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<p><strong>Objective</strong>: To estimate the cost-effectiveness of an influenza immunization strategy directed at healthy children 36 months to 15 years on the herd immunity of entire communities, versus not implementing this strategy.</p> <p><strong>Design</strong>: An economic evaluation, cost-effectiveness analysis (CEA). Costs and effects were estimated jointly with a two-stage bootstrap with shrinkage correction. Uncertainties around input parameters were tested with one-way and multi-way sensitivity analysis.</p> <p><strong>Data Sources</strong>: Effect and resource consumption data were from the Hutterite Influenza Prevention Study. Unit costs were collected from multiple sources including, government reports and schedules, local suppliers, peer-reviewed articles and systematic reviews, Internet searches and study data on file.</p> <p><strong>Outcomes</strong>: Mean costs and effects, incremental cost-effectiveness ratio (ICER), net monetary benefit (NMB) statistic and cost effectiveness acceptability curves (CEAC).</p> <p><strong>Results</strong>: The average cost per patient in the treatment arm was $69.08 and $32.66 in the control arm. The average number of influenza-free cases was of 0.96 in the treatment arm and 0.73 in the control arm. ICER was $164.19 per case of influenza averted, 95% confidence interval $28.38, $2,767.75. CEAC showed that at a willingness to pay of $177, the probability of the treatment strategy being cost effective compared to the control was 0.50. Results from sensitivity analyses were slightly different compared to base case results, supporting the robustness of base case estimates.</p> <p><strong>Conclusion</strong>: This strategy is likely to be cost effective relative to the comparator as the ICER estimate is low and because the estimate is conservative given that the study population was very healthy and the influenza season was mild. A more virulent season and a less healthy population would have produced a lower ICER or seen the treatment arm dominate the control.</p> / Master of Science (MSc)

This thesis presents a comparison of correlation methods in risk analysis. A theoretical solution is given to the correlation problem along with a discussion of each method. Each method is compared to a developed test case and two other cost projects. Restrictions on correlation coefficients are also given followed by the advantages and disadvantages of each method. / Master of Science

In the United States, paper checks are the most widely used mechanism aside from cash to purchase goods and services. The use, production, and collection of paper checks is a costly process involving substantial societal resources. The most recent estimates of the total resources used in check processing were put forth in a 1987 paper by David B. Humphrey and Allen Berger. This paper updates the calculation of the total social cost of paper checks and their electronic substitute, automated clearinghouse payments. / Master of Arts

No / Demand for both Emergency Department (ED) and radiology services continues to increase across the UK while simultaneously, healthcare organisations are being asked to evaluate the quality of care provided and constrain service costs. National guidance on radiograph reporting times recommends ED radiographs are reported on day of patient attendance but in practice, delays in reporting persist. This study considers whether a radiographer led immediate reporting service for ED referrals could provide a cost-effective service improvement solution. A pragmatic multi-centre randomised controlled trial was undertaken. 1502 patients were recruited and randomly assigned to an immediate or delayed reporting arm and treated according to group assignment. Patient health gain was measured in terms of change in utilities derived from EQ-5D responses at baseline and 8 week follow-up. Resources used and the costs of an immediate reporting service were analysed at the patient level and compared to standard reporting practices. 1688 radiographic examinations were performed (1502 patients). 79 discordant radiographic interpretations were identified (n = 79/1688; 4.7%). Interpretive errors were significantly reduced within immediate reporting arm. No significant difference was noted in the relative improvement in patient perceived health status between the 2 arms of the study. The average cost saving per patient in the immediate reporting arm was £23.40. Radiographer led immediate reporting of ED radiographs is a cost-effective service development and its universal introduction could make a significant contribution to the current drive to increase service productivity within current budget constraints. / National Institute for Health Research (NIHR) Research for Patient Benefit (RfPB) programme (PB-PG-0407-13033).

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.

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.

