Le Staphylocoque aureus (S. aureus) est une bactérie pouvant causer des infections d’origine communautaire ou hospitalière. En plus des personnes pouvant être infectées par S. aureus, de nombreux individus environ 20-25% parmi les adultes en bonne santé, portent ce pathogène sur leurs corps (ils sont dits "colonisés"). Bien qu’asymptomatique et souvent bénigne, la colonisation à S. aureus peut rarement impliquer un risque d’infection secondaire grave mais représente un risque d’être transmise à une tierce personne. A l’hôpital, le risque d’infection et de transmission apparaît comme étant particulièrement haut pour la souche de S. aureus résistante à la méticilline (SARM). La prévention et la lutte contre le SARM est un problème de santé publique important. Les Nation Unis se sont récemment engagés dans cette lutte en créant le"Global Action Plan on Antimicrobial Resistance". Ce travail de thèse traite de trois différentes études dans la cadre de la prévention et du contrôle de ce pathogène. / Staphylococcus aureus is a bacterium that can cause blood infections that can have a community or hospital origin. Among people infected with S.aureus, about 20-25% is healthy adults that carry the pathogen on their bodies, without suffering any symptom (they are said "colonized"). Although asymptomatic and often benign, colonization with S. aureus involves a risk of secondary infection and represents a serious risk of transmission to a third party. In hospitals, the risk of infection and transmission appears to be unusually high for methicillinresistant S. aureus (MRSA) and complications can be very severe. Prevention and the fight against MRSA is a major public health concern. The United Nations recently engaged in this struggle by creating the "Global Action Plan on Antimicrobial Resistance". This work is about three different studies in the prevention and control of this pathogen.

Introduction: Facial lipoatrophy is a stigmatizing hallmark for HIV-positive status, and can lead to poor social functioning. Information gleaned from an economic evaluation of facial lipoatrophy treatments would inform policy decision making concerning potential public insurance coverage. Methods: A decision-analytic model was used to estimate the lifetime costs and Quality Adjusted Life Years (QALYs) gained from treatments using either poly-l-lactic or and polyalkylimide gel for HIV positive patients. Disease progression probabilities and utilities were derived from the literature. Costs were obtained from interviews with physicians and product distributors. Findings: Incremental costs per QALY were $66,409 CAD/$57,352 CAD for poly-l-lactic acid, and $48,715 CAD/$45,457 CAD for polyalkylimide gel® (Societal perspective/Ministry of Health perspective). Sensitivity analysis did not have a significant effect on the lower incremental costs per QALY reported for polyalkylimide gel. Conclusion: Our base-case analysis revealed that treatments using polyalkylimide gel offers lower ICUR than treatments using poly-l-lactic acid.

Introduction: Facial lipoatrophy is a stigmatizing hallmark for HIV-positive status, and can lead to poor social functioning. Information gleaned from an economic evaluation of facial lipoatrophy treatments would inform policy decision making concerning potential public insurance coverage. Methods: A decision-analytic model was used to estimate the lifetime costs and Quality Adjusted Life Years (QALYs) gained from treatments using either poly-l-lactic or and polyalkylimide gel for HIV positive patients. Disease progression probabilities and utilities were derived from the literature. Costs were obtained from interviews with physicians and product distributors. Findings: Incremental costs per QALY were $66,409 CAD/$57,352 CAD for poly-l-lactic acid, and $48,715 CAD/$45,457 CAD for polyalkylimide gel® (Societal perspective/Ministry of Health perspective). Sensitivity analysis did not have a significant effect on the lower incremental costs per QALY reported for polyalkylimide gel. Conclusion: Our base-case analysis revealed that treatments using polyalkylimide gel offers lower ICUR than treatments using poly-l-lactic acid.

This paper will examine specific processes involved within the decision-making process of how to allocate limited health care resources. I will start by discussing how in order to compare and differentiate between health states, we have created ranking systems, based on the health state’s impact on people’s quality of life, which health states need more care, and which can be most effectively treated. We evaluate impact on quality of life by assigning quality weights to years of life lived with that health state, which we call quality-adjusted life years, or QALYs. Next, I will discuss the problems with assigning quality weights to health states; specifically, the disability paradox, meaning the distinct differences between quality weights assigned by non-patients versus patients. After that, I will explain how depression defies the trend of the disability paradox, and causes our prior arguments about why patients and non-patients rate health states different to contradict themselves., This leads me to suggest that we should consider a different way of deciding between different quality weights. I examine the arguments for choosing higher or lower quality weights, and conclude that because we have a moral imperative to provide health care resources to those in need, particularly those who are disadvantaged, we should take the lower quality weights and err on the side of overspending on health states. Ultimately, this will create the greatest change in funding for health states like depression that go against the disability paradox. Finally, I address the economic trade-offs we have to consider if we make the decision to spend more on treating health states.

