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Respiratory syncytial virus (RSV) causes a substantial health and economic burden in the population, particularly in infants. A maternal RSV vaccine, aimed at protecting this highly vulnerable population, was recently approved in Australia. Australia currently lacks estimates of the cost-effectiveness of a maternal RSV vaccination program, which are important for helping to inform policy decisions about its introduction. This thesis involves three studies with an overarching aim of assessing the cost-effectiveness of a year-round maternal RSV vaccination program in Australia. The first study used time series analysis to provide a more complete estimation of RSV-attributable hospitalisations in Australia than previously available. The highest population rate of hospitalisation was found in <5-year-olds. Estimates in this age group were similar to those using RSV-specific diagnostic codes (any field). However, the estimated incidence in the ≥75-year-olds was approximately eight times higher than estimates based only on counts of hospitalisations with RSV-specific diagnosis codes (any field). The second study developed an age-structured dynamic model to characterise RSV infection dynamics in Australia prior to introduction of a maternal vaccination program and to estimate the age-specific changes in infection dynamics following introduction of the program. The study predicted reductions in RSV hospitalisations of around 60% in <3-month-olds and 40% in 3–5-month-olds, and a small but important herd effect on the wider population. The third study integrated the dynamic model with the economic evaluation model to evaluate the cost-effectiveness of a year-round maternal RSV vaccination in Australia. Under base case assumptions, the maternal vaccination program was estimated to be cost-effective if priced at less than approximately $AU 120 at an assumed willingness-to-pay threshold of $AU 50,000/quality-adjusted life year (QALY) gained. Most of the overall savings in direct

The Greenhouse Gas Reduction Mandate (GGRM, reduktionsplikten) is Swedish legislation focused on reducing carbon emissions by mandating that the emissions of certain fuels are reduced by a specified percentage, that percentage increasing each year. This paper investigates the rationale behind a political drive to decrease the GGRM, the cost-effectiveness of the GGRM, and the consequences of the proposed changes in relation to binding and non-binding responsibilities and goals relevant for Sweden. The study attempts a comparative analysis of the cost of the GGRM and selected greenhouse gas emission valuations. Among these are the Swedish Carbon Tax and a socio-economic valuation given by Trafikanalys. These values are central to the study, as they can directly be compared to the GGRM. Additionally, the debate surrounding the topic was unusual, as parties that have historically spoken for business find themselves opposed to long-time political allies. Through a mixed-method approach, utilizing both qualitative and quantitative data, this paper aims to provide an understanding of the perspectives of different stakeholders. To collect data, a questionnaire was sent out to stakeholders, specifically political parties and the fuel industry. Once it was clear that the response to the questionnaire was limited, further information was collected from available scientific and gray literature. Ultimately, this study provides no definitive answer, as a dearth of responses from both industry and political parties lead to limited data. Additionally, the humbling number of relevant factors deny the formation of any definite statement regarding the cost-effectiveness of the GGRM. Even so, by utilizing both collected quantitative and qualitative data, light is shed upon the topic and the complexity of the GGRM. A truly complete analysis of the GGRM is beyond the scope of this study, requiring further study and understanding of several disciplines to account for the many factors that, Sverige har ett nationellt mål om att minska utsläppen av växthusgaser från inrikes transporter med 70% fram till år 2030. För att minska dessa utsläpp beslöt Sverige år 2017 om den så kallade reduktionsplikten, som innefattar ett krav på att successivt öka inblandning av biodrivmedel i diesel och bensin. Stigande drivmedelspriser har sen dess fått flera partier att vända sig mot reduktionsplikten. Debatten om reduktionsplikten är fylld med olika åsikter och argument för och emot reduktionsplikten. Huvudargumenten mot reduktionsplikten är dess kostnad eller ineffektivitet. Uppsatsen behandlar reduktionspliktens kostnadseffektivitet jämfört med olika värden av koldioxidekvivalenter, partiernas förslag till en sänkt reduktionsplikt och om dessa är förenliga med Sveriges mål och åtaganden. För att förstå debatten behöver meningsskillnaderna mellan de olika parterna kartläggas för att förstå och identifiera andra påverkande faktorer, samt potentiell bias i deras respons. Den låga responsnivån innebar att arbetet efterliknar en litteraturstudie med kompletterande information från fråge-enkäter. Partiernas och industrins åsiktsskillnader vilar delvis på olika explicita eller implicita monetära värden på minskade utsläpp av växthusgaser, antagna produktionskostnader samt målsättningar i miljöpolitiken. Resultaten demonstrerar att kostnadseffektiviteten av reduktionsplikten beror på vilket monetärt värde på koldioxidekvivalenter som används, och att dessa värden stigit sedan reduktionsplikten infördes. Det måste understrykas att ett flertal faktorer påverkar beräkningen av reduktionspliktens kostnadseffektivitet. Tidsperspektivet liksom diskonteringsräntan är viktig – ju lägre diskonteringsränta, desto mer vikt ges framtida effekter. Om industrin får långsiktiga förutsättningar för investeringar, kan kostnaden för framtida produktion av biodrivmedel förväntas sjunka. Detta arbete kan ses som ett processteg till förståelse av de fundamentala åsikts- och beräkningsskillnader

This thesis consists of three main parts, each addressing different topics regarding the evaluation and improvement of CRC screening and surveillance. In the first part of this thesis, we describe possibilities to improve the CRC screening programme. In Chapter 2, we study the benefit-harm balance of participating in CRC screening for many subgroups aiming to help individuals making an informed decision about screening participation. To do so, we combine risk estimates of the benefits and harms of CRC screening, derived with the ASCCA model, with the relative importance of CRC screening outcomes obtained with a preference eliciting survey in order to obtain the benefit-harm balance of screening. In Chapter 3, we evaluate the clinical utility of a new stool test in a large-scale paired-intervention study conducted in the Dutch CRC screening programme. In Chapter 4, we assess the accuracy of various summarising measures commonly used to report adherence over multiple rounds of stool-based CRC screening. In addition, we assess the impact of using these summarising measures, rather than using detailed longitudinal adherence data, on model-predicted CRC screening effectiveness using the ASCCA model. The second part of this thesis investigates surveillance in two populations who are at increased risk of CRC. In Chapter 5, we evaluate whether stool-based surveillance could serve as an alternative to colonoscopy surveillance in a post-polypectomy surveillance population. In Chapter 6, we study the optimal surveillance strategy for individuals with a family history of CRC, considering colonoscopy surveillance, FIT-based surveillance and surveillance including both colonoscopy and FIT. The third part of this thesis focuses on the impact of the COVID-19 pandemic on CRC screening programmes. For this purpose, multiple independent models are used to answer the same research question. In addition to the ASCCA model, the MISCAN-Colon model, the Policy1-Bowel model, and the OncoSim

Background: High flow nasal cannula therapy (HFNC) and continuous positive airway pressure (CPAP) are two widely used modes of non-invasive respiratory support in paediatric critical care units. The FIRST-ABC randomised controlled trials (RCTs) evaluated the clinical and cost-effectiveness of HFNC compared with CPAP in two distinct critical care populations: acutely ill children (‘step-up’ RCT) and extubated children (‘step-down’ RCT). Clinical effectiveness findings (time to liberation from all forms of respiratory support) showed that HFNC was non-inferior to CPAP in the step-up RCT, but failed to meet non-inferiority criteria in the step-down RCT. This study evaluates the cost-effectiveness of HFNC versus CPAP. Methods: All-cause mortality, health-related Quality of Life (HrQoL), and costs up to six months were reported using FIRST-ABC RCTs data. HrQoL was measured with the age-appropriate Paediatric Quality of Life Generic Core Scales questionnaire and mapped onto the Child Health Utility 9D index score at six months. Quality-Adjusted Life Years (QALYs) were estimated by combining HrQoL with mortality. Costs at six months were calculated by measuring and valuing healthcare resources used in paediatric critical care units, general medical wards and wider health service. The cost-effectiveness analysis used regression methods to report the cost-effectiveness of HFNC versus CPAP at six months and summarised the uncertainties around the incremental cost-effectiveness results. Results: In both RCTs, the incremental QALYs at six months were similar between the randomised groups. The estimated incremental cost at six months was − £4565 (95% CI − £11,499 to £2368) and − £5702 (95% CI − £11,328 to − £75) for step-down and step-up RCT, respectively. The incremental net benefits of HFNC versus CPAP in step-down RCT and step-up RCT were £4388 (95% CI − £2551 to £11,327) and £5628 (95% CI − £8 to £11,264) respectively. The cost-effectiveness results were surrounded by consid

