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Fulltext Upgrade Recycling of Cast Iron Scrap Chips towards β-FeSi₂ Thermoelectric Materials

Laila A, Nanko M, Takeda M

Materials (Basel), 2014 Sep 04;7(9):6304-6316.
PMID: 28788193 DOI: 10.3390/ma7096304

The upgrade recycling of cast-iron scrap chips towards β-FeSi₂ thermoelectric materials is proposed as an eco-friendly and cost-effective production process. By using scrap waste from the machining process of cast-iron components, the material cost to fabricate β-FeSi₂ is reduced and the industrial waste is recycled. In this study, β-FeSi₂ specimens obtained from cast iron scrap chips were prepared both in the undoped form and doped with Al and Co elements. The maximum figure of merit (ZT) indicated a thermoelectric performance of approximately 70% in p-type samples and nearly 90% in n-type samples compared to β-FeSi₂ prepared from pure Fe and other published studies. The use of cast iron scrap chips to produce β-FeSi₂ shows promise as an eco-friendly and cost-effective production process for thermoelectric materials.

Matched MeSH terms: Cost-Benefit Analysis
Fulltext Alternative RNA Extraction Method in Vibrio vulnificus Infected BrownMarbled Grouper, Epinephelus fuscoguttatus

Fahmeeda Mohamad Jazamuddin, Wan Mohd Aizat, Hoe-Han Goh, Chen-Fei Low, Syarul Nataqain Baharum

Trop Life Sci Res, 2019;30(2):2012-209.
MyJurnal

Vibriosis is a prevalent aquatic disease caused by Vibrio species and has led to massive loss of brown-marbled grouper, Epinephelus fuscoguttatus. The complexity of molecular mechanisms associated with immune defence can be studied through transcriptomics analysis. High quality and quantity of total RNAs are crucial for the veracity of RNA sequencing and gene expression analysis. A low quality RNA will compromise downstream analysis, resulting in loss of time and revenue to re-acquire the data again. Thus, a reliable and an efficient RNA isolation method is the first and most important step to obtain high quality RNA for gene expression studies. There are many aspects need to be considered when deciding an extraction method, such as the cost-effectiveness of the protocol, the duration of chemical exposure, the duration required for a complete extraction and the number of sample-transferring. A good RNA extraction protocol must be able to produce high yield and purity of RNA free from enzyme inhibitors, such as nucleases (RNase), phenols, alcohols or other chemicals carryover, apart from protein and genomic DNA contamination, to maintain isolated RNA integrity in storage condition. In this study, TransZolTM Up produced clean and pure RNA samples from control gills only but not from the infected gill and whole-body tissues. Modified conventional CTAB (conventional hexadecyltrimethylammonium bromide) method was then used as an alternative method to isolate RNA from gill and whole-body tissues of Vibrio-infected E. fuscoguttatus. Modified CTAB method produced intact RNA on gel electrophoresis with higher RIN number (>6.5) for infected gill and whole-body tissues, suggesting that this method could also be used to isolate high quality RNA from fish samples. Therefore, this method is potentially suitable to be used to extract RNA from other fish species especially those that have been infected.

Matched MeSH terms: Cost-Benefit Analysis
Optimizing national immunization program supply chain management in Thailand: an economic analysis

Riewpaiboon A, Sooksriwong C, Chaiyakunapruk N, Tharmaphornpilas P, Techathawat S, Rookkapan K, et al.

Public Health, 2015 Jul;129(7):899-906.
PMID: 26027451 DOI: 10.1016/j.puhe.2015.04.016

This study aimed to conduct an economic analysis of the transition of the conventional vaccine supply and logistics systems to the vendor managed inventory (VMI) system in Thailand.

Matched MeSH terms: Cost-Benefit Analysis
Fulltext Is chest x-ray screening for pulmonary tuberculosis by mass radiography--a cost-effective tool in a military population?

