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BackgroundHCV direct-acting antivirals (DAAs) are produced in India at low cost. However, concerns surrounding reinfection and budgetary impact limit treatment scale-up in India. We evaluate the cost-effectiveness and budgetary impact of HCV treatment in India, including reinfection.MethodsA closed cohort Markov model of HCV disease progression, treatment, and reinfection was parameterized. We compared treatment by fibrosis stage (F2-F4 or F0-F4) to no treatment from a health care payer perspective. Costs (2017 USD$, based on India-specific data) and health utilities (in quality-adjusted life years, QALYs) were attached to each health state. We assumed DAAs with 90% sustained viral response at $900/treatment and 1%/year reinfection, varied in the sensitivity analysis from 0.1-15%. We deemed the intervention cost-effective if the incremental cost-effectiveness ratio (ICER) fell below India's per capita GDP ($1,709). We assessed the budgetary impact of treating all diagnosed individuals.ResultsHCV treatment for diagnosed F2-F4 individuals was cost-saving (net costs -$2,881 and net QALYs 3.18/person treated; negative ICER) compared to no treatment. HCV treatment remained cost-saving with reinfection rates of 15%/year. Treating all diagnosed individuals was likely cost-effective compared to delay until F2 (mean ICER $1,586/QALY gained, 67% of simulations falling under the $1,709 threshold) with 1%/year reinfection. For all scenarios, annual retesting for reinfection was more cost-effective than the current policy (one-time retest). Treating all diagnosed individuals and reinfections results in net costs of $445-1,334 million over 5 years (

Background and Objective: Personal wheelchair budgets (PWBs) are offered to everyone in England eligible for a wheelchair provided through the National Health Service (NHS) to support their choice of equipment. The WATCh (Wheelchair outcomes Assessment Tool for Children) and related WATCh-Ad for adults are patient-centred outcome measures (PCOMs) developed to help individual users express their main outcome needs when obtaining a wheelchair and rate their satisfaction with subsequent outcomes after receiving their equipment. Use was explored in a real-world setting, aiming to produce guidance for use alongside the PWB process., Methods: Three wheelchair service provider organisations across four sites participated. Staff and users completed surveys about their experience of assessments using the WATCh and/or WATCh-Ad. Selected patients were interviewed after receipt of their equipment, and staff were interviewed after experiencing a number of assessments. Thematic analysis was undertaken using the tool, survey and interview data. Results of pre- and post-equipment provision were presented graphically., Results: Information on 75 assessments by 15 staff was obtained. Three-quarters of users or their carers rated the use of the tools in the assessment process as 'helpful' or 'very helpful'. Staff reported that the WATCh or WATCh-Ad had been considered 'useful' in developing individual care plans in around 1 in 3 cases and affected the prescription in 1 in 4 cases. Concerns were expressed about the length of time taken to administer the tools in clinic. However, some staff noted this reduced with more hands-on experience and by providing the tools to users in advance of the appointment., Conclusions: The WATCh and WATCh-Ad PCOMs are suitable for routine use by wheelchair service providers to assist the assessment process. It is recommended that tool materials are provided in advance to users/carers and that staff are allowed time to develop their ways of working with them., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: the funding for the the lead author for the study was received from NHS England who had commissioned the initial development of the PCOM study evaluated in the study. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2025 Tuersley et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Bariatric surgery is another treatment options for patients with obesity, who cannot achieve weight controlled by conservative non-surgical therapy. Although bariatric surgery provides clinical benefits for these patients, it is costly. This study aims to evaluate the cost-effectiveness of bariatric surgery, as compared to nonbariatric surgery, in patients with body mass index (BMI) ≥32.5 kg/m2 and type 2 diabetes mellitus (T2DM), and to estimate the budget impact of bariatric surgery in Thailand., Methods: A Markov model was developed to estimate and compare total costs incurred and quality-adjusted life years (QALYs) gained between bariatric surgery and nonbariatric surgery over lifetime horizontal. Analysis was conducted under payer and societal perspectives. Costs and outcomes were discounted at an annual rate of 3%. The outcomes were presented as incremental cost- effectiveness ratio (ICER)., Results: Under payer's perspective, bariatric surgery resulted in higher total lifetime cost (676,658.39 baht vs 574,683.38 baht) and QALYs gained (16.08 QALYs vs 14.78 QALYs), as compared to nonbariatric surgery, resulting in an ICER of 78,643.02 baht/QALY. Similarly, under the societal perspective, bariatric surgery resulted in higher total lifetime cost (1,451,923.83 baht vs 1,407,590.49 baht) and QALYs gained (16.08 QALYs vs 14.78 QALYs), as compared to nonbariatric surgery. Under societal perspective, ICER was estimated at 34,189.82 baht/QALY. A 5-year budget impact analysis indicated that bariatric surgery incurred the total budget of 223,821 million baht., Conclusions: At the cost-effectiveness threshold of 160,000 baht/QALY, bariatric surgery was a cost-effective strategy and should continue to be included in the benefit package for patients with obesity and T2DM., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Noparatayaporn et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The Saudi Food and Drug Authority (SFDA) has approved the subcutaneous (SC) administration of infliximab, presenting a more convenient alternative with reduced outpatient visits and diminished expenses compared to the intravenous (IV) administration. However, the financial implications of this formulation have not been examined from the perspective of Saudi payers., Methods and Materials: A prevalence-based budget impact model was developed to evaluate the financial effects of introducing "environment without" versus "with infliximab SC." The model's time horizon spanned over 2 years (2021-2023), aligning with the biennial national pharmaceutical procurement cycle. The comparison focused on infliximab SC versus all available formulations of infliximab IV in the Saudi market for two inflammatory bowel diseases (IBD): Ulcerative Colitis (UC) and Crohn's Disease (CD). Treatment comparators' comparability and dose escalations were substantiated by published studies, utilizing dosing information from the summary of product characteristics. Drug acquisition costs were derived from SFDA registered prices, with IV formulation administration costs included. Scenario analysis assessed the budget impact of infliximab SC introduction at uptake rates ranging from 0% to 100%., Results: Introducing infliximab SC demonstrated cost-saving potential in the treatment of IBD. At 100% uptake with UC patients for 2 years, infliximab SC resulted in savings of -SAR-31.9 million (-SAR29,145 per patient). Similarly, for CD, introducing infliximab SC at 100% uptake over 2 years yielded savings of -SAR106.2 million (-SAR36,585 per patient)., Conclusion: This study reveals that infliximab SC is associated with cost-saving potential when compared to infliximab IV formulations available in Saudi Arabia. Future research should address uncertainties related to real-world comparative effectiveness, the convenience of administration, patient tolerability, and physician acceptance of the SC formulation of infliximab, alongside comparisons with other TNF-alpha inhibitors., Competing Interests: N Alkhatib holds equity in Pi Pharma Intelligence, LLC, which provides health technology solutions, scientific and consulting services to biopharmaceutical, diagnostics, and medical device companies on a nonexclusivity basis. By the company internal policy, owners, employees, and associates are prohibited from holding equity in client and sponsor organizations or contracting independently with client and sponsor organizations or receiving compensation independently from such organizations. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Alkhatib et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Sodium-glucose co-transporter-2 (SGLT2) inhibitors such as Empagliflozin, are increasingly recommended as part of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) in many developed nations. This recommendation is based on robust clinical evidence showing that adding Empagliflozin to GDMT improves heart failure symptoms, clinical outcomes, functional status, and overall quality of life. In Malaysia, where healthcare is predominantly public and heavily subsidized, the introduction of new treatments can significantly impact costs, requiring detailed economic assessments. This study evaluates the budget impact of incorporating Empagliflozin into GDMT for HFrEF from the perspective of the public healthcare system. A five-year budget impact model was developed, integrating local data such as population, drug use, costs, clinical outcomes, and healthcare expenses. In the current scenario (GDMT alone), the projected five-year expenditure is MYR 6.12 billion (USD 3.92 billion). With Empagliflozin, the total cost rises by 0.71% to MYR 6.16 billion (USD 3.95 billion), driven by drug acquisition costs of MYR 160.12 million (USD 102.64 million) and adverse event costs of MYR 211,543 (USD 135,604). However, these costs are offset by savings from reduced HF hospitalizations, fewer cardiovascular deaths, and improved renal outcomes. Sensitivity analysis identified hospitalization costs, the price of Empagliflozin, and cardiovascular deaths in diabetic patients as key factors influencing the budget impact. Policymakers can improve the affordability of Empagliflozin through strategies like price negotiations, cost-sharing, and focusing on high-risk groups to optimize healthcare expenditure while ensuring effective treatment access., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Yong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The twin deficit hypothesis suggests that budget deficits are crucial factors leading to current account deficits, and substantial empirical evidence documents a significant positive statistical correlation between budget and current account deficits. However, such evidence generally suffers from endogeneity problems due to reverse causality, thereby making it difficult to provide solid evidence to support policy implementation. We use extensive cross-national panel data from developed and developing countries and military expenditure as an instrumental variable to reexamine the impact of budget deficits on the current account and test the validity of the twin deficit hypothesis. Our results demonstrate that budget deficits lead to current account deficits in both developed and developing countries, supporting the twin deficit hypothesis. After considering various factors that may affect the exogeneity of military expenditures, approximating the instrumental variable as exogenous, and performing multiple robustness tests, the hypothesis still holds. This study provides solid evidence supporting the use of fiscal policies to deal with current account imbalances., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Liu, Ren. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: As a result of the success of Maryland's full risk capitated payment model experiment (Global Budget Revenue) in constraining healthcare costs, there is momentum for expanding the reach of such models. However, as these models are implemented, studies analyzing their long-term effects suggest unintended spillover effects that may ultimately influence patient experiences. The aim of this study was to determine whether implementation of the GBR was associated with changes in patient experience., Methods: Cross-sectional study using a difference-in-difference analysis to examine changes in patient experiences according to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) domains before and after implementation of the GBR model. Acute care hospitals from 2010-2016 with completed HCAHPS surveys were included. Hospitals identified for inclusion were then matched, based on county location, to area level characteristics using the Area Health Resource File., Results: A total of 844 hospitals were included. Compared to hospitals in non-GBR states, hospitals in GBR states experienced significant declines in the following HCAHPS domains: "would definitely recommend the hospital to others" [Average treatment effect (ATT) = -1.19, 95% CI = -1.97, -0.41)] and 9-10 rating of the hospital (ATT = -0.93, 95% CI = -1.71, -0.15). Results also showed significant increases in the HCAHPS domains: "if patient's rooms and bathroom were always kept clean" (ATT = 1.10, 95% CI = 0.20, 2.00). There were no significant differences in changes for the other domains, including no improvements in: nursing communication, doctor communication, help from hospital staff, pain control, communication on medicines, discharge information, and quietness of the patient environment., Conclusion: These findings suggest there should be efforts made to ascertain and mitigate potential adverse effects of care transformation initiatives on patient experience. Patients are stakeholders and their inputs should be sought and incorporated in care transformation efforts to ensure that these models align with improved patient experiences., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Shammas et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Durvalumab, used as consolidation immunotherapy, has shown to improve survival in patients with stage III non-small cell lung cancer who respond to chemoradiotherapy, based on the most recent follow-up of PACIFIC. The Chilean healthcare system provides access to certain immunotherapies for this condition. The present study sought to estimate the budget impact of durvalumab versus standard of care in the context of the Chilean healthcare system., Research Design and Methods: A partitioned survival model was adapted to compare two strategies: durvalumab as consolidation therapy and standard of care for treating stage III NSCLC. The number of patients eligible for treatment was estimated using published incidence data and modeled for a 5-year time horizon. Model inputs were based on published literature, and the duration of treatment was estimated using survival curves obtained from PACIFIC. Costs were estimated in Chilean pesos (CLP) and converted to USD dollars using an exchange rate of USD 1  =  CLP 827. Scenario analyses were performed to assess different subsequent therapy splits, variations in the target population and dosage of durvalumab., Results: Durvalumab uptake projected total costs ranging from USD 1.27 in Year 1 to 8.5 million in Year 5 from the public perspective. From the private perspective, the budget impact for the first year is USD 1.3 million to USD 3 million for 2028. This difference relies mostly on the lower number of patients treated. Both perspectives anticipated cost savings over the time horizon through reduced monitoring, adverse events, and end-of-life expenses., Conclusions: This study demonstrates that the inclusion of Durvalumab for NSCLC in Chile represents an investment in the Chilean health system. The incremental costs align with clinical benefits and potential savings in healthcare resource utilization. However, a comprehensive cost-effectiveness analysis is needed to evaluate its economic value thoroughly., Competing Interests: Manuel Espinoza has been compensated by Merck, Grunenthal, Boehringer Ingelheim, Novartis, MSD, Abbvie, and Roche for training activities and presentations. Nicolás Armijo has received fees from Roche and Sandoz for educational services and presentations. I have previously received fees from Novartis and Novo Nordisk for educational services. Manuel, Nicolás, and I also are members of Epsilon Research, a health economics consultancy. However, our commercial affiliation does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Armijo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Adults with a learning disability who receive social care are legally entitled to a personal budget. Personal budgets were introduced to promote choice and control in support. Individual Service Funds were introduced as a flexible way that personal budgets can be managed by a provider while maintaining choice and control for the individual. Individual Service Funds have been shown to improve quality of life for individuals and efficiency in support. Despite this, only 20% of local authorities offer them to adults with a learning disability, demonstrating the need for resources to be developed to support their delivery. This protocol described a co-production study with key stakeholders to develop and refine Individual Service Fund resources. Our primary aim is to co-produce two actionable resources: to support development, delivery, consistency, and sustained provision of ISFs; and to support uptake and optimal use of ISFs by recipients. We also aim to user-test and evaluate these resources with three Local Authorities. The result of this study will be two resources that will support the uptake of Individual Service Funds for adults with a learning disability that will be freely available online., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Dunning et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Retailers have been using promotion as a differentiation strategy that influences consumers' expenditures and their shopping basket budgetary allocation. This study assessed the effect of retail promotions on total shopping basket expenditure and determined whether promotions provoke a reallocation of the shopping budget. The analysis was performed on a chain of supermarkets in Catalonia, Spain using a consumer scanner data set from Kantar Worldpanel for 2017. The methodological approach had two steps: prediction of the effect of promotion on household expenditures using an expenditure regression model and estimation of the promotion own- and cross-effect using the censored Exact Affine Stone Index. Promotion had a positive own-effect and mostly a negative asymmetric cross-effect, implying a small but significant budget reallocation., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Mehaba et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