Purpose: To assess the cost-effectiveness of the treatment of low corneal astigmatism (≤1.5 diopters) at the moment of cataract surgery. Setting: Qvision, Ophthalmology Department, VITHAS Almería Hospital, Spain. Design: Economic evaluation. Methods: A decision tree was used to assess the cost-effectiveness of implanting spherical vs toric intraocular lenses (IOLs) or spherical lens combined with the following corneal incisions: limbal-relaxing incisions conducted manually (M-LRI) or assisted by femtosecond laser (F-LRI), arcuate keratotomies conducted manually (M-AK) or assisted by femtosecond laser (F-AK), and intrastromal arcuate keratotomies (F-iAK). Outcomes of cost were selected from a patient perspective considering the gross cost of each one of the surgeries at European centers, and the effectiveness variable was the probability of achieving a visual acuity of 20/20 postoperatively. A sensitivity analysis was conducted to assess the uncertainty considering the evidence retrieved from the transition probabilities of the model, effectiveness, and cost. Results: F-AK or toric IOLs were the most effective treatments, increasing an 16% or 9%, respectively, in the percentage of eyes attaining 20/20 vision. The M-LRI, F-iAK, and F-LRI procedures were strongly dominated while the M-AK and toric IOL were weakly dominated by the F-AK. A patient with low corneal astigmatism would need to be willing to pay 360€ (95% CI, 231-1224) with F-AK and 472€ (95% CI, 149-4490) with toric IOLs for a 10% increase in the probability of achieving 20/20 vision. Conclusions: From patient perspective, F-AK was generally the most cost-effective treatment, although toric IOLs can dominate in some countries.

Conservation offsets are increasingly used as an instrument for biodiversity conservation on private lands. Since the restoration of degraded land often involves uncertainties and time lags, conservation biologists have recommended that credits in conservation offset schemes be awarded only with the completion of the restoration process (“savings bank”). These arguments, however, ignore that such a scheme design may incur higher economic costs than a design in which credits are already awarded at the initiation of the restoration process (“lending bank”). Here a generic agent-based ecological-economic simulation model is developed to explore the cost-effectiveness of savings and lending banks. The economic model compartment considers spatially heterogeneous and dynamic conservation costs and time preferences in the landowners. The ecological compartment considers uncertainty in the duration and the success of restoration process, and in the metapopulation dynamics of a species described by the rates of local population extinction and the colonisation of empty habitat patches. By this the widely used offset metric of “habitat hectares” is replaced by “metapopulation viability” which is commonly used in conservation biology. It turns out that whether credits should be awarded at the initiation or with completion of restoration depends on the ecological and economic circumstances. Larger colonisation and extinction rates, e.g., tend to favour the awarding of credits with the initiation of habitat restoration.

PurposeWe aimed to estimate health state utility values (HSUVs) for the key health states found in opioid use disorder (OUD) cost-effectiveness models in the published literature.MethodsData obtained from six trials representing 1,777 individuals with OUD. We implemented mapping algorithms to harmonize data from different measures of quality of life (the SF-12 Versions 1 and 2 and the EQ-5D-3 L). We performed a regression analysis to quantify the relationship between HSUVs and the following variables: days of extra-medical opioid use in the past 30 days, injecting behaviors, treatment with medications for OUD, HIV status, and age. A secondary analysis explored the impact of opioid withdrawal symptoms.ResultsThere were statistically significant reductions in HSUVs associated with extra-medical opioid use (-0.002 (95% CI [-0.003,-0.0001]) to -0.003 (95% CI [-0.005,-0.002]) per additional day of heroin or other opiate use, respectively), drug injecting compared to not injecting (-0.043 (95% CI [-0.079,-0.006])), HIV-positive diagnosis compared to no diagnosis (-0.074 (95% CI [-0.143,-0.005])), and age (-0.001 per year (95% CI [-0.003,-0.0002])). Parameters associated with medications for OUD treatment were not statistically significant after controlling for extra-medical opioid use (0.0131 (95% CI [-0.0479,0.0769])), in line with prior studies. The secondary analysis revealed that withdrawal symptoms are a fundamental driver of HSUVs, with predictions of 0.817 (95% CI [0.768, 0.858]), 0.705 (95% CI [0.607, 0.786]), and 0.367 (95% CI [0.180, 0.575]) for moderate, severe, and worst level of symptoms, respectively.ConclusionWe observed HSUVs for OUD that were higher than those from previous studies that had been conducted without input from people living with the condition.

Background Given the degenerative nature of the condition, people living with motor neuron disease (MND) experience high levels of psychological distress. The purpose of this research was to investigate the cost-effectiveness of acceptance and commitment therapy (ACT), adapted for the specific needs of this population, for improving quality of life. Methods A trial-based cost–utility analysis over a 9-month period was conducted comparing ACT plus usual care (n = 97) versus usual care alone (n = 94) from the perspective of the National Health Service. In the primary analysis, quality-adjusted life years (QALYs) were computed using health utilities generated from the EQ-5D-5L questionnaire. Sensitivity analyses and subgroup analyses were also carried out. Results Difference in costs was statistically significant between the two arms, driven mainly by the intervention costs. Effects measured by EQ-5D-5L were not statistically significantly different between the two arms. The incremental cost-effectiveness was above the £20,000 to £30,000 per QALY gained threshold used in the UK. However, the difference in effects was statistically significant when measured by the McGill Quality of Life-Revised (MQOL-R) questionnaire. The intervention was cost-effective in a subgroup experiencing medium deterioration in motor neuron symptoms. Conclusions Despite the intervention being cost-ineffective in the primary analysis, the significant difference in the effects measured by MQOL-R, the low costs of the intervention, the results in the subgroup analysis, and the fact that ACT was shown to improve the quality of life for people living with MND, suggest that ACT could be incorporated into MND clinical services.

To increase the speed of implementation of carbon mitigation technologies, many countries set up publicly funded investment programs, where private and/or public entities can apply for support. These schemes are often criticized for not being cost-effective. The purpose of this study is to evaluate the Swedish Climate Leap Program, which differs from most other programs through the multisector approach. We examine determinants of project approval and evaluate the heterogeneity in implicit carbon pricing across sectors. Several econometric methods are used to assess equality in carbon pricing. Results show that although the cost-effectiveness ratio plays an important role in project approval, carbon pricing differs significantly across project types. Project guidelines favor charging stations and transport measures that aid in adopting new technology and reaching economies of scale. However, the preference for transport measures is not reflected in the carbon pricing while instead energy conversion measures have a higher probability of being funded given the cost-effectiveness of the investment. Funding decisions favor densely populated municipalities, which could be motivated for investments in public goods, but is questionable for transport and housing.

Serverless computing is transforming web development by offering scalable and cost-effective solutions. By using mixed-method approach, correlation studies, and framework creation, the study evaluates its influence to give an understanding of operational implications and guide possible future strategies. Background: The scalability and cost-effectiveness of serverless computing revolutionize web app development. For developers to effectively use this technology, they must comprehend how it affects scalability, architecture, and operations. Objectives: The study investigates the effects of serverless computing on web app development, with a focus on operational, cost, and scalability issues. Using correlation and survey data, it examines the issues and views of developers. Method: Surveys and reviews of the literature are combined in the study to evaluate the impact of serverless computing. Python programming helps in calculating statistics and generating visualizations such as histograms, scatter plots, and the correlation matrix, which guides developers better utilize serverless technology. Results: Developers highly value scalability in serverless architectures, seeing it as essential for modern web applications. Strong correlations between deployment efficiency, security implementation, and long-term scalability emphasize the interdependence of these operational aspects in serverless environments. Conclusion: Serverless computing presents both advantages and challenges for web application development, influencing architecture, scalability, cost, and operations. Strategies to enhance efficiency, scalability, and security within serverless environments are crucial for optimizing developer experiences and outcomes.

This research focuses on comparing two surgical techniques, ACDA and ACDF, for treating neck issues caused by degeneration. The main aim is to investigate if ACDA, a cervical disc prosthesis, can preserve the natural movement of the neck in comparison to ACDF, which causes fusion. By studying the neck movements of healthy individuals, patients, and those who have undergone surgery, the research explores whether ACDA can prevent future spine problems. If successful, this approach could prove cost-effective in the long term, despite the higher initial cost of the implant. The study also highlights the importance of using rigorous methods to evaluate the cost-effectiveness of these treatments in spinal surgery.

