Alone from a Payer's Perspective --- p.134 / Chapter 5.1 --- Methods --- p.134 / Chapter 5.1.1 --- Model Overview --- p.134 / Chapter 5.1.2 --- "Success, Failure and Discontinuation Rates" --- p.138 / Chapter 5.1.3 --- Resources Use and Costs --- p.142 / Chapter 5.1.4 --- Health-Related Quality of Life (HRQOL) --- p.148 / Chapter 5.1.5 --- Base Case Analysis --- p.149 / Chapter 5.1.6 --- Sensitivity Analyses --- p.149 / Chapter 5.2 --- Results --- p.150 / Chapter 5.2.1 --- Base Case Model - CE Analysis: cost per controlled Type 2 DM patient --- p.150 / Chapter 5.2.2 --- Sensitivity Analysis- CE Analysis: cost per controlled Type 2 DM patient --- p.151 / Chapter 5.2.3 --- Base Case Model - CE Analysis: cost per EQ5D utility score --- p.154 / Chapter 5.2.4 --- Sensitivity Analysis- CE Analysis: cost per EQ5D utility score --- p.155 / Chapter 5.3 --- Discussions --- p.158 / Chapter Chapter 6. --- Conclusions --- p.163 / Appendix --- p.165 / References

Para avaliar os benefícios da comunicação rápida ao clínico do diagnóstico de vírus respiratórios, foi analisado a viabilidade econômica de 2 testes, com o tempo de entrega de resultado em 2 horas para teste rápido e 48 horas para Biologia Molecular. As amostras coletadas foram processadas utilizando técnicas convencionais e os testes disponíveis no mercado local. Foram escolhidos dois testes rápidos pelo método de imunocromatografia para quatro parâmetros analíticos: Influenza A, Influenza H1N1, Influenza B e Vírus Sincicial Respiratório (RSV) e em Biologia Molecular um teste de RT-PCR multiplex com 25 patógenos entre vírus e bactérias. O tipo de amostra utilizada foi swab e lavado de nasofaringe. A população escolhida para o estudo foi paciente adulto, em tratamento de câncer, que necessita de uma resposta rápida já que a maioria se encontra com comprometimento do sistema imune por doença ou por tratamento. O estudo foi transversal, realizado entre os anos de 2012 e 2013, para avaliar a viabilidade econômica da introdução de testes de diagnóstico da infecção respiratória aguda de etiologia viral a partir de amostras de nasofaringe em pacientes com câncer atendidos no Centro de Atendimento de Oncologia Intercorrência (CAIO ), do Instituto do Câncer do Estado de São Paulo (ICESP), hospital público que atende exclusivamente Sistema Único de Saúde (SUS) e Hospital A.C. Camargo, que atende tanto a pacientes do SUS como da rede privada. O estudo incluiu 152 pacientes em tratamento para qualquer tipo de câncer, predominantemente do sexo feminino (81 mulheres e 70 homens) com idades entre 18-86 anos. Para participar do estudo o paciente era consultado e o critério para escolha do paciente foi ser portador de câncer, com história de febre (ainda que referida) acompanhada de tosse ou dor de garganta, tosse e sintomas respiratórios agudos, atendidos por protocolo padronizado que inclui avaliação na admissão, seguimento e manejo antimicrobiano. Para a avaliação econômica os pacientes foram classificados de acordo com o estado geral de saúde, se apresentavam bom estado de estado de saúde poderiam receber alta e faziam uso da medicação em casa evitando 5 dias de internação se recebessem algum resultado para Influenza ou RSV, no entanto os pacientes que apresentavam outro vírus, resultado negativo ou o estado geral era ruim permaneciam internados por 7 dias em observação e cuidados com medicação adequada. Foram realizadas análises econômicas em dois âmbitos: o sistema de saúde publico e o privado considerando o fator diminuição de dias de internação. A analise de Custo-benefício foi eficiente no Sistema privado mas inadequada para o SUS assim como, qualquer outra medida monetária já que os valores de reembolso do SUS estão defasados do custo de qualquer internação. A análise de Custo-efetividade que olha para outros fatores além do monetário foi efetiva nos dois sistemas que enfrentam falta de leitos além da condição de saúde do paciente de evitar a ingestão desnecessária de antibióticos, evitar os gastos do acompanhante, perda de dias de trabalho e estudo. Não houve correspondência de resultados dos testes rápidos com o multiplex de Biologia Molecular / To evaluate the benefits of the rapid communication of the respiratory viruses\' diagnosis to the doctor, the economic feasibility of two tests was analyzed, with the result delivery time within 2-hours for the rapid test and 48 hours for Molecular Biology. The samples were processed using conventional techniques and the available tests in the local market. Two rapid tests were selected by the immunochromatography method for four analytical parameters: Influenza A, Influenza A H1N1, Influenza B, and Respiratory Syncytial Virus (RSV) and in Molecular Biology a multiplex RT-PCR assay with 25 pathogens between viruses and bacteria. The type of sample used was swab and nasopharyngeal wash. The population chosen for the study was of adult patients undergoing cancer treatment, which requires a rapid response since most have a compromised immune system due to the disease or treatment. The study, conducted between 2012 and 2013, was cross-sectional to evaluate the economic feasibility of introducing diagnostic tests for acute respiratory infection of viral etiology from nasopharyngeal samples of patients with cancer attended at the Oncology Intercurrence Care Center (CAIO), at the Cancer Institute of the São Paulo State (ICESP), at public hospital that attends exclusively the Unified Health System (SUS) and at AC Camargo hospital, which attends SUS patients as well as the private health system. The study included 152 patients undergoing treatment for any type of cancer, predominantly female (81 women and 70 men) between 18 and 86 years. To participate in the study, the patients were consulted and the criteria for choosing a patient was to be a cancer patient with a history of fever (even if referred) accompanied by cough or sore throat, coughing and acute respiratory symptoms, attended by standardized protocol that includes an evaluation at the admission, tracking and antimicrobial management. For the economic evaluation, patients were classified according to the general health condition. If they were in a good health condition, they could receive medical discharge and make use of the medication at home avoiding five days of hospitalization when receiving a result for influenza or RSV. However, the patients with other viruses, negative results or with bad general condition remained hospitalized for seven days under observation and care with proper medication. Economic analyzes were carried out in two areas: the public health system and private health system considering the factor decreased length of hospital stay. The cost-benefit analysis was efficient in the private system but inadequate for the NHS as well as any other monetary measure since the SUS reimbursement values are too low when compared to the cost of any other hospital. The cost-effectiveness analysis that looks at other factors besides money was effective in both systems that were facing lack of beds in addition to the health condition of the patient to avoid unnecessary intake of antibiotics, avoid the costs of the accompanying person, loss of working and study days. There were no results correspondences of the rapid tests with the Molecular Biology multiplex