With the continuous development of vehicular ad hoc networks (VANET) security, using federated learning (FL) to deploy intrusion detection models in VANET has attracted considerable attention. Compared to conventional centralized learning, FL retains local training private data, thus protecting privacy. However, sensitive information about the training data can still be inferred from the shared model parameters in FL. Differential privacy (DP) is sophisticated technique to mitigate such attacks. A key challenge of implementing DP in FL is that non-selectively adding DP noise can adversely affect model accuracy, while having many perturbed parameters also increases privacy budget consumption and communication costs for detection models. To address this challenge, we propose FFIDS, a FL algorithm integrating model parameter pruning with differential privacy. It employs a parameter pruning technique based on the Fisher Information Matrix to reduce the privacy budget consumption per iteration while ensuring no accuracy loss. Specifically, FFIDS evaluates parameter importance and prunes unimportant parameters to generate compact sub-models, while recording the positions of parameters in each sub-model. This not only reduces model size to lower communication costs, but also maintains accuracy stability. DP noise is then added to the sub-models. By not perturbing unimportant parameters, more budget can be reserved to retain important parameters for more iterations. Finally, the server can promptly recover the sub-models using the parameter position information and complete aggregation. Extensive experiments on two public datasets and two F2MD simulation datasets have validated the utility and superior performance of the FFIDS algorithm., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Chen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The proliferation of cyber threats necessitates robust security measures to safeguard critical assets and data in today's evolving digital landscape. Small and Medium Enterprises (SMEs), which are the backbone of the global economy are particularly vulnerable to these threats due to inadequate protection for critical and sensitive information, budgetary constraints, and lack of cybersecurity expertise and personnel. Security Information and Event Management (SIEM) systems have emerged as pivotal tools for monitoring, detecting, and responding to security incidents. While proprietary SIEM solutions have historically dominated the market, open-source SIEM systems have gained prominence for their accessibility and cost-effectiveness for SMEs. This article presents a comprehensive study focusing on the evaluation of open-source SIEM systems. The research investigates the capabilities of these open-source solutions in addressing modern security challenges and compliance with regulatory requirements. Performance aspects are explored through empirical testing in simulated enterprise-grade SME network environments to assess resource utilization, and real-time data processing capabilities. By providing a rigorous assessment of the security and performance features of open-source SIEM systems, this research offers valuable insights to cybersecurity practitioners, organizations seeking cost-effective security solutions, and the broader academic community. The findings shed light on the strengths and limitations of these systems, aiding decision-makers in selecting the most suitable SIEM solution for their specific requirements while enhancing the cybersecurity posture of SMEs., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Manzoor et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This paper presents a custom made small rover based surveying, mapping and building information modeling solution. Majority of the commercially available mobile surveying systems are larger in size which restricts their maneuverability in the targeted indoor vicinities. Furthermore their functional cost is unaffordable for low budget projects belonging to developing markets. Keeping in view these challenges, an economical indigenous rover based scanning and mapping system has developed using orthogonal integration of two low cost RPLidar A1 laser scanners. All the instrumentation of the rover has been interfaced with Robot Operating System (ROS) for online processing and recording of all sensorial data. The ROS based pose and map estimations of the rover have performed using Simultaneous Localization and Mapping (SLAM) technique. The perceived class 1 laser scans data belonging to distinct vicinities with variable reflective properties have been successfully tested and validated for required structural modeling. Systematically the recorded scans have been used in offline mode to generate the 3D point cloud map of the surveyed environment. Later the structural planes extraction from the point cloud data has been done using Random Sampling and Consensus (RANSAC) technique. Finally the 2D floor plan and 3D building model have been developed using point cloud processing in appropriate software. Multiple interiors of existing buildings and under construction indoor sites have been scanned, mapped and modelled as presented in this paper. In addition, the validation of the as-built models have been performed by comparing with the actual architecture design of the surveyed buildings. In comparison to available surveying solutions present in the local market, the developed system has been found faster, accurate and user friendly to produce more enhanced structural results with minute details., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Jafri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Resource allocation decisions for disease categories can be informed by proper estimates of the magnitude and distribution of total spending. In the backdrop of a high burden of Non-Communicable Diseases and Injuries (NCDI) in India, and a paucity of estimates on government spending on NCDI, this paper attempts to analyse public sector expenditure on NCDI spending in India. Methods: Various recent budget documents of the Centre and States/Union Territories have been used to extract expenditure on NCDI. The aggregates thus arrived at have been analysed to estimate aggregate and state level per capita spending. State level spending have been compared against disease burden using DALYs. Patterns of spending on NCDI across states were also analysed together with state level poverty to observe possible patterns. Findings: The total spending on NCDI by the government is low at less than 0.5% of GDP. NCDI spending is little more than one-fourth of total health spending of the country and most spending takes place at the state level (80%). The Ministry of Health and Family Welfare’s share in Central spending on NCDI is around 65%, and currently it spends 20% of its total health spending on NCDI. The gap between spending and DALYs is the most for the economically vulnerable states. Also, the states with high poverty levels also have low per capita expenditure on NCDI Interpretation: India does not depend on donor funding for health. It will have to step up domestic funding to address the increasing disease burden of NCDIs and to reduce the high out-of-pocket expenditure on NCDI. Policies on NCDI need to focus on UHC, service integration and personnel gaps. [ABSTRACT FROM AUTHOR]