Acquired brain injuries (ABI), resulting from stroke or traumatic brain injury, cause a range of neuropsychological impairments and many patients continue to experience neuropsychological deficits years after onset. The increasing average age of the population highlights the importance of effective management strategies for the consequences of ABI. Despite the well-documented impact of rehabilitation interventions, the cost-effectiveness of neuropsychological rehabilitation remains largely unknown. This study conducted a scoping review to update the findings of Stolwyk et al. (Neuropsychological Rehabilitation, 2021, 31, 316), focusing on the economic evaluations of neuropsychological rehabilitation for individuals with ABI. Following the PIO framework, PRISMA ScR guidelines, and systematic review reporting checklist, the review screened 1027 articles and included eight studies published between 2019 and 2024. The studies encompassed either language rehabilitation or general neuropsychological programs, including neuropsychological interventions. The economic analyses, including two cost-effectiveness, five cost-utility, and one cost-benefit study, mostly adhered to CHEERS guidelines, enhancing the transparency and methodological rigour of their reporting. These studies demonstrated varying degrees of cost-effectiveness for interventions targeting post-stroke language disorders and neuropsychological rehabilitation for ABI, with significant cost savings and health benefits observed, particularly for home-based rehabilitation interventions. The included studies suffered from a short time horizon, limiting the ability to capture the long-term economic impacts and effectiveness of the interventions. Future research should focus on longer-term follow-up data and include broader search strategies to enhance understanding and optimise health care interventions. A comprehensive implementation of these economic analyses is crucial for informing policymakers, enabling them t

This thesis investigates how different cash pooling structures influence the operational efficiency of multinational corporations based in Sweden. Through a qualitative study involving interviews with cash management experts from various multinational corporations, the research explores the advantages and challenges of different cash pooling structures. The findings highlight that centralized cash pooling generally enhances operational efficiency by optimizing resource utilization, reducing costs, and improving liquidity management. However, legal and regulatory constraints can complicate implementing a unified strategy. The study also examines the role of automation and technology in cash management, concluding that a balance between automated solutions and human oversight is central to maintaining efficiency in a complex global environment. This research contributes to the understanding of cash pooling strategies and provides practical insights for multinational corporations aiming to enhance their cash management practices., Denna uppsats undersöker hur olika cash pooling-strukturer påverkar den operationella effektiviteten hos multinationella företag baserade i Sverige. Genom en kvalitativ studie som innefattar intervjuer med experter inom cash management från olika multinationella företag, utforskar studien fördelarna och utmaningarna med olika cash pooling-strukturer. Resultaten visar att centraliserad cash pooling generellt sett förbättrar den operationella effektiviteten genom att optimera resursanvändningen, minska kostnaderna och förbättra likviditetshantering. Dock kan juridiska och regulatoriska begränsningar komplicera implementeringen av en enhetlig strategi. Studien undersöker även automatiseringen och teknologins roll inom cash management och drar slutsatsen att en balans mellan automatiserade lösningar och mänsklig faktor är avgörande för att bibehålla effektiviteten i en komplex global miljö. Denna studie bidrar till en djupare förståelse av cash pooling-strategier och ger praktiska insikter för multinationella företag som strävar efter att förbättra sina cash management-metoder.

Acquired brain injuries (ABI), resulting from stroke or traumatic brain injury, cause a range of neuropsychological impairments and many patients continue to experience neuropsychological deficits years after onset. The increasing average age of the population highlights the importance of effective management strategies for the consequences of ABI. Despite the well-documented impact of rehabilitation interventions, the cost-effectiveness of neuropsychological rehabilitation remains largely unknown. This study conducted a scoping review to update the findings of Stolwyk et al. (Neuropsychological Rehabilitation, 2021, 31, 316), focusing on the economic evaluations of neuropsychological rehabilitation for individuals with ABI. Following the PIO framework, PRISMA ScR guidelines, and systematic review reporting checklist, the review screened 1027 articles and included eight studies published between 2019 and 2024. The studies encompassed either language rehabilitation or general neuropsychological programs, including neuropsychological interventions. The economic analyses, including two cost-effectiveness, five cost-utility, and one cost–benefit study, mostly adhered to CHEERS guidelines, enhancing the transparency and methodological rigour of their reporting. These studies demonstrated varying degrees of cost-effectiveness for interventions targeting post-stroke language disorders and neuropsychological rehabilitation for ABI, with significant cost savings and health benefits observed, particularly for home-based rehabilitation interventions. The included studies suffered from a short time horizon, limiting the ability to capture the long-term economic impacts and effectiveness of the interventions. Future research should focus on longer-term follow-up data and include broader search strategies to enhance understanding and optimise health care interventions. A comprehensive implementation of these economic analyses is crucial for informing policymakers, enabling them t

Falls are the most common cause of injury in older people, with consequences for the individual and society. With an increasing population of older people, falls and related costs are expected to increase. It is crucial to identify scalable and cost-effective interventions and subsequently reduce fall-related costs. The aim was to evaluate the cost-effectiveness of the Safe Step digital fall preventive exercise intervention over a period of 12 years and, in addition, to evaluate the impact of increased recruitment cost and decreased intervention effect. The intervention was evaluated in an observational study in a municipality context targeting community-dwelling older people of age 70 +. A Markov model with five states was used to model the cost-effectiveness of the Safe Step intervention and evaluate quality-adjusted life years (QALYs) and fall-related costs from a societal perspective. By using data from a meta-analysis as basis for the estimated intervention effect, the Safe Step intervention was compared with a no-intervention alternative. The results showed that the Safe Step intervention dominated no intervention. In the sensitivity analysis with the most conservative estimate of intervention effect, the ICER was €7 616 per QALY gained. Hence, Safe Step showed to be a cost-saving fall preventive intervention in older people at risk of falling and potentially cost-effective even with a low estimated intervention effect. Future studies on efficacy of fall preventive digital interventions will contribute in precising effect estimates and enhance the validity of these cost-effectiveness results.

Bakgrund – Essity, en framstående aktör inom hygien- och hälsobranschen, står inför utmaningar gällande logistikflödet för konsumentprodukter från produktionsanläggningen i Lilla Edet till kunder i Danmark. Den nuvarande logistikprocessen involverar intern transport med egna lastbilar till externa lager. I detta sammanhang är det av yttersta vikt att säkerställa snabba och kostnadseffektiva leveranser, samtidigt som kundtillfredsställelse upprätthålls. Syfte – Projektet syftar till att analysera och optimera Essitys nuvarande logistikflöde för konsumentprodukter. Fokus ligger på att identifiera potentiella förbättringar för att säkerställa smidiga och effektiva leveranser till den danska marknaden. En central del av studien innefattar även övervägandet av att integrera en tredjepartslogistikpartner (3PL) för att ytterligare förbättra logistikstrukturen. Metod – En omfattande metodik har använts, där både kvalitativa och kvantitativa aspekter har analyserats. Genom intervjuer och observationer har data samlats in för att skapa en holistisk förståelse för nuvarande logistikflöde och eventuella alternativa lösningar. Resultat och diskussion – Den omfattande analysen av Essitys nuvarande logistikflöde avslöjar viktiga insikter. Den befintliga metoden, med intern transport till externa lager, visar sig vara ekonomiskt gynnsam, särskilt när kontrakterade kostnader för externa lager och andra projektrelaterade utgifter för år 2023 beaktas. Det är värt att notera att de ekonomiska data för en alternativ lösning från en potentiell 3PL-leverantör gäller för år 2025. För att förstå möjliga förändringar i kostnader över tid har hänsyn tagits till den potentiella ökningen av kostnaderna för den befintliga metoden. Diskussionen inkluderar också miljöaspekter, där olika lösningar övervägs för att identifiera den mest hållbara och lönsamma strategin för Essitys logistik. Lösning 2, som involverar byggandet av ett nytt lager (green warehouse) och användning av elfordon och HVO-driv, Background – Essity, a prominent player in the hygiene and health industry, faces challenges regarding the logistics flow for consumer products from its production facility in Lilla Edet to customers in Denmark. The current logistics process involves internal transportation with company-owned trucks to external warehouses. In this context, ensuring swift and cost- effective deliveries while maintaining customer satisfaction is of utmost importance. Purpose – The project aims to analyze and optimize Essity's current logistics flow for consumer products. The focus is on identifying potential improvements to ensure smooth and efficient deliveries to the Danish market. A central part of the investigation also involves considering the integration of a third-party logistics partner (3PL) to further enhance the logistics structure. Method – A comprehensive methodology has been employed, analyzing both qualitative and quantitative aspects. Through interviews and observations, data has been collected to gain a holistic understanding of the current logistics flow and potential alternative solutions. Results and Discussion – The extensive analysis of Essity's current logistics flow reveals crucial insights. The existing method, involving internal transport to external warehouses, proves to be economically advantageous, especially when considering contracted costs for external warehouses and other project-related expenses for the year 2023. It is worth noting that the economic data for an alternative solution from a potential 3PL provider applies to the year 2025. To understand possible changes in costs over time, considerations have been made for the potential increase in costs for the existing method. The discussion also includes environmental aspects, where different solutions are considered to identify the most sustainable and profitable strategy for Essity's logistics. Solution 2, involving the construction of a new warehouse (green warehouse) and the use of electric vehic