The Western and Central Pacific Ocean (WCPO) is home to the largest tuna fishery stock in the world. However, Pacific Island members of the Western and Central Pacific Tuna Commission (WCPTC) argue that their share of the economic rent from the tuna catches taken out of the Pacific region is very small, being on average only about 6% of the total net benefit, when compared to the share earned by Distant Water Fishing Nations (DWFNs). Kiribati is one of the Pacific Island Countries (PICs), which relies heavily on its fishery for its economic development and sustainability. Kiribati earns 40% - 50 % of its government revenue from fisheries access fees paid by DWFNs for tuna caught in the the Kiribati EEZ. The Government of Kiribati (GoK) believes that Kiribati could get greater benefit if they develop their own domestic tuna fishery. This study uses Cost-Benefit Analysis (CBA) and SWOT Analysis to investigate whether domestication of the tuna fishery is the right move for Kiribati or not. The CBA reported in this thesis adapted a model developed by Campbell (2004) to investigate and evaluate fisheries policy in Papua New Guinea (PNG). However the model in this thesis is reflective of the situation and case of Kiribati. In analyzing the different options identified in this study, the CBA indicated negative (-) NPV(s) for the medium-sized vessel option and positive (+) NPV(s) for the large-sized vessel option. The SWOT analysis however, complemented the CBA by further investigating the tuna domestication options in the economic, social and business and business environment of Kiribati. The SWOT analysis indicated that the existing situation and business conditions in Kiribati appears to favor the small to medium sized vessel options which are less risky than the large purse seine vessel option.

This paper attempts to provide a cost-benefit analysis of the economic and social effects of hosting the Olympic Games. I provide an overview of the economic and social impacts of the Games and analyze their effects. I focus the economic effects of the Games on tourism, trade, corporate sponsorship and the sale of television rights. I also look at the social effects of the Games on infrastructure and employment. Finally I assess why the Olympics remain an appealing venture for cities, despite evidence that demonstrates how they produce more actual harm than good for the host city. In addition, I provide predictions for two alternative directions that the Olympics could take in the future: to either continue in the current trend of immense growth and commercialization, or alternatively, implement a new Olympic bidding process that establishes stricter criteria for candidate cities.