Social capital has long been associated with opportunities of access to valuable resources that individuals, groups, communities, and places can extract from the social structure emerging from their interactions. Despite the overall consensus on the structural signature of social capital, there is still controversy over the relative benefits associated with different types of social structure. In this article, we advocate a two-faceted perspective on social capital, regarded as value originating from both closed (rich in third-party relationships) and open (rich in brokerage opportunities) bridging structures. We uncover these structures from place-centric networks and investigate their association with key socio-economic indicators. To this end, we draw on aggregated mobile phone usage data, and construct the place-centric communication and mobility networks in the city of Abidjan in Côte d’Ivoire. We begin by defining appropriate network metrics to capture the interplay between bonding and bridging social structures in each of the 10 districts (communes) in Abidjan. We then examine the correlation between these metrics and a number of district-level socio-economic indicators related to economic prosperity, wealth, security and democratic participation. Our findings suggest that both closed and open structures can serve as wellsprings of social capital: while closed bonding structures are associated with higher economic prosperity, open bridging structures are associated with increased democratic participation and security. By uncovering sources of social capital from communication and mobility place-centric networks in a developing country, our work contributes to a better understanding of how these networks could be used to enhance and sustain socio-economic growth and prosperity, and ultimately paves the way towards a broader comparative study of social capital in developed and developing countries. [ABSTRACT FROM AUTHOR]

In this research letter, we examine the impact of municipal budget policy on the percentage of votes for the incumbent majority parties in subsequent elections. We contribute to the academic literature by examining the combined influence of taxes, expenditures and debt. Based on data for Flanders (Belgium) between 1994 and 2012, we find no significant association between these budget variables and the actual election results. [ABSTRACT FROM AUTHOR]

Objectives: Changes in treatment choice of therapy and size of treated population that can lead to under- or overestimate of payer’s budget are less likely to be reassured after reimbursement adoption of a new drug. The aim of this study was to evaluate the effects of febuxostat introduction and the modifications in its insurance coverage on the utilization and expenditure of urate-lowering therapy (ULT). Methods: Electronic medical records for adults patients prescribed any ULT during 2010–2015 was derived from the largest medical organization in Taiwan. Aggregated estimates of ULT use and costs were assessed per 3-month and per patient per month (PPPM). Factors associated with total ULT expenditure were assessed using a time series design with factored Autoregressive Integrated Moving Average (ARIMA) models. Results: ULT prevalent users increased 34.1% from 2010 to 2015 and a 123% increase in total ULT expenditure. Numbers on allopurinol and sulfinpyrazone both declined 31%, and on benzbromarone and febuxostat gradually increased to 38.21% and 22.89% of all users in 2015. Insurance payments PPPM ($4.44 to $9.22) and total monthly ULT cost ($32,946 to $ 85,732) growth more than doubled in 6 years, trend changes generated mostly by individuals switching to febuxostat. Conclusions: ULT use moved to favor benzbromarone and febuxostat; greater expensive uptake for febuxostat led to a rapid rise in ULT cost. Marginal values of increasing access to febuxostat for asymptomatic hyperuricemia should be focus on future studies to facilitate drug prices negotiation and ensure appropriate ULT use. [ABSTRACT FROM AUTHOR]

Detections of invasive species outbreaks are often followed by the removal of susceptible host organisms in order to slow the spread of the invading pest population. We propose the acceptance sampling approach for detection and optional removal of susceptible host trees to manage an outbreak of the emerald ash borer (EAB), a highly destructive forest pest, in Winnipeg, Canada. We compare the strategy with two common delimiting survey techniques that do not consider follow-up management actions such as host removal. Our results show that the management objective influences the survey strategy. The survey-only strategies maximized the capacity to detect new infestations and prioritized sites with high likelihood of being invaded. Comparatively, the surveys with subsequent host removal actions allocated most of the budget to sites where complete host removal would minimize the pest’s ability to spread to uninvaded locations. Uncertainty about the pest’s spread causes the host removal measures to cover a larger area in a uniform spatial pattern and extend to farther distances from already infested sites. If a decision maker is ambiguity-averse and strives to avoid the worst-case damages from the invasion, the optimal strategy is to survey more sites with high host densities and remove trees from sites at farther distances, where EAB arrivals may be uncertain, but could cause significant damage if not detected quickly. Accounting for the uncertainty about spread helps develop a more robust pest management strategy. The approach is generalizable and can support management programs for new pest incursions. [ABSTRACT FROM AUTHOR]