Background: Eating disorders (EDs), such as (atypical) Anorexia (AN) and Bulimia Nervosa (BN), are difficult to treat, causing socioeconomic impediments. Although enhanced cognitive behavioral therapy (CBT-E) is widely considered clinically effective, it may not be the most beneficial treatment for (atypical) AN and BN patients who do not show a rapid response after the first 4 weeks (8 sessions) of a CBT-E treatment. Alternatively, group schema therapy (GST) may be a valuable treatment for this ED population. Even though GST for EDs has yielded promising preliminary findings, the current body of evidence requires expansion. On top of that, data on cost-effectiveness is lacking. In light of these gaps, we aim to describe a protocol to examine whether GST is more (1) clinically effective and (2) cost-effective than CBT-E for (atypical) AN and BN patients, who do not show a rapid response after the first 4 weeks of treatment. Additionally, we will conduct (3) process evaluations for both treatments. Methods: Using a multicenter RCT design, 232 Dutch (atypical) AN and BN patients with a CBT-E referral will be recruited from five treatment centers. Clinical effectiveness and cost-effectiveness will be measured before treatment, directly after treatment, at 6 and at 12 months follow-up. In order to rate process evaluation, patient experiences and the degree to which treatments are implemented according to protocol will be measured. In order to assess the quality of life and the achievement of personalized goals, interviews will be conducted at the end of treatment. Data will be analyzed, using a regression-based approach to mixed modelling, multivariate sensitivity analyses and coding trees for qualitative data. We hypothesize GST to be superior to CBT-E in terms of clinical effectiveness and cost-effectiveness for patients who do not show a rapid response to the first 4 weeks of a CBT-E treatment. Discussion: To our knowledge, this is the first study protocol describ

Older adults with multiple chronic conditions and polypharmacy are at an increased risk of having adverse health outcomes, affecting quality of life and generating costs. Primary care has to be effective to guarantee excellent treatment to these patients, who are among the most vulnerable. This project aimed to assess the cost-effectiveness of a tool aimed at improving general practitioners' (GPs) performance, namely a medication review intervention centered around an electronic clinical decision support system (eCDSS). We performed a pre-planned within-trial cost-effectiveness analysis of the OPTICA trial, a cluster randomized controlled trial in Swiss primary care practices aimed at optimizing medication appropriateness and reducing prescribing omissions. Trial participants were older adults aged ≥65 years with ≥3 chronic conditions and ≥5 medications. The 160 participants in the intervention group received a medication review intervention centered around an eCDSS provided by their GP and followed by shared decision-making with their GP. The 163 participants in the control group had a medication discussion in line with usual care with their GP. Patients were followed-up for 12 months. Considering the clustered structure of the data at GP practice level, we applied Generalized Structural Equation Models (GSEMs) on a multiple imputed sample to estimate intervention effects on costs and quality-adjusted life years (QALYs). The intervention strategy was dominant with cost-savings of CHF 1′857 (95 % confidence interval (CI): CHF -3′620 to −93, p-value <0.039, with CHF 1≅USD 1.11 as of November 2023) and a gain of 0.026 incremental QALYs (95 % CI: 0.013 to 0.040, p-value <0.001) per study participant. In robustness analyses, directions of effects were fully consistent, albeit some effect estimates non-significant. Subgroup analyses suggested stronger effects in men and older adults aged 65–74 years or aged ≥85 years. The medication review intervention led to co

BACKGROUND: Chronic diseases, or non-communicable diseases (NCD), are conditions of long duration and often influenced and contributed by complex interactions of several variables, including genetic, physiological, environmental, and behavioral factors. These conditions contribute to death, disability, and subsequent health care costs. Primary and secondary school settings provide an opportunity to deliver relatively low cost and effective interventions to improve public health outcomes. However, there lacks systematic evidence on the cost-effectiveness of these interventions. METHODS: We systematically searched four databases (PubMed/Medline, Cochrane, Embase, and Web of Science) for published studies on the cost-effectiveness of chronic-disease interventions in school settings. Studies were eligible for inclusion if they assessed interventions of any chronic or non-communicable disease, were conducted in a school setting, undertook a full cost-effectiveness analysis and were available in English, Spanish, or French. RESULTS: Our review identified 1029 articles during our initial search of the databases, and after screening, 33 studies were included in our final analysis. The most used effectiveness outcome measures were summary effectiveness units such as quality-adjusted life years (QALYs) (22 articles; 67%) or disability-adjusted life years (DALYs) (4 articles; 12%). The most common health condition for which an intervention targets is overweight and obesity. Almost all school-based interventions were found to be cost-effective (30 articles; 81%). CONCLUSION: Our review found evidence to support a number of cost-effective school-based interventions targeting NCDs focused on vaccination, routine physical activity, and supplement delivery interventions. Conversely, many classroom-based cognitive behavioral therapy for mental health and certain multi-component interventions for obesity were not found to be cost-effective.

BackgroundRecently-updated global guidelines for cervical cancer screening incorporated new technologies-most significantly, the inclusion of HPV DNA detection as a primary screening test-but leave many implementation decisions at countries' discretion. We sought to develop recommendations for Malawi as a test case since it has the second-highest cervical cancer burden globally and high HIV prevalence. We incorporated updated epidemiologic data, the full range of ablation methods recommended, and a more nuanced representation of how HIV status intersects with cervical cancer risk and exposure to screening to model outcomes of different approaches to screening.MethodsUsing a Markov model, we estimate the relative health outcomes and costs of different approaches to cervical cancer screening among Malawian women. The model was parameterized using published data, and focused on comparing "triage" approaches-i.e., lesion treatment (cryotherapy or thermocoagulation) at differing frequencies and varying by HIV status. Health outcomes were quality-adjusted life years (QALYs) and deaths averted. The model was built using TreeAge Pro software.ResultsThermocoagulation was more cost-effective than cryotherapy at all screening frequencies. Screening women once per decade would avert substantially more deaths than screening only once per lifetime, at relatively little additional cost. Moreover, at this frequency, it would be advisable to ensure that all women who screen positive receive treatment (rather than investing in further increases in screening frequency): for a similar gain in QALYs, it would cost more than four times as much to implement once-per-5 years screening with only 50% of women treated versus once-per-decade screening with 100% of women treated. Stratified screening schedules by HIV status was found to be an optimal approach.ConclusionsThese results add new evidence about cost-effective approaches to cervical cancer screening in low-income countries. At relati

Topology Optimization is a useful methodology in aviation since it enables the design of lightweight structures, enhancing fuel and performance efficiency while maintaining safety and reliability. It is based on a simple principle: create new geometries in any structure by removing material as long as its properties and efficiency are maintained. To carry out the process, algorithms based on numerical methods and finite elements are used. At the same time, Additive Manufacturing is the chosen technology for the manufacturing of these structures with non-conventional patterns. This present thesis analyses the numerical methods implemented in Swan, an open source software developed at CIMNE, and proposes new methodologies for the implementation of a multi-material environment based on the research of Augusto A. R. Onco and Sebastian M. Giusti. Until now, topological optimization had been applied to various structures, both macroscopic and microscopic, but always constituted by a single material. The aim of this project is to study the theoretical foundations, their numerical implementation and the corresponding feasibility of performing these processes in structures that contain more than one material, with focus on macro-structures. By strategically applying materials with different properties in specific regions of a structure, reinforcing high-load areas with hard materials and using softer materials in less stressed areas, optimization can be achieved by combining multiple materials and selectively removing excess material. This work focuses on analysing the reliability of a multi-material environment with respect to several parameters. To do this, it is necessary to understand the formulation of Topology Optimization, covering the distinct methods and optimizers that exist, and the logic of Object-Oriented Programming in MatLab. Furthermore, the theoretical foundations in the implementation of multiple materials are also covered. Additionally, diverse case studie

This thesis investigated the cost-effectiveness of several innovations in cataract surgery and corneal transplantation surgery. One study found that performing cataract surgery on both eyes in a single operating session was cost-effective. Another study found that implantation of toric implant lenses during cataract surgery reduced the need for distance spectacles after surgery, but was not cost-effective. Finally, using a combination of two anti-inflammatory eye drops reduced the incidence of retinal edema after surgery, and it was also cost-effective. Regarding corneal transplantation surgery, a novel technique using the thinnest possible corneal transplants (DMEK) resulted in better visual outcomes, but was not cost-effective compared to a thicker transplant (DSAEK).