Supramaniam V

Med J Malaysia, 1980 Mar;34(3):301-6.
PMID: 6774221

279 cases of pulmonary tuberculosis were diagnosed during a 10 year period from 1969 to 1978. 60% as a result of self-referral and 40% from mass miniature radiography of the chest. For every case of pulmonary tuberculosis picked up, the number of MMRs required has been steadily rising from 1 in 1900 to 1 in 6700. Using South Korea study figures, it costs US$42600 for a case of pulmonary tuberculosis detected by MMR. Besides being not cost effective, there is little advantage in early detection with regard to prognosis, in preventing subsequent cases and in picking up other lung or cardiac abnormalities. Unnecessary radiation results from frequent MMR whose dosage is 10 or more times greater than standard chest X-rays. MMR should be limited to. contact tracing, prior to overseas courses and on termination of service.
Study site: medical boards submitted to Medical Directorate, Ministry of Defence, Malaysia

Matched MeSH terms: Cost-Benefit Analysis
Economic Impact of Pneumococcal Protein-D Conjugate Vaccine (PHiD-CV) on the Malaysian National Immunization Programme

Aljunid S, Maimaiti N, Ahmed Z, Muhammad Nur A, Md Isa Z, Azmi S, et al.

Value Health Reg Issues, 2014 May;3:146-155.
PMID: 29702920 DOI: 10.1016/j.vhri.2014.04.008

OBJECTIVE: To assess the cost-effectiveness of introducing pneumococcal polysaccharide and nontypeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) in the National Immunization Programme of Malaysia. This study compared introducing PHiD-CV (10 valent vaccine) with current no vaccination, as well as against the alternative 13-valent pneumococcal conjugate vaccine (PCV13).

METHODS: A lifetime Markov cohort model was adapted using national estimates of disease burden, outcomes of pneumococcal disease, and treatment costs of disease manifestations including pneumonia, acute otitis media, septicemia, and meningitis for a hypothetical birth cohort of 550,000 infants. Clinical information was obtained by review of medical records from four public hospitals in Malaysia from the year 2008 to 2009. Inpatient cost from the four study hospitals was obtained from a diagnostic-related group-based costing system. Outpatient cost was estimated using clinical pathways developed by an expert panel. The perspective assessed was that of the Ministry of Health, Malaysia.

RESULTS: The estimated disease incidence was 1.2, 3.7, 70, and 6.9 per 100,000 population for meningitis, bacteremia, pneumonia, and acute otitis media, respectively. The Markov model predicted medical costs of Malaysian ringgit (RM) 4.86 billion (US $1.51 billion) in the absence of vaccination. Vaccination with PHiD-CV would be highly cost-effective against no vaccination at RM30,290 (US $7,407) per quality-adjusted life-year gained. On comparing PHiD-CV with PCV13, it was found that PHiD-CV dominates PCV13, with 179 quality-adjusted life-years gained while saving RM35 million (US $10.87 million).

CONCLUSIONS: It is cost-effective to incorporate pneumococcal vaccination in the National Immunization Programme of Malaysia. Our model suggests that PHiD-CV would be more cost saving than PCV13 from the perspective of the Ministry of Health of Malaysia.

Study site: UKM Medical Centre, Hospital Kuala Lumpur, Hospital
Alor Setar, and Hospital Queen Elizabeth, Kota Kinabalu

Matched MeSH terms: Cost-Benefit Analysis
Fulltext PFO-DBT:MEH-PPV:PC₇₁BM ternary blend assisted platform as a photodetector

Zafar Q, Ahmad Z, Sulaiman K

Sensors (Basel), 2015;15(1):965-78.
PMID: 25574936 DOI: 10.3390/s150100965

We present a ternary blend-based bulk heterojunction ITO/PEDOT:PSS/PFO-DBT: MEH-PPV:PC71BM/LiF/Al photodetector. Enhanced optical absorption range of the active film has been achieved by blending two donor components viz. poly[2,7-(9,9-di-octyl-fluorene)-alt-4,7-bis(thiophen-2-yl)benzo-2,1,3-thiadiazole] (PFO-DBT) and poly(2-methoxy-5(2'-ethylhexyloxy) phenylenevinylene (MEH-PPV) along with an acceptor component, i.e., (6,6)-phenyl-C71 hexnoic acid methyl ester. The dependency of the generation rate of free charge carriers in the organic photodetector (OPD) on varied incident optical power density was investigated as a function of different reverse biasing voltages. The photocurrent showed significant enhancement as the intensity of light impinging on active area of OPD is increased. The ratio of Ilight to Idark of fabricated device at -3 V was ~3.5 × 10(4). The dynamic behaviour of the OPD under on/off switching irradiation revealed that sensor exhibits quick response and recovery time of ∼800 ms and 500 ms, respectively. Besides reliability and repeatability in the photoresponse characteristics, the cost-effective and eco-friendly fabrication is the added benefit of the fabricated OPD.