The purpose of this study was to propose and field test a cost-benefit analysis model to determine the profitability of secondary vocational education programs. The model consisted of costs, process, and benefits components. Instructional personnel, building, equipment, materials and supplies, administration, travel, services, utilities, and maintenance were the major components of the costs. Process implied the actual conduct of the program. Increased earnings from graduates' employment, earnings from cooperative placement, provision of services, and noneconomic benefits obtained by the graduates were the components of the benefits. Costs and benefits data for field testing the model were obtained from four programs from the four vocational service areas of trade and industrial, occupational home economics, business education, and marketing and distributive education selected from both a comprehensive high school and an area vocational education center in the Roanoke County School Division, Virginia. All graduates of 1983/84 of the four programs were surveyed to gather data on them. A 73.9% return was obtained from the survey. The difference between the graduates' current earnings and earnings determined by using the Federal minimum wage for the same number of work hours by employed graduates was considered as an income benefit. Actual differences between discounted benefits and the gross costs were used to determine the profitability of programs. The following conclusions were drawn from the findings of this study: 1. The trade and industrial, business education, and marketing and distributive education programs were economically profitable. 2. The occupational home economics program was not economically profitable. 3. Graduates in each program have obtained several noneconomic benefits. 4. The proposed cost-benefit analysis model was determined useable and transportable to other vocational education settings. Based on the findings and conclusions of this study, the following recommendations were drawn: 1. That local vocational administrative units use the concept of cost-benefit analysis as an evaluation technique for secondary vocational education programs. 2. That a research study be conducted to determine what other costs and benefits should be considered in the model. 3. That a research study be conducted to determine the economic value of noneconomic benefits. 4. That a longitudinal cost-benefit analysis is needed to determine economic earning and type of jobs held by graduates after graduation. 5. That a study be conducted using cost-benefit analysis with an appropriate comparison group to vocational graduates. 6. That an annual cost-benefit analysis of vocational programs be conducted for each school system to make comparative judgement of their programs. 7. That post-secondary vocational programs explore the possibility of using cost-benefit analysis for evaluating programs. / Ed. D.

Yes / Background:To inform the development of the European Academy of Allergy and Clinical Immunology’s (EAACI) Guidelines on Allergen Immunotherapy (AIT) for allergic asthma, we assessed the evidence on the effectiveness, cost-effectiveness and safety of AIT. Methods:We performed a systematic review, which involved searching nine data-bases. Studies were screened against predefined eligibility criteria and critically appraised using established instruments. Data were synthesized using random-effects meta-analyses.Results:98 studies satisfied the inclusion criteria. Short-term symptom scores were reduced with a standardized mean difference (SMD) of 1.11 (95% CI 1.66, 0.56). This was robust to a prespecified sensitivity analyses, but there was evidence suggestive of publication bias. Short-term medication scores were reduced SMD 1.21 (95% CI 1.87, 0.54), again with evidence of potential publication bias. There was no reduction in short-term combined medication and symptom scores SMD 0.17 (95% CI 0.23, 0.58), but one study showed a beneficial long-term effect. For secondary outcomes, subcutaneous immunotherapy (SCIT) improved quality of life and decreased allergen-specific airway hyperreactivity (AHR), but this was not the case for sublingual immunotherapy (SLIT). There were no consistent effects on asthma control, exacerbations, lung function, and nonspecific AHR. AIT resulted in a modest increased risk of adverse events (AEs). Although relatively uncommon, systemic AEs were more frequent with SCIT; however no fatalities were reported. The limited evidence on cost-effectiveness was mainly available for sublingual immunotherapy (SLIT) and this suggested that SLIT is likely to be cost-effective. Conclusions: AIT can achieve substantial reductions in short-term symptom and medication scores in allergic asthma. It was however associated with a modest increased risk of systemic and local AEs. More data are needed in relation to secondary outcomes, longer-term effectiveness and cost-effectiveness. / EAACI; BM4SIT. Grant Number: 601763; European Union's Seventh Framework Programme FP7