Greenhouse gas emissions from the transport sector can be reduced by decreasing fuel use by different means, and by blending biofuels into fossil fuels. A cost-effective combination of these measures is determined by spatially specific characteristics such as fuel demand, feedstock production costs, and greenhouse gas emissions from the feedstock production. We developed a spatially explicit model to explore the role of reduced transport fuel use and increased use of domestically produced biofuel, respectively, in a cost-effective policy for greenhouse gas abatement. The model is applied to domestic lignocellulosic biofuel from agricultural land, gasoline, and diesel for road transport in Sweden. The results show that the use of biofuel is particularly cost-effective under low and modestly stringent abatement targets. For more stringent targets, decreased fuel end use dominates the abatement portfolio. Replacing the emissions target by a biofuel production target increases the marginal cost of reducing emissions by up to 250%. With the current vehicle fleet, technical constraints on blendin possibilities limit the role of biofuels at higher target levels.

Background Providing secondary prevention through structured and comprehensive cardiac rehabilitation programmes to patients after a myocardial infarction (MI) reduces mortality and morbidity and improves health-related quality of life. Cardiac rehabilitation has the highest recommendation in current guidelines. While treatment target attainment rates at Swedish cardiac rehabilitation centres is among the highest in Europe, there are considerable differences in service delivery and variations in patient-level outcomes between centres. In this trial, we aim to study whether centre-level guideline adherence and patient-level outcomes across Swedish cardiac rehabilitation centres can be improved through a) regular audit and feedback of cardiac rehabilitation structure and processes through a national quality registry and b) supporting cardiac rehabilitation centres in implementing guidelines on secondary prevention. Furthermore, we aim to evaluate the implementation process and costs. Methods The study is an open-label cluster-randomized effectiveness-implementation hybrid trial including all 78 cardiac rehabilitation centres (attending to approximately 10 000 MI patients/year) that report to the SWEDEHEART registry. The centres will be randomized 1:1:1 to three clusters: 1) reporting cardiac rehabilitation structure and process variables to SWEDEHEART every six months (audit intervention) and being offered implementation support to implement guidelines on secondary prevention (implementation support intervention); 2) audit intervention only; or 3) no intervention offered. Baseline cardiac rehabilitation structure and process variables will be collected. The primary outcome is an adherence score measuring centre-level adherence to secondary prevention guidelines. Secondary outcomes include patient-level secondary prevention risk factor goal attainment at one-year after MI and major adverse coronary outcomes for up to five-years post-MI. Implementation outcomes include

The decision of which hosting platform to use is a critical one for businesses today, with the primary options being on-premises hosting and cloud hosting. This thesis addresses the significant and contemporary problem of evaluating the effectiveness of these two hosting solutions for web applications, specifically within the context of performance, scalability, downtime, cost, and security. This problem is particularly relevant because of the rapid growth and evolution of cloud services, coupled with the diverse needs of businesses. Despite the extensive adoption of cloud services, a comprehensive comparison that considers all critical aspects—performance, cost, scalability, downtime, and security—remains lacking. The need for such a comparative study is underscored by the fact that businesses must make informed decisions to optimize their IT infrastructure. To tackle this problem, we conducted a detailed literature review and a practical case study. The case study involved hosting an e-commerce web application on both an on-premises server and Amazon Web Services. We collected and analyzed data on performance metrics, scalability under varying loads, downtime incidents, total cost of ownership, and security vulnerabilities. This multi-faceted approach provided a holistic view of each hosting solution’s strengths and weaknesses. The findings reveal that the on-premises solution excelled in terms of performance and cost efficiency, delivering faster response times and lower costs over the evaluation period. Conversely, Amazon Web Services demonstrated superior scalability, robust security features, and better downtime management. These results highlight that while on-premises hosting is more advantageous for scenarios requiring high performance and cost control, Amazon Web Services offers significant benefits in scalability, security, and reliability. The impact of this thesis is twofold: it provides businesses with actionable insights for making informed hosting de, Beslutet om vilken hostingplattform som ska användas är avgörande för företag idag, där de primära alternativen är lokala hostinglösningar och molnbaserade hostinglösningar. Detta examensarbete behandlar det betydande och aktuella problemet med att utvärdera effektiviteten hos dessa två hostinglösningar för webbapplikationer, specifikt inom kontexten prestanda, skalbarhet, nedtid, kostnad och säkerhet. Detta problem är särskilt relevant på grund av den snabba tillväxten och utvecklingen av molntjänster, i kombination med företagens varierande behov. Trots den omfattande användningen av molntjänster saknas det fortfarande en grundlig jämförelse som beaktar alla kritiska aspekter - prestanda, kostnad, skalbarhet, nedtid och säkerhet. Behovet av en sådan jämförande studie understryks av det faktum att företag måste fatta välgrundade beslut för att optimera sin IT-infrastruktur. För att ta itu med detta problem genomförde vi en detaljerad litteraturöversikt och en praktisk fallstudie. Fallstudien involverade att hosta en e-handelsapplikation på både en lokal server och Amazon Web Services. Vi samlade in och analyserade data om prestandamått, skalbarhet under varierande belastningar, nedtidshändelser, totala ägandekostnader och säkerhetssårbarheter. Detta angreppssätt gav en helhetssyn på varje hostinglösnings styrkor och svagheter. Resultaten visar att den lokala hostinglösningen överträffade Amazon Web Services vad gäller prestanda och kostnadseffektivitet, med snabbare svarstider och lägre kostnader under utvärderingsperioden. Å andra sidan visade Amazon Web Services överlägsen skalbarhet, robusta säkerhetsfunktioner och bättre hantering av nedtid. Dessa resultat belyser att medan lokala hostinglösningar är mer fördelaktiga för scenarier som kräver hög prestanda och kostnadskontroll, erbjuder Amazon Web Services betydande fördelar i skalbarhet, säkerhet och tillförlitlighet. Effekten av detta examensarbete är tvåfaldig: det ger företag värdefulla insikter för att fatt

TITLE: Short Term Impact and Markov Modeling Analysis of the Cost-Effectiveness of the Meta Salud Diabetes Cluster Randomized Controlled Trial for Cardiovascular Risk Reduction Among Diabetics in the Mexican National Primary Care Health System. BACKGROUND: The cost-effectiveness of the Meta Salud Diabetes (MSD) trial is not well established. This was a clinically integrated lifestyle intervention designed to reduce modifiable cardiovascular (CVD) risk factors and promote diabetes control via self-help groups within the structure of a support group (GAM: Grupo de Ayuda Mutua) in government-run (community) Health Centers (Centros de Salud) in Sonora, Mexico. The MSD trial has previously been shown to demonstrate a positive trend in reducing CVD risk in adults with type 2 diabetes in a low-resource setting. OBJECTIVE: To conduct a cost-effectiveness analysis of the use of a self-management diabetes program (Meta Salud Diabetes) delivered in a culturally appropriate context (Sonora Mexico) from the payer perspective. DESIGN: Cohort level Markov based modeling. DATA SOURCES: Clinical and cost data from the MSD trial (a parallel, two-arm, cluster-randomized, behavioral clinical trial across 22 clinics in Sonora, Mexico, between August 2016 and October 2018) and data from published literature. TARGET POPULATION: Mexican adults aged 45 years or older with known type 2 diabetes and receiving care in government-run (community) Health Centers (Centros de Salud) in Sonora, Mexico. TIME HORIZON: 10 years. PERSPECTIVE: Payer. METHODS: A Markov based decision model was built through TreeAge Pro to analyze the cost-effectiveness of MSD compared to GAM. In each treatment strategy, two patient groups were modeled: patients with controlled diabetes (defined as A1c ≤7.0g/dl) and patients with uncontrolled diabetes (A1c>7.0g/dl). Patients could transition through various health states determined by transition probabilities. The incremental cost per glycemic improvement (HbA1c improvemen