Introduction: The Temprano and START trials provided evidence to support early ART initiation recommendations. We projected long-term clinical and economic outcomes of immediate ART initiation in Côte d’Ivoire. Methods: We used a mathematical model to compare three potential ART initiation criteria: 1) CD4 <350/μL (ART<350/μL); 2) CD4 <500/μL (ART<500/μL); and 3) ART at presentation (Immediate ART). Outcomes from the model included life expectancy, 10-year medical resource use, incremental cost-effectiveness ratios (ICERs) in $/year of life saved (YLS), and 5-year budget impact. We simulated people with HIV (PWH) in care (mean CD4: 259/μL, SD 198/μL) and transmitted cases. Key input parameters to the analysis included first-line ART efficacy (80% suppression at 6 months) and ART cost ($90/person-year). We assessed cost-effectiveness relative to Côte d’Ivoire’s 2017 per capita annual gross domestic product ($1,600). Results: Immediate ART increased life expectancy by 0.34 years compared to ART<350/μL and 0.17 years compared to ART<500/μL. Immediate ART resulted in 4,500 fewer 10-year transmissions per 170,000 PWH compared to ART<350/μL. In cost-effectiveness analysis, Immediate ART had a 10-year ICER of $680/YLS compared to ART<350/μL, ranging from cost-saving to an ICER of $1,440/YLS as transmission rates varied. ART<500/μL was “dominated” (an inefficient use of resources), compared with Immediate ART. Immediate ART increased the 5-year HIV care budget from $801.9M to $812.6M compared to ART<350/μL. Conclusions: In Côte d’Ivoire, immediate compared to later ART initiation will increase life expectancy, decrease HIV transmission, and be cost-effective over the long-term, with modest budget impact. Immediate ART initiation is an appropriate, high-value standard of care in Côte d’Ivoire and similar settings. [ABSTRACT FROM AUTHOR]

Present bias, or the overvaluation of an immediate payoff, causes under-saving and financial difficulty. We investigate whether married couples utilize their spouses as a savings commitment device to alleviate the present bias problem using experimental and survey data in Vietnam. We find that individuals are less present biased when making joint decisions with their spouses than they are when making decisions alone. However, present-biased individuals turn over a smaller ratio of their earnings to their spouses and are more likely to manage household resources than time-consistent individuals are. Present-biased individuals also receive larger amounts of money from their spouses’ incomes, indicating that marriage not only fails to function as a savings commitment device but also exacerbates the problem. Married couples whose joint decisions are not present biased try to alleviate this problem by allocating smaller allowances to present-biased spouses, but the present-biased spouses conceal money to counteract this strategy. Our study indicates the importance of external savings commitment devices in helping people protect money from their present-biased spouses. [ABSTRACT FROM AUTHOR]

Background: Private providers dominate health care in India and provide most tuberculosis (TB) care. Yet efforts to engage private providers were viewed as unsustainably expensive. Three private provider engagement pilots were implemented in Patna, Mumbai and Mehsana in 2014 based on the recommendations in the National Strategic Plan for TB Control, 2012–17. These pilots sought to improve diagnosis and treatment of TB and increase case notifications by offering free drugs and diagnostics for patients who sought care among private providers, and monetary incentives for providers in one of the pilots. As these pilots demonstrated much higher levels of effectiveness than previously documented, we sought to understand program implementation costs and predict costs for their national scale-up. Methods and findings: We developed a common cost structure across these three pilots comprising fixed and variable cost components. We conducted a retrospective, activity-based costing analysis using programmatic data and qualitative interviews with the respective program managers. We estimated the average recurring costs per TB case at different levels of program scale for the three pilots. We used these cost estimates to calculate the budget required for a national scale up of such pilots. The average cost per privately-notified TB case for Patna, Mumbai and Mehsana was estimated to be US$95, US$110 and US$50, respectively, in May 2016 when these pilots were estimated to cover 50%, 36% and 100% of the total private TB patients, respectively. For Patna and Mumbai pilots, the average cost per case at full scale, i.e. 100% coverage of private TB patients, was projected to be US$91 and US$101, respectively. In comparison, the national TB program’s budget for 2015 averages out to $150 per notified TB case. The total annual additional budget for a national scale up of these pilots was estimated to be US$267 million. Conclusions: As India seeks to eliminate TB, extensive national engagement of private providers will be required. The cost per privately-notified TB case from these pilots is comparable to that already being spent by the public sector and to the projected cost per privately-notified TB case required to achieve national scale-up of these pilots. With additional funds expected to execute against national TB elimination commitments, the scale-up costs of these operationally viable and effective private provider engagement pilots are likely to be financially viable. [ABSTRACT FROM AUTHOR]

We propose a funding scheme for theoretical research that does not rely on project proposals, but on recent past scientific productivity. Given a quantitative figure of merit on the latter and the total research budget, we introduce a number of policies to decide the allocation of funds in each grant call. Under some assumptions on scientific productivity, some of such policies are shown to converge, in the limit of many grant calls, to a funding configuration that is close to the maximum total productivity of the whole scientific community. We present numerical simulations showing evidence that these schemes would also perform well in the presence of statistical noise in the scientific productivity and/or its evaluation. Finally, we prove that one of our policies cannot be cheated by individual research units. Our work must be understood as a first step towards a mathematical theory of the research activity. [ABSTRACT FROM AUTHOR]

Introduction: Renin-angiotensin system inhibitors (RAS) drugs have a proteinuria-reducing effect that could prevent the progression of kidney disease in diabetic patients. Our study aimed to assess the budget impact based on healthcare payer perspective of increasing uptake of RAS drugs into the current treatment mix of standard anti-hypertensive treatments to prevent progression of kidney disease in patient’s comorbid with hypertension and diabetes. Methods: A Markov model of a Malaysian hypothetical cohort aged ≥30 years (N = 14,589,900) was used to estimate the total and per-member-per-month (PMPM) costs of RAS uptake. This involved an incidence and prevalence rate of 9.0% and 10.53% of patients with diabetes and hypertension respectively. Transition probabilities of health stages and costs were adapted from published data. Results: An increasing uptake of RAS drugs would incur a projected total treatment cost ranged from MYR 4.89 billion (PMPM of MYR 27.95) at Year 1 to MYR 16.26 billion (PMPM of MYR 92.89) at Year 5. This would represent a range of incremental costs between PMPM of MYR 0.20 at Year 1 and PMPM of MYR 1.62 at Year 5. Over the same period, the care costs showed a downward trend but drug acquisition costs were increasing. Sensitivity analyses showed the model was minimally affected by the changes in the input parameters. Conclusion: Mild impact to the overall healthcare budget has been reported with an increased utilization of RAS. The long-term positive health consequences of RAS treatment would reduce the cost of care in preventing deterioration of kidney function, thus offsetting the rising costs of purchasing RAS drugs. Optimizing and increasing use of RAS drugs would be considered an affordable and rational strategy to reduce the overall healthcare costs in Malaysia. [ABSTRACT FROM AUTHOR]

Background: The comprehensive effectiveness of the HPV vaccine has been widely acknowledged. However, challenges such as dosing adherence and limited budgets have led to delays in HPV vaccination implementation in many countries. A potential solution to these issues could lie in a one-dose vaccination with an HPV vaccine, as indicated by promising outcomes in multiple studies., Methods: In this systematic review and meta-analysis, we examine the comparative effectiveness of the one-dose vaccination with an HPV vaccine against two- and three-dose regimens. Our investigation focuses on clinical efficacy, encompassing the prevention of HPV16, HPV18, and hrHPV infections, HSIL or ASC-H incidence, and CIN2/3 incidence., Results: Our analysis suggests that a single-dose HPV vaccine may offer effectiveness on par with two- or three-dose schedules. This conclusion is drawn from its capacity to confer immunogenic protection for at least 8 years of follow-up, coupled with its ability to mitigate infections and pre-cancerous occurrences., Conclusion: While our findings underscore the potential of the one-dose vaccination with an HPV vaccine, further research and prolonged study durations are necessary to establish robust evidence supporting this recommendation. As such, continued investigation will be critical for informing vaccination strategies., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Setiawan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Crowdfunding has gained traction as a mechanism to raise resources for entrepreneurial and artistic projects, yet there is little systematic evidence on the potential of crowdfunding for scientific research. We first briefly review prior research on crowdfunding and give an overview of dedicated platforms for crowdfunding research. We then analyze data from over 700 campaigns on the largest dedicated platform, Experiment.com. Our descriptive analysis provides insights regarding the creators seeking funding, the projects they are seeking funding for, and the campaigns themselves. We then examine how these characteristics relate to fundraising success. The findings highlight important differences between crowdfunding and traditional funding mechanisms for research, including high use by students and other junior investigators but also relatively small project size. Students and junior investigators are more likely to succeed than senior scientists, and women have higher success rates than men. Conventional signals of quality–including scientists’ prior publications–have little relationship with funding success, suggesting that the crowd may apply different decision criteria than traditional funding agencies. Our results highlight significant opportunities for crowdfunding in the context of science while also pointing towards unique challenges. We relate our findings to research on the economics of science and on crowdfunding, and we discuss connections with other emerging mechanisms to involve the public in scientific research. [ABSTRACT FROM AUTHOR]

