In Myanmar, Plasmodium falciparum malaria is important because of both the burden of disease and the emergence of parasites resistant to artemisinin-based therapies. In 2012, concomitant with the lifting of international economic sanctions, funding for malaria control and elimination in Myanmar rose significantly. The University of Oxford was asked to support priority setting by assessing the relative cost-effectiveness of insecticide- treated bed nets and community health workers, particularly with respect to planning in the Myanmar Artemisinin Resistance Containment region along the east of the country. In the context of rising artemisinin resistance and, later, the goal of regional malaria elimination by 2030, reduction in malaria transmission was an important consideration in prioritising between interventions. A cost-effectiveness analysis was undertaken using both a static decision tree model and a dynamic disease transmission model. Supporting work towards this analysis included a systematic review of dynamic-transmission economic-evaluations and the creation of a data repository to collate governmental and non-governmental malaria case records. In addition, initially unplanned work on economic evaluation methodology was completed; identifying challenges in the application of cost utility analysis to this decision problem and proposing a framework for budget-based geographic resource allocation as an adaptation of standard methods. The results of this work include a tripling of the number of malaria diagnostic reports available between 2012 and 2014 (71% increase in Plasmodium falciparum cases) with this data showing a decrease in Plasmodium falciparum cases over time, alongside rising testing rates. Cost utility analysis found that, in general, malaria community health workers are more costly yet more effective than insecticide treated bed nets, though in both cases cost effectiveness is very much context dependent. Geographic allocation analyses using both static and dynamic models illustrate the potential for economic evaluation to provide both more detailed and more practical policy recommendations. Parameter uncertainty was explored in both cases. Some township recommendations were robust to both parameter uncertainty and model variation (structural uncertainty). Viewed through the lens of the Reference Case for Economic Evaluation in Low and Middle Income Countries (published during the course of this DPhil), budget-based geographic resource allocation largely adheres to the healthcare economic evaluation principles and offers improvements to dealing with heterogeneity and resource constraints. This DPhil recommends that Myanmar malaria policy is tailored to reflect geographic variation in intervention cost-effectiveness, rather than focusing on universal coverage, and illustrates a framework for economic evaluation to support budget-based geographic allocation.

Typescript (photocopy). / Digitized by Kansas Correctional Industries

Thesis (B.S.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 1982. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ENGINEERING / Bibliography: leaf 47. / by John Christopher Moran. / B.S.

The thesis project explores the use of an optimization methodology for selecting the lowest monetary cost combinations of technologies to meet a set operational energy efficiency targets for buildings. The optimization approach, which is operated on a normative energy model, is compared with existing prescriptive methodologies for selecting technology combinations and a metric is developed for ranking their effectiveness; the E/C Ratio. The energy savings/ cost ratio is also the objective function that the optimization algorithm is set to maximize. The optimization routine is coded in to a custom MATLAB script and is used in two case studies to optimize a proto-typical Korean apartment and office building. The optimization methodology finds technology combinations that are much more cost effective than the prescriptive methodology at meeting an energy savings target and can generically be applied to other buildings given a palette of technology alternatives and the corresponding cost data.

This thesis investigated the cost-effectiveness of a 12-month supervised aerobic walking program with or without a behavioural intervention and an educational pamphlet, compared to an unsupervised/self-directed educational pamphlet intervention, among individuals with moderate osteoarthritis (OA) of the knee. Analyses included an economic evaluation to assess the cost effectiveness of the two walking interventions from both the societal and Canadian provincial/territorial health care payer perspectives. A value of information analysis exploring the potential value of future research was also performed. Results revealed that the unsupervised/self-directed intervention was the most cost-effective approach given that it cost the least to implement and participants had higher quality-adjusted life years (QALYs). Walking, either supervised in a community setting, or unsupervised in a setting such as the home, may be a favourable non-pharmacological option for the management of OA of the knee. The thesis concludes with a policy discussion relating to the funding of non-pharmacological therapies.

Background: The presence of calcified deposits in the coronary arteries has become established as a marker of coronary atherosclerosis. Design and Setting: Single medical center observational study. Study objective: 1) To determine the sensitivity and specificity of coronary calcium by cinefluoroscopy (CF) and to validate the reliability of CF in the angiographic detection of > 50% coronary artery stenosis. 2) To assess the financial benefit of adding CF-determined coronary calcium into the self-paid executive physical examination items. 3) To evaluate whether an algorithm using CF to assess coronary calcium has potential as an initial cost-effective testing pathway for diagnosis of > 50% coronary artery stenosis. Methods: Between November 1, 2004 and April 25, 2005, 333 patients who underwent angiography for diagnosis of and determine the extent of coronary artery disease were enrolled in the study. All patients received CF to determine presence or absence of calcium in the coronary artery system prior to selective angiography. Sensitivity and specificity were then obtained to confirm CF as a reliable non-invasive test for diagnosing > 50% coronary artery stenosis. Direct cost, total cost and estimated profit were calculated with and without the cost of cardiac catheterization laboratory at Chang Gung Memorial Hospital, which has an average of 475 patients/month who undergo self-paid executive physical examinations. Direct cost, total cost and estimated loss of coronary calcium by electron beam computed tomography (EBCT) were calculated for the acquisition of an EBCT machine by Chang Gung Memorial Hospital. A test model was applied to examine the costs and cost-effectiveness of the following diagnostic modalities: the traditional treadmill exercise (TMET); stress thallium and positron emission tomography (THALLIUM); coronary calcium by EBCT calcium score > 0 and > 168; and, coronary calcium by CF for diagnosis of obstructive coronary artery disease (CAD) as a function of pretest likelihood (i.e., prevalence) of disease. Results: Two hundred fifty three men and 80 women were enrolled in this study (mean age, 63.9+11.4 years; age range, 35-90 years). Sensitivity and specificity of CF in the detection of patients with angiographically coronary artery stenosis >50% were 96% and 86%, respectively. The profit accrued from implementing the CF test at Chang Gung Memorial Hospital, including the cost of the cardiac catheterization laboratory, was NT$329/patient. At 475 patients per month, this test will produce revenue of NT$156,275/month or NT$1,875,300/year. The profit achieved by implementing the CF test at Chang Gung Memorial Hospital, excluding the cost of the cardiac catheterization laboratory was NT$838.7/patient, or NT$398,382.5/month and NT$4,780,590/year. Conversely, implementing the EBCT test will cost Chang Gung Memorial Hospital NT$ 1,124,990/month or NT$ 13,499,880/year. With disease prevalence at < 0.7, CF examination was the most cost-efficient initial diagnostic testing pathway. However, for the group with prevalence at 1.0, the highest group, initial angiography with no prior non-invasive testing was the most cost-effective strategy for diagnosis of obstructive coronary artery disease. Conclusion: 1) Calcium detection with CF is a highly sensitive and moderately specific test, and a simple, inexpensive, and safe technique for identifying CAD. 2) Instituting CF as a screening test for self-paid executive physical examinations would result in considerable profit for the hospital. Conversely, establishing an EBCT program will produce a substantial financial loss. 3) For patients evaluated for obstructive CAD, a test pathway utilizing CF to detect coronary artery calcium as an initial non-invasive test minimized direct costs and maximized cost-effectiveness. Cinefluoroscopy has been neglected as a noninvasive technique for diagnosis of coronary stenosis and is sufficiently promising to warrant increased clinical use.