[Resumen] Antecedentes y objetivo. La hiperpotasemia (HK) es una alteración electrolítica en la concentración de iones potasio (K+), cuyo riesgo aumenta en pacientes con enfermedad renal crónica (ERC) o insuficiencia cardiaca (IC) y/o en pacientes en tratamiento con inhibidores del sistema renina-angiotensina-aldosterona (iSRAA). Los nuevos quelantes orales de K+ ofrecen un tratamiento seguro y eficaz para mantener la normopotasemia en estos pacientes. El objetivo del análisis es estimar el coste-efectividad del ciclosilicato de sodio y zirconio (CSZ) para el tratamiento de la HK crónica en pacientes con ERC o IC vs. tratamiento estándar (poliestireno sulfonato cálcico y modificaciones del estilo de vida) desde la perspectiva del Sistema Nacional de Salud (SNS) español. Materiales y métodos. Se utilizaron dos modelos de microsimulación que reflejan la historia natural de la ERC y de la IC. En ambos modelos se realizó una simulación de forma individual de los niveles de K+. Con base en la eficacia (reducción de los niveles de K+), la calidad de vida de los pacientes (utilidades según estado de salud, y disutilidades de los eventos derivados de cada patología y los eventos adversos [EA] del tratamiento) y a los costes contemplados (coste del tratamiento para la HK, del tratamiento con iSRAA y su modificación, de los estados de salud, del manejo de los eventos derivados de cada patología, de los episodios de HK, y de los EA del tratamiento) (€, 2022), se obtuvieron resultados de beneficio clínico (años de vida ajustados por calidad [AVAC]) y costes. Se empleó un horizonte temporal de toda la vida del paciente y se aplicó una tasa de descuento del 3% para costes y resultados. Resultados. El CSZ resulta una opción más efectiva en ambas patologías, con una diferencia de AVAC de 0,476 en ERC, y de 0,978 en IC vs. tratamiento estándar, y supone un coste incremental de 3.616 € y 14.749 €, respectivamente, obteniéndose un ratio coste-utilidad incremental (RCUI) de 7.605 €/AVA, [Abstract] Background and objective. Hyperkalemia (HK) is an electrolyte disturbance in the concentration of potassium ions (K+), whose risk increases in patients with chronic kidney disease (CKD) or heart failure (HF) and/or in patients being treated with renin-angiotensin-aldosterone system inhibitors (RAASi). The new oral K+ chelators offer a safe and effective treatment to maintain normokalemia in these patients. The objective of the analysis is to estimate the cost-effectiveness of sodium zirconium cyclosilicate (SZC) for the treatment of chronic HK in patients with CKD or HF versus standard treatment (calcium polystyrene sulfonate and lifestyle modifications) from the perspective of the Spanish National Health System. Materials and methods. Two microsimulation models reflecting the natural history of CKD and HF were used. In both models, K+ levels were simulated individually. Based on efficacy (reduction of K+ levels), quality of life of patients (utilities according to health states, and disutilities of events derived from each pathology and adverse events [AEs] of treatment) and costs considered (cost of treatment for HK, of RAASi treatment and its modification, health states, management of events derived from each pathology, HK episodes, and AEs treatment) (€, 2022), clinical benefit (quality-adjusted life years [QALYs]) and cost results were obtained. A time horizon of the patient's lifetime was used and a discount rate of 3% was applied for costs and outcomes. Results. SZC is a more effective option in both pathologies, with a difference in QALYs of 0.476 in CKD and 0.978 in HF compared to standard treatment, and it represents an incremental cost of € 3,616 and € 14,749, respectively, obtaining an incremental cost-utility ratio of € 7,605 /QALY in CKD and € 15,078 /QALY in HF. Conclusions. SZC is a cost-effective alternative for the treatment of HK in patients with CKD or HF, taking into account the reference efficiency values commonly used in Spain.

A wider deployment of nearly zero energy buildings (NZEBs) is expected to contribute to the transition to a decarbonized and energy-efficient building sector in Europe. This study proposed an integrated energy-economic analysis to exemplify the feasibility of NZEB renovation in temperate climate. A parametric analysis was performed to identify technical building system configurations that give minimum share of renewable energy systems contributing to NZEB level. Final energy savings, global costs and cost-effectiveness of renovating a building to NZEB level are analysed, considering active and passive energy efficiency measures (EEMs). The active EEMs included efficient water taps and heat recovery ventilation, and the passive EEMs encompassed insulations to roof, exterior walls and ground floor, and improvements of windows and doors. The building had initial final energy use of 133 kWh/m2 year for space heating, domestic hot water production (DHW) and facility electricity. The results show that NZEB level is achieved with active and passive EEMs, without renewable energy systems for scenarios with low discount rates and high future energy price escalations. The annual final energy use for space heating, DHW and facility electricity is reduced cost-effectively by 37-54%. Furthermore, increasing size of PV-system enhanced cost-effectiveness by lowering total global costs.

Spending in social welfare areas such as healthcare, wider public health, education, and social care consumes a major part of the public budget. Cost-effective resource allocation is a moral obligation towards both taxpayers and beneficiaries: tax money should be used efficiently, and it should be transparently accounted for. After all, economical management of resources is important for sustaining future prosperity and for addressing fundamental challenges such as climate change and demographic shift. In healthcare, cost‐effectiveness using quality-adjusted life years (QALYs) is a well-established tool to inform policymakers. Using cost per QALY implies that health-related quality of life (QoL), and not money, is an end on its own. Moreover, cost per QALY allows one to compare unrelated interventions by measuring the effects on the common QALY scale. However, for actors concerned with broader social welfare, such as the Swedish municipalities, QALYs may be less useful because their measurement focus is largely limited to health. Comparable outcome measures for broader social welfare are still sparsely available and employed, and a context-specific measure for Sweden is lacking. The aim of this thesis was to develop, value, and apply capability-adjusted life years Sweden (CALY‐SWE), a QoL outcome measure conceptually based on the capability approach, for broader social welfare and specific for Sweden. Within study 1, we organized a Delphi panel to select relevant capability attributes and then developed the phrasing for the questionnaire. The resulting questionnaire contains six attributes –health, social relations, financial situation & housing, security, occupation, and political & civil rights – each with three answer levels. The phrasing integrates an implicit threshold so that the sensitivity is focused on the lower range of the scale, thus incorporating equity considerations that relate to sufficientarianism and prioritarianism. In study 2, we devel, Kostnader inom välfärdsområden som hälso- och sjukvård, socialt arbete, folkhälsa, utbildning och arbetsmarknad utgör en stor andel av den offentliga budgeten. En kostnadseffektiv resursallokering är en moralisk plikt mot både skattebetalare och de som använder välfärden. Skattepengar ska användas effektivt, och nyttan borde redovisas mer transparent. Till syvende och sist är ekonomisk hushållning viktigt för ett hållbart framtida välstånd och för att kunna möta grundläggande utmaningar som klimatpåverkan och demografiska förändringar. I hälso- och sjukvården är kostnadseffektivitetsanalyser med kvalitetsjusterade levnadsår (QALY) ett etablerat verktyg för beslutsfattande. Med kostnader i förhållande till vunna QALYs blir hälsorelaterad livskvalitet ‐ inte pengar ‐ ett explicit självändamål. Dessutom möjliggör kostnad per QALY jämförelser av olika interventioner genom att effekterna mäts på en gemensam QALY skala. För aktörer med verksamhet som berör välfärd i allmänhet, som svenska kommuner, är dock QALYs ett mindre användbart mått eftersom QALYs fokuserar på hälsa. Användbara mått, som beaktar bredare konsekvenser för livskvalitet och som liknar QALYs till konstruktionen, saknas i nuläget. Syftet med avhandlingen var att utveckla, värdera och tillämpa Goda år (CALY-SWE), ett mått som konceptuellt bygger på handlingsfrihetsansatsen (capability approach), för beskrivning och analys av välfärd i Sverige. I delstudie 1 genomförde vi en Delfi-panel i syfte att välja ut relevanta handlingsfriheter för det nya måttet (capability-adjusted life years Sweden, CALY-SWE). Det resulterade i sex attribut – hälsa, nära relationer, ekonomi och boende, sysselsättning, säkerhet, politiska och medborgerliga rättigheter – som vardera har tre svarsnivåer. Formuleringarna inbegriper ett implicit tröskelvärde med syfte att fokusera sensitiviteten på nedre delen av skalan. På så sätt integreras effektivitets- och jämlikhetaspekter i samhällets prioriteringar. I delstudie 2 utveckla, Ausgaben im Zusammenhang mit sozialer Wohlfahrt, zum Beispiel für öffentliche Gesundheit, für Ausbildung und im Sozialwesen, beanspruchen einen großen Teil des öffentlichen Haushalts. Eine kosteneffektive Mittelverteilung ist eine moralische Verpflichtung sowohl gegenüber dem Steuerzahler als auch gegenüber den Begünstigten. Steuergelder sollten effizient und transparent genutzt werden. Letztendlich ist ein wirtschaftlicher Umgang mit Ressourcen wichtig, um zukünftig den Wohlstand aufrechtzuerhalten und um grundlegende Herausforderungen wie den Klimaschutz oder den demografischen Wandel anzugehen. Im Gesundheitswesen ist Kosteneffizienz mittels qualitätskorrigierter Lebensjahre (quality-adjusted life years, QALYs) ein anerkanntes Werkzeug, um politische Entscheidungsträger zu informieren. Die Anwendung von QALYs impliziert, verglichen mit ausschließlich finanziellen Überlegungen, dass die Förderung gesundheitsbezogener Lebensqualität einen Selbstwert hat. Außerdem erlauben Kosten per QALY den Vergleich unterschiedlicher Interventionen, da die Effekte auf der gemeinsamen QALY-Skala gemessen werden. Für Akteure, die sich mit sozialer Wohlfahrt im weiteren Sinne befassen, wie zum Beispiel die schwedischen Gemeinden, sind QALYs hingegen weniger anwendbar, da der Messfokus mehrheitlich auf Gesundheit gerichtet ist. Vergleichbare Messinstrumente für breitere soziale Wohlfahrt sind noch relativ wenig verfügbar und ein kontextspezifisches Instrument für Schweden ist nicht vorhanden. Die Zielsetzung dieser Doktorarbeit war die Entwicklung, Wertung, und Anwendung von befähigungskorrigierten Lebensjahren Schweden (capability-adjusted life years Sweden, CALY-SWE) für die weitere soziale Wohlfahrt und spezifisch für Schweden. In Teilstudie 1 organisierten wir ein Delphi-Panel, um relevante Befähigungsattribute auszuwählen. Im Anschluss entwickelten wir die Formulierungen für den Fragebogen. Der resultierende Fragebogen enthält sechs Attribute: Gesundheit, soziale Beziehungen