Matched MeSH terms: Cost-Benefit Analysis
Fulltext Cost effectiveness analysis of carbetocin during cesarean section in a high volume maternity unit

Voon HY, Shafie AA, Bujang MA, Suharjono HN

J Obstet Gynaecol Res, 2018 Jan;44(1):109-116.
PMID: 29027315 DOI: 10.1111/jog.13486

AIM: To evaluate the cost effectiveness of carbetocin compared to oxytocin when used as prophylaxis against post-partum hemorrhage (PPH) during cesarean deliveries.
METHODS: A systematic review of the literature was performed to identify randomized controlled trials that compared the use of carbetocin to oxytocin in the context of cesarean deliveries. Cost effectiveness analysis was then performed using secondary data from the perspective of a maternity unit within the Malaysian Ministry of Health, over a 24 h time period.
RESULTS: Seven randomized controlled trials with over 2000 patients comparing carbetocin with oxytocin during cesarean section were identified. The use of carbetocin in our center, which has an average of 3000 cesarean deliveries annually, would have prevented 108 episodes of PPH, 104 episodes of transfusion and reduced the need for additional uterotonics in 455 patients. The incremental cost effectiveness ratio of carbetocin for averting an episode of PPH was US$278.70.
CONCLUSION: Reduction in retreatment, staffing requirements, transfusion and potential medication errors mitigates the higher index cost of carbetocin. From a pharmacoeconomic perspective, in the context of cesarean section, carbetocin was cost effective as prophylaxis against PPH. Ultimately, the relative value placed on the outcomes above and the individual unit's resources would influence the choice of uterotonic.

Matched MeSH terms: Cost-Benefit Analysis/economics; Cost-Benefit Analysis/statistics & numerical data*
Fulltext Massive open online courses (MOOCs) for continuing medical education - why and how?

Setia S, Tay JC, Chia YC, Subramaniam K

Adv Med Educ Pract, 2019;10:805-812.
PMID: 31572042 DOI: 10.2147/AMEP.S219104

Continuing medical education (CME) is meant to not only improve clinicians' knowledge and skills but also lead to better patient care processes and outcomes. The delivery of CME should be able to encourage the health providers to accept new evidence-based practices, and discard or discontinue less effective care. However, continuing use of expensive yet least effective and inappropriate tools and techniques predominates for CME delivery. Hence, the evidence shows a disconnect between evidence-based recommendations and real-world practice - borne out by less than optimal patient outcomes or treatment targets not being met especially in low- to middle-income countries. There is an ethical and professional obligation on CME-providers and decision-makers to safeguard that CME interventions are appraised not only for their quality and effectiveness but also for cost-effectiveness. The process of learning needs to be engaging, convenient, user-friendly and of minimal cost, especially where it is most needed. Today's technology permits these characteristics to be integrated, along with further enhancement of the engagement process. We review the literature on the mechanics of CME learning that utilizes today's technology tools and propose a framework for more engaging, efficient and cost-effective approach that implements massive open online courses for CME, adapted for the twenty-first century.