Governments in high income countries allocate funding for Official Development Assistance (ODA), and population-based surveys tend to show support for the concept of affluent nations assisting the development of poorer regions. A public opinion survey was conducted in Hong Kong to: (1) assess public support for foreign aid for social development and Hong Kong's current Disaster Relief Fund (DRF); and (2) assess how much respondents thought should be contributed to foreign aid for social development and/or DRF. Interviewers conducted a random telephone survey of Cantonese-speaking Hong Kong citizens aged 18 or above during 2017. Of the 1004 individuals surveyed, 55% (552) agreed that a portion of the government budget should be allocated to the DRF and 37% (372) disagreed. The mean and the median amount of the government budget suggested to be allocated were 5.1% and 2.4% respectively. However only 16% (164) supported the government giving foreign aid for social development, with 79% (793) not supporting, and 5% (47) undecided. The suggested portions of government budget that should be allocated for this purpose were 1.5% (mean) and 0.0% (median). The degree of support for DRF and foreign aid for social development was associated with both age (DRF P < 0.0005; foreign aid for social development P < 0.0005) and education (DRF P = 0.010; foreign aid for social development: P < 0.0005). There was little support for foreign aid for social development amongst the Hong Kong public, in contrast to similar surveys in other countries, but this could be related to the lack of a local tradition of providing ODA to foreign countries. Most respondents supported the current DRF and would like to see a greater proportion of government budget allocated. [ABSTRACT FROM AUTHOR]

Background: Decentralization is promoted as a strategy to improve health system performance by bringing decision-making closer to service delivery. Some studies have investigated if decentralization actually improves the health system. However, few have explored the conditions that enable it to be effective. To determine these conditions, we have analyzed the perspectives of decision-makers in the Philippines where devolution, one form of decentralization, was introduced 25 years ago. Methods: Drawing from the “decision space” approach, we interviewed 27 decision-makers with an average of 23.6 years of working across different levels of the Philippine government health sector and representing various local settings. Qualitative analysis followed the “Framework Method.” Conditions that either enable or hinder the effectiveness of decentralization were identified by exploring decision-making in five health sector functions. Results: These conditions include: for planning, having a multi-stakeholder approach and monitoring implementation; for financing and budget allocation, capacities to raise revenues at local levels and pooling of funds at central level; for resource management, having a central level capable of augmenting resource needs at local levels and a good working relationship between the local health officer and the elected local official; for program implementation and service delivery, promoting innovation at local levels while maintaining fidelity to national objectives; and for monitoring and data management, a central level capable of ensuring that data collection from local levels is performed in a timely and accurate manner. Conclusions: The Philippine experience suggests that decentralization is a long and complex journey and not an automatic solution for enhancing service delivery. The role of the central decision-maker (e.g. Ministry of Health) remains important to assist local levels unable to perform their functions well. It is policy-relevant to analyze the conditions that make decentralization work and the optimal combination of decentralized and centralized functions that enhance the health system. [ABSTRACT FROM AUTHOR]

Background: UNAIDS estimates global HIV investment needs in low- and middle-income countries (LMICs) at $26 billion per year in 2020. Yet international financing for HIV programs has stagnated amidst despite the increasing number of people requiring and accessing treatment. Despite increased efficiencies in HIV service delivery, evaluating programs for greater efficiencies remains necessary. While HIV budgets have been under scrutiny in recent years, indirect costs have not been quantified for any major global HIV program, but may constitute an additional avenue to identify program efficiencies. This analysis presents a method for estimating indirect costs in the President’s Emergency Plan for AIDS Relief (PEPFAR). Methods: Utilizing PEPFAR country operational plan (COP) funding data from 2007 to 2016 for international organizations (IOs) and universities and standard regulatory cost bases, we calculated modified total direct costs on which indirect cost rates may be applied by partner and funding agency. We then apply a series of plausible indirect cost rates (10%–36.28%) to develop a range for total indirect costs that have accrued over the period. Findings: Of $37.01 billion in total COP funding between 2007 and 2016, $22.24 billion (60.08%) was identifiably allocated to IOs ($17.95B) and universities ($4.29B). After excluding funding for sub-awards ($1.92B) and other expenses ($3.89B) to which indirect rates cannot be applied, $16.44B remained in combined direct and indirect costs. From this, we estimate that between $1.85B (8.30% of total international partner funding) and $4.34B (19.51%) has been spent on indirect costs from 2007–2016, including $157-$369 million in 2016. Interpretation: To our knowledge, this is the first analysis to quantify the indirect costs of major implementing partners of a global HIV funder. However, lack of transparency in the indirect cost rates of non-University international partners creates an opaque layer of programmatic costs. Given the current funding environment and evolution of HIV programming in PEPFAR countries, the findings motivate a re-examination of the current policies and the return on investment in indirect cost recovery across the PEPFAR program. [ABSTRACT FROM AUTHOR]

Motivation and method: Existing rational expectations models cannot satisfactorily explain why political budget manipulations systematically raise re-election chances and only occur in “specific contexts”. This paper offers a theoretical explanation by including unsophisticated voters into an opportunistic political cycle model; unsophisticated voters are unable to take the optimal behaviour of other agents (fully) into account, but may, nonetheless, vaguely suspect government deception. Results: First, rationally expected manipulations are, on average, fruitless in equilibrium. By including unsophisticated voters we can, however, corroborate empirically found electoral effects of political budget manipulations. Second, unsophisticated voters become anxious and suspicious in an intransparent or uncertain world, but the government tries to “outperform” their scepticism by increasing budget manipulations in order to appear more competent and, ultimately, increase re-election chances. It is, therefore, not surprising that political budget cycles are observed in countries suffering from intransparencies such as developing countries or new democracies. Third and in addition, the model presented here predicts that political opportunism produces, unintentionally, a countercyclical policy effect in election years, thereby, for instance, alleviating the typical problem of policy procyclicality in developing countries. Additional contribution: The paper also offers a theoretical explanation for political distortions found in forecasts by US states. Based on overly optimistic revenue forecasts the incumbent state government can conduct expansionary fiscal policies in order to appear more competent prior to an upcoming election. Since the resulting deficit can only be observed afterwards, the government can effectively circumvent a constitutional balanced budget constraint. As a result, there are political forecast and budget cycles in the state. More generally, however, these findings may also apply to European countries where balanced budget constraints are or will be in place (for instance the debt brakes in Switzerland and Germany); similarly, they apply to the supra-national European Fiscal Compact of the European Union. [ABSTRACT FROM AUTHOR]

Introduction: Following a period of interruption of Gavi’s funds for health system strengthening (HSS) in Cameroon and Chad, the two countries reprogramed their HSS grants. To implement the reprogrammed HSS, Chad committed to better management of the funds. Cameroon chose to channel the HSS funds through one of the health partners. This process is new to Gavi’s HSS grants, and little is known about its effectiveness or characteristics. We investigated the advantages and disadvantages of this process to inform the global health community about the added value of this solution. Materials and methods: We retrospectively evaluated Gavi’s HSS programs in Cameroon and Chad through a mixed methodology. To explore the pros and cons of channeling the funds through a health partner, we triangulated data from document review, key informant interviews (KIIs), field visits, and financial analysis of HSS expenditures in both countries. Results: Data triangulated from multiple sources showed that channeling HSS funds thorugh a health partner in Cameroon allowed compliance with budget, the development of a stronger accounting system at the Ministry of Health (MOH), and a rigid monitoring system. However, this mechanism delayed implementation by six months, accounted for 15% of the total cost, and created a tension around roles between MOH and the health partner. Achievement of program’s output indicators was average. In Chad, expenditures complied with budget as well. However, implementation was delayed longer causing a second reprogramming of the funds. While the program had fewer output indicators in Chad, these were minimally achieved. Discussion: To our knowledge, this is the first study of channeling Gavi HSS funds through a health partner. This new process contributed to a higher level of implementation, stronger monitoring, and strengthened accountability in Cameroon. Recipient countries of Gavi HSS grants who lack the financial management capacity can benefit from a similar process. [ABSTRACT FROM AUTHOR]