Aim: The aim of the study is to assess the accuracy of overall survival (OS) extrapolations in cost-effectiveness analysis made by the Dental and Pharmaceutical Benefits Agency (TLV) to decide on the reimbursement and use of oncology drugs in Sweden. Material and methods: TLV appraisals for oncology drugs were identified during a 5-year period (2013-2017). To be included each appraisal and health economic model must include a TLV base case extrapolation of OS. Further, Kaplan-Meier (KM) estimates on OS from the original and follow-up clinical trials must be available. Potential follow-up trials on OS were identified in ClinicalTrials.gov and the Lund University Libraries databases, and in the Swedish Medical Products Agency (MPA) and the European Medicines Agency (EMA) databases. In cases where the KM estimates were not available, data points from figures published in TLV's appraisals were extracted using the semi-automated tools Digitizelt and WebPlotDigitizer. The accuracy of survival extrapolations was assessed by comparing extrapolated and observed life-years (LYs), using three different measures: 1) difference in LYs between the treatment and control group; 2) LYs in the treatment group, 3) LYs in the control group. Results: We study TLV's preferred OS extrapolations and show that on average they overestimate the observed mean gain in LYs by 17%, and underestimate observed LYs by 5% and 1% in the treatment and control group, respectively. Conclusions: We conclude that it is feasible to validate OS extrapolations by comparing extrapolated and observed life-years. Even if survival extrapolations are reasonably accurate for the treatment and control group, respectively, this may still imply that extrapolations of LYs gained deviates to a larger extent. Follow-up studies on OS should be carried out to an increased extent to be able to validate, update and improve OS extrapolations in cost-effectiveness analysis of oncology drugs.

Net-zero energy system configurations can be met in numerous ways, implying diverse economic effects. However, what is usually ignored in techno-economic and economy-wide analysis are the distinct social-political drivers and barriers, which might constrain certain elements of future energy systems. We thus apply a model ensemble that defines social-political storylines which constrain feasible net-zero configurations of the European energy system. Using these configurations in a macroeconomic general equilibrium model allows us to explore economy-wide effects and ultimately the cost-effectiveness of different systems. We find that social-political storylines provide valuable boundary conditions for feasible net-zero designs of the energy system and that the costliest energy sector configuration in fact leads to the highest European-wide welfare levels. This result originates in indirect effects, particularly positive employment effects, covered by the macroeconomic model. However, adverse public budget effects on the transition to net-zero energy may limit the willingness of policymakers who focus on shorter time-horizons to foster such a development. Our results highlight the relevance of considering the interaction of energy system-changes with labor, emission allowance and capital markets, as well as considering long-term perspectives., Energie and Industrie

Varicella zoster virus (VZV) is a highly infectious member of the alpha-herpesvirus family that is specific to humans presenting initially as varicella (chickenpox, CP) upon primary infection. It is so infectious that in an unvaccinated population the annual incidence of CP is considered roughly equivalent to the populations birth cohort. While CP is generally considered a relatively benign childhood disease resulting in a characteristic rash accompanied by fever, infection can result in hospitalisation and even death due to secondary infections such as pneumonia. Prior to VZV vaccination, it was estimated that CP infection resulted in 1,500 hospitalisations and five deaths annually in Australia. While cases only have CP once, in all cases that recover there is the lifetime risk of further disease as the VZV virus is not eliminated but rather enters a latency period residing in the hosts dorsal root (spinal) ganglia with the ability to re-emerge as herpes zoster (HZ or shingles) usually associated with aging or immunocompromise. The burden of disease with HZ is considered to be greater than that of CP with the risk of repeated infection and a high proportion of HZ cases suffering from complications, most notably post-herpetic neuralgia (PHN). PHN is an enduring dermatomal pain that is estimated to occur in over 60% of HZ cases and can last over one year in about 5% of cases. It has been estimated that prior to VZV vaccination, HZ re-emergence resulted in 10 deaths per year and over 3,000 hospitalisations annually in Australia. To combat this disease the Australian Nation Immunisation Program currently recommends and funds the provision of a single dose of VZV vaccine in combination with the measles, mumps and rubella vaccine (i.e., MMRV) at 18 months of age, as well as a live attenuated HZ vaccine for person aged 70 to 79 years. However, several Australian studies have examined the effectiveness of VZV vaccination on CP and HZ and concluded that a two-dose VZV regim, Thesis (PhD Doctorate), Doctor of Philosophy (PhD), School of Medicine & Dentistry, Griffith Health, Full Text

This thesis focuses on the optimization of care of a very common form of skin cancer: superficial basal cell carcinoma (sBCC). There are several treatment options for this superficial growing skin cancer. In order to help patients make a personalized treatment decision, a patient decision aid was developed and tested. First, we noticed that all patients had a low level of decisional conflict. This was not significantly lowered by using the decision aid nor was knowledge on treatment options increased. However, patients using the decision aid were more satisfied with their treatment decision afterwards compared to a control group that did not use the decision aid. Furthermore, cost-effectiveness of treatment was evaluated by a systematic literature review. From the few studies that were available, we concluded that, surgical treatment provides value for money compared to alternative treatments for sBCC and that imiquimod cream (a cream that clears tumour by a local immunological reaction) provides value for money compared to other non-surgical treatments.

Food supply chains are constantly challenged by food safety hazards entering the chain. The ability of the supply chain to provide safe food within a reasonable time after such a food safety threat or shock can be investigated with the concept of resilience using food safety as an indicator. Resilience is then defined as the food safety performance deviation due to the shock and takes both the severity of the shock as well as the time to fully recover or reach a new equilibrium into account. This study developed a stochastic simulation model to evaluate the resilience of the Dutch pork supply chain to dioxin contamination in the feed. The resilience of the supply chain as well as the potential costs associated with the contamination are compared between several monitoring strategies with the aim to determine the optimal control points for dioxin monitoring. Model results show that collecting and analyzing samples at more than one control point along the pork supply chain, in particular at feed mills and fat melting facilities, resulted in the highest resilience and the lowest costs after a shock. This model and these results can be used by public and private decision makers to make proactive and informed decisions on the monitoring strategies to control dioxins in the pork supply chain that result in optimal resilience to a dioxin crises.