Matched MeSH terms: Cost-Benefit Analysis
Chitosan modifications for adsorption of pollutants - A review

Saheed IO, Oh WD, Suah FBM

J Hazard Mater, 2021 04 15;408:124889.
PMID: 33418525 DOI: 10.1016/j.jhazmat.2020.124889

In recent times, research interest into the development of biodegradable, cost-effective and environmental friendly adsorbents with favourable properties for adsorption of pollutants is a challenge. Modification of chitosan via different physical and chemical methods have gained attention as a promising approach for removing organic (such as dyes and pharmaceuticals) and inorganic (such as metal/metal ions) pollutants from aqueous medium. In this regard, researchers have reported grafting and cross-linking approach among others as a potentially useful method for chitosan's modification for improved adsorption efficiency with respect to pollutant uptake. This article reviews the trend in chitosan modification, with regards to the summary of some recently published works on modification of chitosan and their adsorption application in pollutants (metal ion, dyes and pharmaceuticals) removal from aqueous medium. The review uniquely highlights some common cross-linkers and grafting procedures for chitosan modification, their influence on structure and adsorption capacity of modified-chitosan with respect to pollutants removal. Findings revealed that the performance of modified chitosan for adsorption of pollutants depends largely on the modification method adopted, materials used for the modification and adsorption experimental conditions. Cross-linking is commonly utilized for improving the chemical and mechanical stabilities of chitosan but usually decreases adsorption capacity of chitosan/modified-chitosan for adsorption of pollutants. However, literature survey revealed that adsorption capacity of cross-linked chitosan based materials have been enhanced in recently published works either by grafting, incorporation of solid adsorbents (e.g metals, clays and activated carbon) or combination of both prior to cross-linking.

Matched MeSH terms: Cost-Benefit Analysis
Fulltext Cost of preterm birth during initial hospitalization: A care provider's perspective

Zainal H, Dahlui M, Soelar SA, Su TT

PLoS One, 2019;14(6):e0211997.
PMID: 31237874 DOI: 10.1371/journal.pone.0211997

Preterm birth incidence has risen globally and remains a major cause of neonatal mortality despite improved survival. Demand and cost of initial hospitalization has also increased. This study assessed the cost of preterm birth during initial hospitalization from care provider perspective in neonatal intensive care units (NICU) of two hospitals in the state of Kedah, Malaysia. It utilized universal sampling and prospectively followed up preterm infants till discharge. Care provider cost was assessed using mixed method of top down approach and activity based costing. A total of 112 preterm infants were recruited from intensive care (93 infants) and minimal care (19 infants) units. Majority were from the moderate (23%) and late (36%) preterm groups followed by very preterm (32%) and extreme preterm (9%). Median cost per infant increased with level of care and degree of prematurity. Cost was dominated by overhead (fixed) costs for general (hospital), intermediate (clinical support services) and final (NICU) cost centers where it constituted at least three quarters of admission cost per infant while the remainder was consumables (variable) cost. Breakdown of overhead cost showed NICU specific overhead contributing at least two thirds of admission cost per infant. Personnel salary made up three quarters of NICU specific overhead. Laboratory investigation was the cost driver for consumables. Gender, birth weight and length of stay were significant factors and cost prediction was developed with these variables. This study demonstrated the inverse relation between resource utilization, cost and prematurity and identified personnel salary as the cost driver. Cost estimates and prediction provide in-depth understanding of provider cost and are applicable for further economic evaluations. Since gender is non-modifiable and reducing LOS alone is not effective, birth weight as a cost predictive factor in this study can be addressed through measures to prevent or delay preterm birth.

Matched MeSH terms: Cost-Benefit Analysis
Singapore's foreign workforce: some reflections on its benefits and costs

Stahl CW

Int Migr Rev, 1984;18(1):37-49.
PMID: 12312927

"This article provides some empirical information pertaining to the benefits and costs of foreign labor to Singapore and subjects to critical analysis some of Pang and Lim's hypotheses concerning the costs of labor importation presented in a previous article.... The article concludes with a discussion of the real cost to Malaysia of Singapore's labor importation policies and its potential for disruption of Malaysia's development plans."

Matched MeSH terms: Cost-Benefit Analysis*
Fulltext Cost-effectiveness of oral cancer screening programmes: a systematic review of design and outcomes

Sivaraj Raman, Asrul Akmal Shafie, Sok, Ching Cheong

Borneo Journal of Medical Sciences, 2020;3(101):15-16.
MyJurnal

Introduction: Oral cancer screening programmes have been promoted to be an integral part of national-control strategies. However, such programmes are often not endorsed due to lack of evidence of its cost-effectiveness. This study aims to systematically review studies on the cost-effectiveness of oral cancer screening programmes.