In a competitive model where agents are subject to endogenous trading constraints, we make the access to financial trade dependent on prices and consumption decisions. Our framework is compatible with the existence of both credit market segmentation and market exclusion. In this context, we show equilibrium existence in two scenarios. In the first one, individuals can fully hedge the payments of segmented financial contracts by trading unsegmented assets. In the second one, it is assumed that agents may compensate with increments in present demand the losses of well-being generated by reductions of future consumption. [ABSTRACT FROM AUTHOR]

In controlled laboratory experiments with and without overlapping generations, we study the role of intergenerational altruism in public debt accumulation. Public debt is chosen by popular vote, pays for public goods, and is repaid with general taxes. We use an optimal control model to derive a theoretical benchmark. With a single generation, public debt is accumulated prudently. With multiple and over-lapping generations, the burden of debt and the risk of over-indebtedness are shifted to future generations. We find a weak but significant sign of intergenerational altruism, observing that the revealed debt preferences increase as the number of following generations decreases. However, we find considerably fewer intergenerational fairness concerns than one would expect on the basis of the behavioral and experimental literature. Instead, political debt cycles that vary with voters’ age emerge. Debt ceiling mechanisms fail to encourage intergenerational altruism and do not mitigate the problem of burden shifting. [ABSTRACT FROM AUTHOR]

Team formation, which aims to form a team to complete a given task by covering its required skills, furnishes a natural way to help organizers complete projects effectively. In this work, we propose a new team hiring problem. Given a set of projects with required skills, and a pool of experts , each of which has his own skillset, compensation demand and participation constraint (i.e., the maximum number of projects the expert can participate in simultaneously), we seek to hire a team of participation-constrained experts to complete all the projects so that the overall compensation is minimized. We refer to this as the participation constrained team hire problem. To the best of our knowledge, this is the first work to investigate the problem. We also study a special case of the problem, where the number of projects is within the participation constraint of each expert and design an exact algorithm for it. Since participation constrained team hire problem is proven to be NP-hard, we design three novel efficient approximate algorithms as its solution, each of which focuses on a particular perspective of the problem. We perform extensive experimental studies, on both synthetic and real datasets, to evaluate the performance of our algorithms. Experimental results show that our exact algorithm far surpasses the brute-force solutions and works well in practice. Besides, the three algorithms behave differently when distinct facets of the problem are involved. [ABSTRACT FROM AUTHOR]

The increasing cost of electoral campaigns raises the need for effective campaign planning and a precise understanding of the return of such investment. Interestingly, despite the strong impact of elections on our daily lives, how this investment is translated into votes is still unknown. By performing data analysis and modeling, we show that top candidates spend more money per vote than the less successful and poorer candidates, a relation that discloses a diseconomy of scale. We demonstrate that such electoral diseconomy arises from the competition between candidates due to inefficient campaign expenditure. Our approach succeeds in two important tests. First, it reveals that the statistical pattern in the vote distribution of candidates can be explained in terms of the independently conceived, but similarly skewed distribution of money campaign. Second, using a heuristic argument, we are able to explain the observed turnout percentage for a given election of approximately 63% in average. This result is in good agreement with the average turnout rate obtained from real data. Due to its generality, we expect that our approach can be applied to a wide range of problems concerning the adoption process in marketing campaigns. [ABSTRACT FROM AUTHOR]

A new sequential method based on multi-resolution approximation is proposed for solving computationally expensive multi-objective optimization problems. A traditional strategy is to decompose a multi-objective optimization problem into a number of single-objective optimization problems, whereby the PF can be regarded as a function of weights. Therefore, it is very natural to use wavelet multi-resolution approximation techniques for setting weight vectors. In our framework, the sequential approach starts with sampling aggressive functions on the initial coarsest grid with a few collocation points; once a rough PF is obtained, new points are automatically added on the basis of an adaptive wavelet collocation method. Therefore, the PF can be approximated with a relatively small number of weights. The efficiency of our method is demonstrated on two examples: a typical multi-objective optimization problem and an expensive multi-objective control optimal problem. [ABSTRACT FROM AUTHOR]

Background: The role of non-governmental organisations (NGOs) in health research has attracted growing attention. NGOs are important service providers and advocates in international health, and conducting research can help NGOs to strengthen these service delivery and advocacy activities. However, capacity to conduct research varies among NGOs. There is currently limited evidence on NGOs’ research capacity that can explain why capacity varies or indicate potential areas for support. We examined NGOs’ capacity to conduct research, identifying factors that affect their access to the funds, time and skills needed to undertake research. Methods: We examined research capacity through qualitative case studies of three NGOs in Malawi, including one national and two international NGOs. Data were generated through interviews and focus groups with NGO staff, observation of NGO activities, and document reviews. Results: Availability of funding, skills and time to conduct research varies considerably between the case NGOs. Access to these resources is affected by internal processes such as sources of funding and prioritisation of research, and by the wider environment and external relationships, including the nature of donor support. Constraints include limited ability to apply for research funding, a perception that donors will not support research costs, lack of funding to hire or train research staff, and prioritisation of service delivery over research in funding proposals and staff schedules. Conclusion: The findings suggest strategies for NGOs and for donors interested in supporting NGOs’ research capacity. Above all, the findings reinforce the importance of initial capacity assessments to identify organisational needs and opportunities. In addition, the need for time and funding as well as skills suggests that strengthening NGOs’ research capacity will often require more than research training. [ABSTRACT FROM AUTHOR]

In the public transport industry, travellers’ perceived satisfaction is a key element in understanding their evaluation of, and loyalty to ridership. Despite its notable importance, studies of customer satisfaction are under-represented in the literature, and most previous studies are based on survey data collected from a single city only. This does not allow a comparison across different transport systems. To address this underrepresentation, this paper reports on a study of train passengers’ satisfaction with the fare paid for their most recent home-based train trip in five Australian capital cities: Sydney, Melbourne, Brisbane, Adelaide, and Perth. Two data sources are used: a nation-wide survey, and objective information on the train fare structure in each of the targeted cities. In particular, satisfaction with train fares is modelled as a function of socio-economic factors and train trip characteristics, using a random parameters ordered Logit model that accounts for unobserved heterogeneity in the population. Results indicate that gender, city of origin, transport mode from home to the train station, eligibility for either student or senior concession fare, one-way cost, and waiting time as well as five diverse interaction variables between city of origin and socio-economic factors are the key determinants of passenger satisfaction with train fares. In particular, this study reveals that female respondents tend to be less satisfied with their train fare than their male counterparts. Interestingly, respondents who take the bus to the train station tend to feel more satisfied with their fare compared with the rest of the respondents. In addition, notable heterogeneity is detected across respondents’ perceived satisfaction with train fare, specifically with regard to the one-way cost and the waiting time incurred. An intercity comparison reveals that a city’s train fare structure also affects a traveller’s perceived satisfaction with their train fare. The findings of this research are significant for both policy makers and transport operators, allowing them to understand traveller behaviours, and to subsequently formulate effective transit policies. [ABSTRACT FROM AUTHOR]

Introduction: California’s Workers’ Compensation System (CAWCS) Department of Industrial Relations questioned the adequacy of the current Medi-Cal fee-schedule pricing and requested analysis of alternatives that maximize price availability and maintain budget neutrality. Objectives: To compare CAWCS pharmacy-dispensed (PD) drug prices under alternative fee schedules, and identify combinations of alternative benchmarks that have prices available for the largest percentage of PD drugs and that best reach budget neutrality. Methods: Claims transaction-level data (2011–2013) from CAWCS were used to estimate total annual PD pharmaceutical payments. Medi-Cal pricing data was from the Workman’s Compensation Insurance System (WCIS). Average Wholesale Prices (AWP), Wholesale Acquisition Costs (WAC), Direct Prices (DP), Federal Upper Limit (FUL) prices, and National Average Drug Acquisition Costs (NADAC) were from Medi-Span. We matched National Drug Codes (NDCs), pricing dates, and drug quantity for comparisons. We report pharmacy-dispensed (PD) claims frequency, reimbursement matching rate, and paid costs by CAWCS as the reference price against all alternative price benchmarks. Results: Of 12,529,977 CAWCS claims for pharmaceutical products 11.6% (1,462,814) were for PD drugs. Prescription drug cost for CAWCS was over $152M; $63.9M, $47.9M, and $40.6M in 2011–2013. Ninety seven percent of these CAWCS PD claims had a Medi-Cal price. Alternative mechanisms provided a price for fewer claims; NADAC 94.23%, AWP 90.94%, FUL 73.11%, WAC 66.98%, and DP 14.33%. Among CAWCS drugs with no Medi-Cal price in PD claims, AWP, WAC, NADAC, DP, and FUL provided prices for 96.7%, 63.14%, 24.82%, 20.83%, and 15.08% of claims. Overall CAWCS paid 100.52% of Medi-Cal, 60% of AWP, 97% of WAC, 309.53% of FUL, 103.83% of DP, and 136.27% of NADAC. Conclusions: CAWCS current Medi-Cal fee-schedule price list for PD drugs is more complete than all alternative fee-schedules. However, all reimbursement approaches would require combinations of pricing benchmarks. We suggest keeping primary reimbursement at 100% of Medi-Cal and for drugs without a primary Medi-Cal price calculating the maximum fee as 60% of AWP and then 97% of WAC. Alternatively, we suggest using NADAC as a primary fee-schedule followed by either 60% AWP and 97% WAC or AWP-40% for drugs with no NADAC price. Fee-schedules may not offer the best price and a formulary approach may provide more flexibility. [ABSTRACT FROM AUTHOR]