Forests play an essential role in climate change mitigation by absorbing carbon dioxide from the atmosphere and storing carbon in biomass. Carbon sequestration can be increased by the extension of rotation cycles in existing plantation forests. This study examines the cost-effectiveness of the remuneration scheme employed by Verified Carbon Standard (VCS), a commonly used carbon accounting method based on the average amount of carbon stored in the forest. We compare the net present value of carbon remuneration under VCS with that of a scheme that remunerates actual carbon storage in each year which we call “current carbon accounting.” We use data for an Acacia mangium plantation in Indonesia where the forestry sector is expected to contribute more than half of the reductions of carbon emissions according to Indonesia's Nationally Determined Contribution (NDC) under the Paris Agreement. For our baseline scenario, we find, first, that the payments needed to incentivise additional carbon storage under VCS are considerably higher than under current carbon accounting. Second, the inefficiency is more pronounced at lower discount rates. Third, recent prices reported for VCS forest credits are not sufficient to incentivise forest managers to lengthen the forest rotation in Indonesian plantation forests.

The objective of the study was to assess the cost-effectiveness of real-world spinal muscular atrophy newborn screening followed by treatment. We modeled the lifetime cost-effectiveness of the spinal muscular atrophy newborn screening followed by treatment (screening) compared to treatment without screening (no screening) from the Belgian healthcare perspective. Real-world data, including quality of life, costs, and motor development data, were collected on 12 patients identified by screening and 43 patients identified by their symptoms. "Screening" was associated with slightly higher healthcare costs (€ 6,858,061 vs. € 6,738,120) but more quality-adjusted life years (QALY) (40.95 vs. 20.34) compared to "no screening", leading to an incremental cost-effectiveness ratio of € 5,820 per QALY gained. "Screening" was dominant from a societal perspective (negative incremental costs: € -14,457; incremental QALY = 20.61), when incorporating the burden on caregivers (negative incremental costs = € -74,353; incremental QALY = 27.51), and when the treatment was chosen by the parents (negative incremental costs = € -2,596,748; incremental QALY = 20.61). Spinal muscular atrophy newborn screening coupled with early treatment is thus cost-effective compared with late treatment following clinical diagnosis and is dominant when societal perspective, caregiver burden, and treatment based on parental preference were considered.

Osteoarthritis (OA) is a degenerative joint disease with a substantial global burden, causing chronic pain and reduced quality of life. Managing OA efficiently while maximizing healthcare resources is crucial. Health economics and health technology assessment (HTA) are central tools providing a framework to evaluate the clinical, economic, and ethical aspects of healthcare technologies and interventions. This article presents some insights into the role of health economics and the HTA process in OA management. It also illustrates an example of cost-effectiveness analysis in a specific healthcare context, on the basis of a recent clinical trial involving hyaluronic acid treatment for knee OA. While HTA offers valuable insights, it faces challenges like data availability and resource constraints. Integrating health economics into decision-making can enhance patient care and allocate resources effectively in OA and other healthcare domains.

AimTo assess, from a United States (US) payer's perspective, the cost-effectiveness of gels designed to separate the endometrial surfaces (intrauterine spacers) placed following intrauterine surgery.Materials and methodsA decision tree model was developed to estimate the cost-effectiveness of intrauterine spacers used to facilitate endometrial repair and prevent the formation (primary prevention) and reformation (secondary prevention) of intrauterine adhesions (IUAs) and associated pregnancy- and birth-related adverse outcomes. Event rates and costs were extrapolated from data available in the existing literature. Sensitivity analyses were conducted to corroborate the base case results.ResultsIn this model, using intrauterine spacers for adhesion prevention led to net cost savings for US payers of $2,905 per patient over a 3.5-year time horizon. These savings were driven by the direct benefit of preventing procedures associated with IUA formation ($2,162 net savings) and the indirect benefit of preventing pregnancy-related complications often associated with IUA formation ($3,002). These factors offset the incremental cost of intrauterine spacer use of $1,539 based on an assumed price of $1,800 and the related increase in normal deliveries of $931. Model outcomes were sensitive to the probability of preterm and normal deliveries. Budget impact analyses show overall cost savings of $19.96 per initial member within a US healthcare plan, translating to $20 million over a 5-year time horizon for a one-million-member plan.LimitationsThere are no available data on the effects of intrauterine spacers or IUAs on patients' quality of life. Resultingly, the model could not evaluate patients' utility related to treatment with or without intrauterine spacers and instead focused on costs and events avoided.ConclusionThis analysis robustly demonstrated that intrauterine spacers would be cost-saving to healthcare payers, including both per-patient and per-plan member, through a re

BACKGROUND: A recently undertaken multicenter randomized controlled trial (RCT) "Treatment Of BOoking Gestational diabetes Mellitus" (TOBOGM: 2017-2022) found that the diagnosis and treatment of pregnant women with early gestational diabetes mellitus (GDM) improved pregnancy outcomes. Based on data from the trial, this study aimed to assess the cost-effectiveness of diagnosis and treatment of early GDM (from <20 weeks') among women with risk factors for hyperglycemia in pregnancy compared with usual care (no treatment until 24-28 weeks') from a healthcare perspective. METHODS: Participants' healthcare resource utilization data were collected from their self-reported questionnaires and hospital records, and valued using the unit costs obtained from standard Australian national sources. Costs were reported in US dollars ($) using the purchasing power parity (PPP) estimates to facilitate comparison of costs across countries. Intention-to-treat (ITT) principle was followed. Missing cost data were replaced using multiple imputations. Bootstrapping method was used to estimate the uncertainty around mean cost difference and cost-effectiveness results. Bootstrapped cost-effect pairs were used to plot the cost-effectiveness (CE) plane and cost-effectiveness acceptability curve (CEAC). FINDINGS: Diagnosis and treatment of early GDM was more effective and tended to be less costly, i.e., dominant (cost-saving) [-5.6% composite adverse pregnancy outcome (95% CI: -10.1%, -1.2%), -$1373 (95% CI: -$3,749, $642)] compared with usual care. Our findings were confirmed by both the CE plane (88% of the bootstrapped cost-effect pairs fall in the south-west quadrant), and CEAC (the probability of the intervention being cost-effective ranged from 84% at a willingness-to-pay (WTP) threshold value of $10,000-99% at a WTP threshold value of $100,000 per composite adverse pregnancy outcome prevented). Sub-group analyses demonstrated that diagnosis and treatment of early GDM among women in t, FUNDING: National Health and Medical Research Council (grants 1104231 and 2009326), Region O¨rebro Research Committee (grants Dnr OLL-970566 and OLL-942177), Medical Scientific Fund of the Mayor of Vienna (project 15,205 and project 23,026), South Western Sydney Local Health District Academic Unit (grant 2016), and Western Sydney University Ainsworth Trust Grant (2019).

Background: Rheumatic Heart Disease (RHD) is a neglected public health problem, which is most prevalent in low-and middle-income countries. It affects over 460 million people and causes about 390,000 deaths annually, predominantly children, young adults, and women. This thesis aimed to assess the burden of Rheumatic Heart Disease in Namibia and to evaluate the cost-effectiveness of a preventive strategy. Methods: Data was obtained from primary and secondary sources in four distinct studies. The first study analysed the RHD outpatient and inpatient data from 2010-2020. The second employed a cross-sectional survey, incorporating a questionnaire with the EQ-5D-5L tool, to assess the health-related quality of life and healthcare usage pre- and post-RHD diagnosis. A systematic review was conducted in the third study synthesising preventive interventions, while the fourth study used a Markov model to evaluate the cost-effectiveness of a secondary prevention strategy in Namibia. Results: The clinical RHD prevalence was estimated at 28 per 100,000 cases. From the survey, 83 RHD patients participated, predominantly women (77%) and primarily young adults aged 20-29 (41%). The majority (84%) had received surgical treatment. Notably, there was a significant increase in mean QALY from 0.773 pre-diagnosis to 0.941 post-diagnosis (p<0.001). The systematic review underscored the effectiveness of school and nurse-led prevention programmes. The health economic evaluation demonstrated that echocardiographic RHD screening was cost-effective, with an Incremental Cost-Effectiveness Ratio of N$ 28,516.75 per QALY gained, which falls below Namibia’s GDP per capita. Conclusions: The findings highlight a significant gap in RHD data, particularly in high-endemic regions like Sub-Saharan Africa, emphasising the need for enhanced data quality and surveillance. The effectiveness of school-based and community-led programmes is apparent, but the scarcity of data from diverse regions limits a co