Matched MeSH terms: Cost-Benefit Analysis
Cost-effectiveness of warfarin medication therapy adherence clinic versus usual medical clinic at Kuala Lumpur Hospital

Thanimalai S, Shafie AA, Ahmad Hassali MA, Sinnadurai J

Value Health Reg Issues, 2018 May;15:34-41.
PMID: 29474176 DOI: 10.1016/j.vhri.2017.05.006

BACKGROUND: Systematic anticoagulation management clinic is recommended to manage patients on chronic warfarin therapy. In Malaysia, the service was introduced as warfarin medication therapy adherence clinic (WMTAC), which is managed by pharmacists with a physician advisory.
OBJECTIVES: To assess the cost-effectiveness of WMTAC in comparison with usual medical clinic (UMC), which is managed by medical officers in Kuala Lumpur Hospital, a tertiary referral hospital in Malaysia.
METHODS: Data from a 6-month retrospective cohort study comparing the two clinics and the mean percentages of time in the therapeutic range for the patients were used to estimate the cost-effectiveness. The mean clinic costs were estimated using the time-motion study. A Markov model with a 6-monthly cycle was used to simulate lifetime cost-effectiveness from the perspective of the health care service provider. The base-case analysis assumed a cohort of patients with atrial fibrillation, 57 years of age with comorbid illnesses. The transition probabilities of these clinic outcomes were obtained from a literature search. Future costs and effectiveness were discounted by 3% to convert to present values. All costs were in Malaysian ringgit standardized for the year 2007.
RESULTS: The mean 6-month treatment cost was lower for the WMTAC, which was significantly lower (P < 0.001). The UMC was found to be dominated by the WMTAC for both intermediate and lifetime analyses. The sensitivity analysis showed that clinic consultation costs had a major impact on the cost-effectiveness analysis.
CONCLUSIONS: WMTAC is a more cost-effective option than UMC in Kuala Lumpur Hospital.
Study site: Medical clinic, Hospital Kuala Lumpur, Malaysia

Matched MeSH terms: Cost-Benefit Analysis*
Fulltext Pressure ulcers--randomised controlled trial comparing hydrocolloid and saline gauze dressings

Chang KW, Alsagoff S, Ong KT, Sim PH

Med J Malaysia, 1998 Dec;53(4):428-31.
PMID: 10971989

An open comparative randomised study comparing the performance of hydrocolloid dressings (DuoDERM CGF) to saline gauze dressings in the treatment of pressure ulcers was done to evaluate the overall dressing performance, wound healing and cost effectiveness. Thirty-four subjects were enrolled at the University Hospital, Kuala Lumpur over a 643 days period. Inclusion criteria were Stage II or III pressure ulcers, at least 18 years of age and written informed consent. Only one pressure ulcer per subject was enrolled in the study. Patients with infected pressure ulcers, diabetes mellitus, an immuno-compromised status and known sensitivity to the study dressings were excluded. Subjects who met the enrollment criteria were randomised to one of the two dressing regimes. They were expected to participate in the study for a maximum of eight weeks or until the pressure ulcer healed, which ever occurred first. Overall subject age averaged 58 years and the mean duration of pressure ulcer existence was about 1 month. Twenty-one of the thirty-four ulcers enrolled were stage II and thirteen were stage III. The majority of the ulcers (88%) were located in the sacral area and seventeen subjects (50%) were incontinent. In the evaluation of dressing performance in terms of adherence to wound bed, exudate handling ability, overall comfort and pain during dressing removal; all favoured the hydrocolloid dressing by a statistically significant margin (p < 0.001). Subjects assigned the hydrocolloid dressing experienced a mean 34% reduction from their baseline surface area measurement compared to a mean 9% increase by subjects assigned gauze dressings. This was not statistically significant (p = 0.2318). In cost evaluation of the study products, there was no statistical significance in the total cost of wound management per subject. When only labour time and cost was evaluated, there was a statistically significant advantage towards hydrocolloid dressings.