Objective: To estimate the optimal allocation of Centers for Disease Control and Prevention (CDC) HIV prevention funds for health departments in 52 jurisdictions, incorporating Health Resources and Services Administration (HRSA) Ryan White HIV/AIDS Program funds, to improve outcomes along the HIV care continuum and prevent infections. Methods: Using surveillance data from 2010 to 2012 and budgetary data from 2012, we divided the 52 health departments into 5 groups varying by number of persons living with diagnosed HIV (PLWDH), median annual CDC HIV prevention budget, and median annual HRSA expenditures supporting linkage to care, retention in care, and adherence to antiretroviral therapy. Using an optimization and a Bernoulli process model, we solved for the optimal CDC prevention budget allocation for each health department group. The optimal allocation distributed the funds across prevention interventions and populations at risk for HIV to prevent the greatest number of new HIV cases annually. Results: Both the HIV prevention interventions funded by the optimal allocation of CDC HIV prevention funds and the proportions of the budget allocated were similar across health department groups, particularly those representing the large majority of PLWDH. Consistently funded interventions included testing, partner services and linkage to care and interventions for men who have sex with men (MSM). Sensitivity analyses showed that the optimal allocation shifted when there were differences in transmission category proportions and progress along the HIV care continuum. Conclusion: The robustness of the results suggests that most health departments can use these analyses to guide the investment of CDC HIV prevention funds into strategies to prevent the most new cases of HIV. [ABSTRACT FROM AUTHOR]

Recent research suggests that psychological needs can influence the political attitudes of ordinary citizens, often outside of their conscious awareness. In this paper, we investigate whether psychological needs also shape the spending priorities of political elites in the US. Most models of policymaking assume that political elites respond to information in relatively homogeneous ways. We suggest otherwise, and explore one source of difference in information processing, namely, threat sensitivity, which previous research links to increased support for conservative policy attitudes. Drawing on a sample of state-level policymakers, we measure their spending priorities using a survey and their level of threat sensitivity using a standard psychophysiological measure (skin conductance). We find that, like ordinary citizens, threat sensitivity leads even state-level policymakers to prioritize spending on government polices that are designed to minimize threats. [ABSTRACT FROM AUTHOR]

Strategic purchasing is an essential health financing function. This paper compares the strategic purchasing practices of Thailand’s two tax-financed health insurance schemes, the Universal Coverage Scheme (UCS) and the Civil Servant Medical Benefit Scheme (CSMBS), and identifies factors contributing to successful universal health coverage outcomes by analysing the relationships between the purchaser and government, providers and members. The study uses a cross-sectional mixed-methods design, including document review and interviews with 56 key informants. The Comptroller General Department (CGD) of Ministry of Finance manages CSMBS as one among civil servant welfare programmes. Their purchasing is passive. Fee for service payment for outpatient care has resulted in rapid cost escalation and overspending of their annual budget. In contrast, National Health Security Office (NHSO) manages purchasing for UCS, which undertakes a range of strategic purchasing actions, including applying closed ended provider payment, promoting primary healthcare’s gate keeping functions, exercising collective purchasing power and engaging views of members in decision making process. This difference in purchasing arrangements resulted in expenditure per CSMBS member being 4 times higher than UCS in 2014. The governance of the purchaser organization, the design of the purchasing arrangements including incentives and use of information, and the institutional capacities to implement purchasing functions are essential for effective strategic purchasing which can improve health system efficiency as a whole. [ABSTRACT FROM AUTHOR]

When standard optimization methods fail to find a satisfactory solution for a parameter fitting problem, a tempting recourse is to adjust parameters manually. While tedious, this approach can be surprisingly powerful in terms of achieving optimal or near-optimal solutions. This paper outlines an optimization algorithm, Adaptive Stochastic Descent (ASD), that has been designed to replicate the essential aspects of manual parameter fitting in an automated way. Specifically, ASD uses simple principles to form probabilistic assumptions about (a) which parameters have the greatest effect on the objective function, and (b) optimal step sizes for each parameter. We show that for a certain class of optimization problems (namely, those with a moderate to large number of scalar parameter dimensions, especially if some dimensions are more important than others), ASD is capable of minimizing the objective function with far fewer function evaluations than classic optimization methods, such as the Nelder-Mead nonlinear simplex, Levenberg-Marquardt gradient descent, simulated annealing, and genetic algorithms. As a case study, we show that ASD outperforms standard algorithms when used to determine how resources should be allocated in order to minimize new HIV infections in Swaziland. [ABSTRACT FROM AUTHOR]

Political campaigns involve, in the simplest case, two competing campaign groups which try to obtain a majority of votes. We propose a novel mathematical framework to study political campaign dynamics on social networks whose constituents are either political activists or persuadable individuals. Activists are convinced and do not change their opinion and they are able to move around in the social network to motivate persuadable individuals to vote according to their opinion. We describe the influence of the complex interplay between the number of activists, political clout, budgets, and campaign costs on the campaign result. We also identify situations where the choice of one campaign group to send a certain number of activists already pre-determines their victory. Moreover, we show that a candidate’s advantage in terms of political clout can overcome a substantial budget disadvantage or a lower number of activists, as illustrated by the US presidential election 2016. [ABSTRACT FROM AUTHOR]

Background: As in many health care systems, some Canadian jurisdictions have begun shifting away from global hospital budgets. Payment for episodes of care has begun to be implemented. Starting in 2012, the Province of Ontario implemented hospital funding reforms comprising three elements: Global Budgets; Health Based Allocation Method (HBAM); and Quality-Based Procedures (QBP). This evaluation focuses on implementation of QBPs, a procedure/diagnosis-specific funding approach involving a pre-set price per episode of care coupled with best practice clinical pathways. We examined whether or not there was consensus in understanding of the program theory underpinning QBPs and how this may have influenced full and effective implementation of this innovative funding model. Methods: We undertook a formative evaluation of QBP implementation. We used an embedded case study method and in-depth, one-on-one, semi-structured, telephone interviews with key informants at three levels of the health care system: Designers (those who designed the QBP policy); Adoption Supporters (organizations and individuals supporting adoption of QBPs); and Hospital Implementers (those responsible for QBP implementation in hospitals). Thematic analysis involved an inductive approach, incorporating Framework analysis to generate descriptive and explanatory themes that emerged from the data. Results: Five main findings emerged from our research: (1) Unbeknownst to most key informants, there was neither consistency nor clarity over time among QBP designers in their understanding of the original goal(s) for hospital funding reform; (2) Prior to implementation, the intended hospital funding mechanism transitioned from ABF to QBPs, but most key informants were either unaware of the transition or believe it was intentional; (3) Perception of the primary goal(s) of the policy reform continues to vary within and across all levels of key informants; (4) Four years into implementation, the QBP funding mechanism remains misunderstood; and (5) Ongoing differences in understanding of QBP goals and funding mechanism have created challenges with implementation and difficulties in measuring success. Conclusions: Policy drift and policy layering affected both the goal and the mechanism of action of hospital funding reform. Lack of early specification in both policy goals and hospital funding mechanism exposed the reform to reactive changes that did not reflect initial intentions. Several challenges further exacerbated implementation of complex hospital funding reforms, including a prolonged implementation schedule, turnover of key staff, and inconsistent messaging over time. These factors altered the trajectory of the hospital funding reforms and created confusion amongst those responsible for implementation. Enacting changes to hospital funding policy through a process that is transparent, collaborative, and intentional may increase the likelihood of achieving intended effects. [ABSTRACT FROM AUTHOR]