Introduction: Most literatures researched radiofrequency ablation (RFA) for early hepatocellular carcinoma (HCC) defined the early tumor size as 3cm or less. However, detection rate of HCC smaller than 2 cm became increasing since high risk patients had received regular screening and the imaging techniques has been much improved. Whether RFA or percutaneous ethanol injection (PEI) is better for a patient with such a small HCC is still controversial. Methods: We retrospectively obtained patients with single HCC 2 cm in diameter or smaller from the computerized medical records database in a local teaching hospital located at southern Taiwan, diagnosed during January 1, 2002 to April 30, 2008. Those patients received RFA (RFA group) or PEI (PEI group) as the first-line nonsurgical treatments were enrolled for further analysis. We compared baseline characteristics of RFA and PEI groups, including gender, age, possible risk factors of recurrence, and prognostic factors. Then, we analyzed recurrent rate, time to recurrence, survival rate, complication rate, mean cost of each treatment, and hospital stay of RFA and PEI groups. Results: There were 32 patients qualified for the study design, including 22 in PEI group¡G13 males and 9 females with mean age was 63.73 years; and 10 in RFA group¡G7 males and 3 females with mea age was 58.30 years¡CNo statistically significant differences between RFA and PEI groups were observed with respect to baseline characteristics. Nevertheless, there was significant difference between these two groups with respect to mean hospital stay (p=0.007) and mean cost (p¡Õ0.001): mean cost of PEI was NTD $16934.7; mean cost of RFA was NTD $51677.6, the difference was NTD $34732.9. There was no difference respect to complication rate, recurrent rate, time to recurrence and overall survival rate between RFA and PEI groups. Conclusion: For patients with single HCC 2 cm in diameter or smaller (i.e. very early HCC), we concluded that: if under similar basic background, the cost of RFA was much higher than that of PEI, but no difference in the complication rate, recurrent rate, time to recurrence and overall survival rate between these two treatment.

Thesis (M.S.)--Naval Postgraduate School, 2002. / Thesis advisor(s): William Gates, Julie Carpenter. Includes bibliographical references (p. 83-84). Also available online.

Adenoviruses, particularly types 4 and 7, are associated with febrile respiratory illness (FRI) outbreaks in US military basic trainees. Vaccines against these two serotypes controlled FRI in basic trainees until production ceased in the mid-1990s. After contracting a new manufacturer, adenovirus vaccination of military basic trainees resumed in 2011. The purpose of this dissertation was to assess the cost-effectiveness of using the new adenovirus type 4 and type 7 vaccines for the prevention of FRI in US military basic trainees from the perspective of each military branch. Two decision tree models comparing adenovirus vaccination to no adenovirus vaccination were used for this dissertation. The first model is similar to previous models used to assess the cost-effectiveness of the adenovirus vaccine in the military, where the outcome is number of FRI hospitalizations prevented. The second model created for this dissertation used information gathered from published literature and conversations with experts on the adenovirus vaccine. The outcome for the second model was number of training days lost (TDL) averted. Results from part I indicated that adenovirus vaccination of basic trainees was cost-effective as measured by FRI hospitalizations prevented in all US military service branches but the Coast Guard. The model showed that reintroducing the adenovirus vaccine to basic trainees saved the Army $5.8 million, the Navy, $1 million, the Marine Corps, $238,000, and the Air Force, $5.2 million, annually. In addition, adenovirus vaccination prevented 1,221, 543, 317, 677 cases of FRI hospitalization annually in the Army, Navy, Marine Corps, and Air Force respectively. In part II of this study, adenovirus vaccination of basic trainees was the dominant strategy as measured by TDL averted in all US military service branches but the Marine Corps and the Coast Guard. Results indicate that it would cost approximately $37.63 and $563.78 per TDL averted for the Marine Corps and Coast Guard respectively. Both models used for this dissertation provide evidence supporting the cost-effectiveness of using the adenovirus vaccine in US basic trainees in all services but the Coast Guard. / text

published_or_final_version / Environmental Management / Master / Master of Science in Environmental Management