Matched MeSH terms: Cost-Benefit Analysis
A review on effective removal of emerging contaminants from aquatic systems: Current trends and scope for further research

Rathi BS, Kumar PS, Show PL

J Hazard Mater, 2021 05 05;409:124413.
PMID: 33183841 DOI: 10.1016/j.jhazmat.2020.124413

Wastewater is water that has already been contaminated by domestic, industrial and commercial activity that needs to be treated before it could be discharged into some other water bodies to avoid even more groundwater contamination supplies. It consists of various contaminants like heavy metals, organic pollutants, inorganic pollutants and Emerging contaminants. Research has been doing on all types of contaminates more than a decade, but this emerging contaminants is the contaminants which arises mostly from pharmaceuticals, personal care products, hormones and fertilizer industries. The majority of emerging contaminants did not have standardized guidelines, but may have adverse effects on human and marine organisms, even at smaller concentrations. Typically, extremely low doses of emerging contaminants are found in the marine environment and cause a potential risk to the aquatic animals living there. When contaminants emerge in the marine world, they are potentially toxic and pose many risks to the health of both man and livestock. The aim of this article is to review the Emerging contaminate sources, detection methods and treatment methods. The purpose of this study is to consider the adsorption as a beneficial treatment of emerging contaminants also advanced and cost effective emerging contaminates treatment methods.

Matched MeSH terms: Cost-Benefit Analysis
Liquid biphasic flotation for the purification of C-phycocyanin from Spirulina platensis microalga

Chew KW, Chia SR, Krishnamoorthy R, Tao Y, Chu DT, Show PL

Bioresour Technol, 2019 Sep;288:121519.
PMID: 31128541 DOI: 10.1016/j.biortech.2019.121519

Liquid biphasic flotation (LBF), an integrated process of liquid biphasic system (LBS) and adsorptive bubbles flotation, was used for the purification of C-phycocyanin from S. platensis microalgae. Various experimental parameters such as type of phase forming polymer and salt, concentration of phase forming components, system pH, volume ratio, air flotation time and crude extract concentration were evaluated to maximise the C-phycocyanin recovery yield and purity. The optimal conditions for the LBF system achieving C-phycocyanin purification fold of 3.49 compared to 2.43 from the initial LBF conditions was in polyethylene glycol (PEG) 4000 and potassium phosphate combination, with 250 g/L of polymer and salt concentration each, volume ratio of 1:0.85, system pH of 7.0, air flotation duration of 7 min and phycocyanin crude extract concentration of 0.625 %w/w. The LBF has effectively enhanced the purification of C-phycocyanin in a cost effective and simple processing.

Matched MeSH terms: Cost-Benefit Analysis
Novel, energy efficient and green cloud point extraction: technology and applications in food processing

Arya SS, Kaimal AM, Chib M, Sonawane SK, Show PL

J Food Sci Technol, 2019 Feb;56(2):524-534.
PMID: 30906010 DOI: 10.1007/s13197-018-3546-7

Recently, a novel technique for extraction of functional thermally sensitive bioactive components from food has been developed due to its green efficacy (no toxic chemicals) and cost effectiveness. Cloud point extraction (CPE) is one of the such best alternative techniques that can be used for extraction of wide range of organic and inorganic components using green surfactants. It is a simple, rapid and inexpensive extraction technique which involves clustering of non-ionic surfactant monomers to form a hydrophobic core (micelle), which then entraps the hydrophobic bioactive compounds within it. CPE can be applied for extraction of bioactives from food processing waste as well as separation and purification of proteins. Besides that, research has received special attention on sample preparation for analysis of food constituents in the last decade. The scope of CPE is very vast in these sectors because of the advantages of CPE over other methods. This review deals with significance of CPE method and their potential green applications in food processing.