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<p>Air pollution and a general concern for lack of physical activity in North America have motivated governments to encourage non-motorized modes of transportation. A key infrastructure component for these forms of transportation is sidewalks. The City of Saskatoon has identified the need to formalize sidewalk management policies to demonstrate diligence for community protection regarding sidewalk safety. Prioritization of sidewalk maintenance and rehabilitation actions must be objective and minimize risk to the community. Most research on prioritization of pedestrian facilities involved new construction projects. This research proposes a decision model that prioritizes a given list of existing unsafe sidewalk locations needing maintenance or rehabilitation using a direct measure of pedestrian safety, namely, quality-adjusted life years lost per year. </p><p>A decision model was developed for prioritizing a given list of unsafe sidewalk locations, aiding maintenance and rehabilitation decisions by providing the associated risk to pedestrian safety. The model used data mostly from high quality sources that had already been collected and validated. Probabilities and estimations were used to produce value-added decision policy.</p> <p>The decision analysis framework applied probability and multi-attribute utility theories. This study differed from other research due to the inclusion of age and gender groups. Total average daily population of the city was estimated. This population was distributed to sidewalk locations using probabilities for trip purposes and a locations ability to attract people relative to the city total. Then trip injury events were predicted. Age and gender distribution and trip injury type estimations were used to determine the impact of those injuries on quality of life.</p><p>There exist much observable high quality data that can be used as indicators of unknown or unobserved events. A decision policy was developed that prioritizes unsafe sidewalk locations based on the direct safety impact on pedestrians. Results showed that quality-adjusted life years lost per year sufficiently prioritized a given list of unsafe sidewalk locations. It was demonstrated that the use of conditional probabilities (n=594) allowed for the ability to abstract data representing a different source population to another. Average daily population confined and distributed within the city boundary minimized problems of accuracy. Gender-age distribution was important for differentiating the risk at unsafe sidewalk locations. Concepts from this research provide for possible extension to the development of sidewalk service levels and sidewalk priority maps and for risk assessment of other public services.</p>

<p>Air pollution and a general concern for lack of physical activity in North America have motivated governments to encourage non-motorized modes of transportation. A key infrastructure component for these forms of transportation is sidewalks. The City of Saskatoon has identified the need to formalize sidewalk management policies to demonstrate diligence for community protection regarding sidewalk safety. Prioritization of sidewalk maintenance and rehabilitation actions must be objective and minimize risk to the community. Most research on prioritization of pedestrian facilities involved new construction projects. This research proposes a decision model that prioritizes a given list of existing unsafe sidewalk locations needing maintenance or rehabilitation using a direct measure of pedestrian safety, namely, quality-adjusted life years lost per year. </p><p>A decision model was developed for prioritizing a given list of unsafe sidewalk locations, aiding maintenance and rehabilitation decisions by providing the associated risk to pedestrian safety. The model used data mostly from high quality sources that had already been collected and validated. Probabilities and estimations were used to produce value-added decision policy.</p> <p>The decision analysis framework applied probability and multi-attribute utility theories. This study differed from other research due to the inclusion of age and gender groups. Total average daily population of the city was estimated. This population was distributed to sidewalk locations using probabilities for trip purposes and a locations ability to attract people relative to the city total. Then trip injury events were predicted. Age and gender distribution and trip injury type estimations were used to determine the impact of those injuries on quality of life.</p><p>There exist much observable high quality data that can be used as indicators of unknown or unobserved events. A decision policy was developed that prioritizes unsafe sidewalk locations based on the direct safety impact on pedestrians. Results showed that quality-adjusted life years lost per year sufficiently prioritized a given list of unsafe sidewalk locations. It was demonstrated that the use of conditional probabilities (n=594) allowed for the ability to abstract data representing a different source population to another. Average daily population confined and distributed within the city boundary minimized problems of accuracy. Gender-age distribution was important for differentiating the risk at unsafe sidewalk locations. Concepts from this research provide for possible extension to the development of sidewalk service levels and sidewalk priority maps and for risk assessment of other public services.</p>