Background: The WHO HIV Treatment Guidelines suggest routine viral-load monitoring can be used to differentiate antiretroviral therapy (ART) delivery and reduce the frequency of clinic visits for patients stable on ART. This recommendation was informed by economic analysis that showed the approach is very likely to be cost-effective, even in the most resource constrained of settings. The health benefits were shown to be modest but the costs of introducing and scaling up viral load monitoring can be offset by anticipated reductions in the costs of clinic visits, due to these being less frequent for many patients. Key issues for economic evaluation: The cost-effectiveness of introducing viral-load informed differentiated care depends upon whether cost reductions are possible if the number of clinic visits is reduced and/or how freed clinic capacity is used for alternative priorities. Where freed resources, either physical or financial, generate large health gains (e.g. if committed to patients failing ART or to other high value health care interventions), the benefits of differentiated care are expected to be high; if however these freed physical resources are already under-utilized or financial resources are used less efficiently and would not be put to as beneficial an alternative use, the policy may not be cost-effective. The implication is that the use of conventional unit costs to value resources may not well reflect the latter’s value in contributing to health improvement. Analyses intended to inform resource allocated decisions in a number of settings may therefore have to be interpreted with due consideration to local context. In this paper we present methods of how economic analyses can reflect the real value of health care resources rather than simply applying their unit costs. The analyses informing the WHO Guidelines are re-estimated by implementing scenarios using this framework, informing how differentiated care can be prioritized to generate greatest gains in population health. Implications: The findings have important implications for how economic analyses should be undertaken and reported in HIV and other disease areas. Results provide guidance on conditions under which viral load informed differentiated care will more likely prove to be cost effective when implemented. [ABSTRACT FROM AUTHOR]

This paper proposes an optimization model, using Mixed-Integer Linear Programming (MILP), to support decisions related to making investments in the design of power grids serving industrial clients that experience interruptions to their energy supply due to disruptive events. In this approach, by considering the probabilities of the occurrence of a set of such disruptive events, the model is used to minimize the overall expected cost by determining an optimal strategy involving pre- and post-event actions. The pre-event actions, which are considered during the design phase, evaluate the resilience capacity (absorption, adaptation and restoration) and are tailored to the context of industrial clients dependent on a power grid. Four cases are analysed to explore the results of different probabilities of the occurrence of disruptions. Moreover, two scenarios, in which the probability of occurrence is lowest but the consequences are most serious, are selected to illustrate the model’s applicability. The results indicate that investments in pre-event actions, if implemented, can enhance the resilience of power grids serving industrial clients because the impacts of disruptions either are experienced only for a short time period or are completely avoided. [ABSTRACT FROM AUTHOR]

Background: The use of cost-effectiveness thresholds based on a country’s income per capita has been criticized for not being relevant to decision making, in particular in middle-income countries such as South Africa. The recent South African HIV Investment Case produced an alternative cost-effectiveness threshold for HIV prevention and treatment interventions based on estimates of life years saved and the country’s committed HIV budget. Methods: We analysed the optimal mix of HIV interventions over a baseline of the current HIV programme under the committed HIV budget for 2016–2018. We calculated the incremental cost-effectiveness ratio (ICER) as cost per life-year saved (LYS) of 16 HIV prevention and treatment interventions over 20 years (2016–2035). We iteratively evaluated the most cost effective option (defined by an intervention and its coverage) over a rolling baseline to which the more cost effective options had already been added, thereby allowing for diminishing marginal returns to interventions. We constrained the list of interventions to those whose combined cost was affordable under the current HIV budget. Costs are presented from the government perspective, unadjusted for inflation and undiscounted, in 2016 USD. Results: The current HIV budget of about $1.6 billion per year was sufficient to pay for the expansion of condom availability, medical male circumcision, universal treatment, and infant testing at 6 weeks to maximum coverage levels, while also implementing a social and behavior change mass media campaign with a message geared at increasing testing uptake and reducing the number of sexual partners. The combined ICER of this package of services was $547/ LYS. The ICER of the next intervention that was above the affordability threshold was $872/LYS. Conclusions: The results of the South African HIV Investment Case point to an HIV cost-effectiveness threshold based on affordability under the current budget of $547–872 per life year saved, a small fraction of the country’s GDP per capita of about $6,000. [ABSTRACT FROM AUTHOR]

Background: Prioritizing investments across health interventions is complicated by the nonlinear relationship between intervention coverage and epidemiological outcomes. It can be difficult for countries to know which interventions to prioritize for greatest epidemiological impact, particularly when budgets are uncertain. Methods: We examined four case studies of HIV epidemics in diverse settings, each with different characteristics. These case studies were based on public data available for Belarus, Peru, Togo, and Myanmar. The Optima HIV model and software package was used to estimate the optimal distribution of resources across interventions associated with a range of budget envelopes. We constructed “investment staircases”, a useful tool for understanding investment priorities. These were used to estimate the best attainable cost-effectiveness of the response at each investment level. Findings: We find that when budgets are very limited, the optimal HIV response consists of a smaller number of ‘core’ interventions. As budgets increase, those core interventions should first be scaled up, and then new interventions introduced. We estimate that the cost-effectiveness of HIV programming decreases as investment levels increase, but that the overall cost-effectiveness remains below GDP per capita. Significance: It is important for HIV programming to respond effectively to the overall level of funding availability. The analytic tools presented here can help to guide program planners understand the most cost-effective HIV responses and plan for an uncertain future. [ABSTRACT FROM AUTHOR]

Scientists are increasingly dissatisfied with funding systems that rely on peer assessment and, accordingly, have suggested several proposals for reform. One of these proposals is to distribute available funds equally among all qualified researchers, with no interference from peer review. Despite its numerous benefits, such egalitarian sharing faces the objection, among others, that it would lead to an unacceptable dilution of resources. The aim of the present paper is to assess this particular objection. We estimate (for the Netherlands, the U.S. and the U.K.) how much researchers would receive were they to get an equal share of the government budgets that are currently allocated through competitive peer assessment. For the Netherlands, we furthermore estimate what researchers would receive were we to differentiate between researchers working in low-cost, intermediate-cost and high-cost disciplines. Given these estimates, we then determine what researchers could afford in terms of PhD students, Postdocs, travel and equipment. According to our results, researchers could, on average, maintain current PhD student and Postdoc employment levels, and still have at their disposal a moderate (the U.K.) to considerable (the Netherlands, U.S.) budget for travel and equipment. This suggests that the worry that egalitarian sharing leads to unacceptable dilution of resources is unjustified. Indeed, our results strongly suggest that there is room for far more egalitarian distribution of funds than happens in the highly competitive funding schemes so prevalent today. [ABSTRACT FROM AUTHOR]

Background: In a previous trial in Vietnam, a facilitation strategy to secure evidence-based practice in primary care resulted in reduced neonatal mortality over a period of three years. While little is known as to what ensures sustainability in the implementation of community-based strategies, the aim of this study was to investigate factors promoting or hindering implementation, and sustainability of knowledge implementation strategies, by means of the former Neonatal Knowledge Into Practice (NeoKIP) trial. Methods: In 2014 we targeted all levels in the Vietnamese healthcare system: six individual interviews with representatives at national, provincial and district levels, and six focus group discussions with representatives at the commune level. The interviews were transcribed verbatim, translated to English, and analysed using inductive and deductive thematic analysis. Results: To achieve successful implementation and sustained effect of community-based knowledge implementation strategies, engagement of leaders and key stakeholders at all levels of the healthcare system is vital–prior to, during and after a project. Implementation and sustainability require thorough needs assessment, tailoring of the intervention, and consideration of how to attain and manage funds. The NeoKIP trial was characterised by a high degree of engagement at the primary healthcare system level. Further, three years post trial, maternal and neonatal care was still high on the agenda for healthcare workers and leaders, even though primary aspects such as stakeholder engagement at all levels, and funding had been incomplete or lacking. Conclusions: The current study illustrates factors to support successful implementation and sustain effects of community-based strategies in projects in low- and middle-income settings; some but not all factors were represented during the post-NeoKIP era. Most importantly, trials in this and similar contexts require deliberate management throughout and beyond the project lifetime, and engagement of key stakeholders, in order to promote and sustain knowledge implementation. [ABSTRACT FROM AUTHOR]