Matched MeSH terms: Cost-Benefit Analysis
Fulltext Sustainability of rainwater harvesting system in terms of water quality

Rahman S, Khan MT, Akib S, Din NB, Biswas SK, Shirazi SM

ScientificWorldJournal, 2014;2014:721357.
PMID: 24701186 DOI: 10.1155/2014/721357

Water is considered an everlasting free source that can be acquired naturally. Demand for processed supply water is growing higher due to an increasing population. Sustainable use of water could maintain a balance between its demand and supply. Rainwater harvesting (RWH) is the most traditional and sustainable method, which could be easily used for potable and nonpotable purposes both in residential and commercial buildings. This could reduce the pressure on processed supply water which enhances the green living. This paper ensures the sustainability of this system through assessing several water-quality parameters of collected rainwater with respect to allowable limits. A number of parameters were included in the analysis: pH, fecal coliform, total coliform, total dissolved solids, turbidity, NH3-N, lead, BOD5, and so forth. The study reveals that the overall quality of water is quite satisfactory as per Bangladesh standards. RWH system offers sufficient amount of water and energy savings through lower consumption. Moreover, considering the cost for installation and maintenance expenses, the system is effective and economical.

Matched MeSH terms: Cost-Benefit Analysis
Fulltext Cost-effectiveness of dengue vaccination in ten endemic countries

Zeng W, Halasa-Rappel YA, Baurin N, Coudeville L, Shepard DS

Vaccine, 2018 01 08;36(3):413-420.
PMID: 29229427 DOI: 10.1016/j.vaccine.2017.11.064

Following publication of results from two phase-3 clinical trials in 10 countries or territories, endemic countries began licensing the first dengue vaccine in 2015. Using a published mathematical model, we evaluated the cost-effectiveness of dengue vaccination in populations similar to those at the trial sites in those same Latin American and Asian countries. Our main scenarios (30-year horizon, 80% coverage) entailed 3-dose routine vaccinations costing US$20/dose beginning at age 9, potentially supplemented by catch-up programs of 4- or 8-year cohorts. We obtained illness costs per case, dengue mortality, vaccine wastage, and vaccine administration costs from the literature. We estimated that routine vaccination would reduce yearly direct and indirect illness cost per capita by 22% (from US$10.51 to US$8.17) in the Latin American countries and by 23% (from US$5.78 to US$4.44) in the Asian countries. Using a health system perspective, the incremental cost-effectiveness ratio (ICER) averaged US$4,216/disability-adjusted life year (DALY) averted in the five Latin American countries (range: US$666/DALY in Puerto Rico to US$5,865/DALY in Mexico). In the five Asian countries, the ICER averaged US$3,751/DALY (range: US$1,935/DALY in Malaysia to US$5,101/DALY in the Philippines). From a health system perspective, the vaccine proved to be highly cost effective (ICER under one times the per capita GDP) in seven countries and cost effective (ICER 1-3 times the per capita GDP) in the remaining three countries. From a societal perspective, routine vaccination proved cost-saving in three countries. Including catch-up campaigns gave similar ICERs. Thus, this vaccine could have a favorable economic value in sites similar to those in the trials.

Matched MeSH terms: Cost-Benefit Analysis*
Treatment and care for injecting drug users with HIV infection: a review of barriers and ways forward

Wolfe D, Carrieri MP, Shepard D

Lancet, 2010 Jul 31;376(9738):355-66.
PMID: 20650513 DOI: 10.1016/S0140-6736(10)60832-X

We review evidence for effectiveness, cost-effectiveness, and coverage of antiretroviral therapy (ART) for injecting drug users (IDUs) infected with HIV, with particular attention to low-income and middle-income countries. In these countries, nearly half (47%) of all IDUs infected with HIV are in five nations--China, Vietnam, Russia, Ukraine, and Malaysia. In all five countries, IDU access to ART is disproportionately low, and systemic and structural obstacles restrict treatment access. IDUs are 67% of cumulative HIV cases in these countries, but only 25% of those receiving ART. Integration of ART with opioid substitution and tuberculosis treatment, increased peer engagement in treatment delivery, and reform of harmful policies--including police use of drug-user registries, detention of drug users in centres offering no evidence-based treatment, and imprisonment for possession of drugs for personal use--are needed to improve ART coverage of IDUs.

Matched MeSH terms: Cost-Benefit Analysis

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