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This study aimed to determine the measurement of performance in the Village Government of Jabal Nur, Kec. Kodeoha, North Kolaka Regency in 2015-2019 using the concept of Value For Money. Performance measurement is one of the factors for a private or public organization. Performance measurement is used as a control tool in an organization to evaluate the results of activity and determine the success of the management carried out by an organization. The application of the value for money concept is important for the government as a public service because the implementation of this concept will provide benefits for assessing: 1) the effectiveness of public services, 2) the quality of public services, 3) spending allocations that are more oriented to the public interest, and 4) increasing public cost awareness as the root of the implementation of public accountability. The results of this study indicate that the performance of the Jabal Nur village government has been said to be economical because the percentage ratio has never exceeded 100%; in terms of efficiency, government performance is efficient even though the first 3 years are in balanced efficiency, but in years 4 and 5 the level of efficiency has increased, and from in terms of the effectiveness of the performance of the village government of Jabal Nur has been effective even though in 2017 the level of effectiveness was according to. Still, the following year the level of effectiveness increased again.

Since the creation of the National Health Service in 1948, different groups of experts have competed to inform the development of British health policy. This article analyzes the long-term rise of one of these groups-management consultants. The scale and regularity of their engagement has increased considerably over time, strikingly in recent years, and the functions fulfilled by consultants have become ever more diverse. At important moments they were often seen by policymakers-particularly when there was understood to be a lack of internal expertise-as possessors and imparters of important knowledge. Firms and individuals worked consciously to integrate themselves into emerging health policy networks. But there has often been relatively little consideration of their real suitability for work in the health field. Many debates around the use of external consultants today-accountability, value for money, dependency-were foreshadowed during earlier periods, with implications for current policymakers.

Bu çalışma Sağlıkta Dönüşüm Programı ile birlikte Sağlık Bakanlığı’nın geçirdiği yapısal ve işlevsel dönüşümü konu edinmektedir. Çalışma Sağlıkta Dönüşüm Programı’nın yeni uygulamaları olarak şehir hastanelerine odaklanmakta; devlet ve özel sektörün arasındaki ilişki biçimi ise hastanelerdeki dönüşüm çerçevesinde ele alınmaktadır. Sağlıkta dönüşüm ile Sağlık Bakanlığı yapısal ve işlevsel bir dönüşüm geçirmektedir. Dönüşümün yapısal ayağı Kamu Özel Ortaklığı modeli üzerinden gerçekleştirilmekte şehir hastaneleri ise bu modelin uygulaması olarak karşımıza çıkmaktadır. İşlevsel dönüşüm ise Sağlık Bakanlığı’nın planlama, düzenleme ve denetleme rollerinin dönüşümü üzerinden gerçekleşmektedir. Çalışmada Kamu Özel Ortaklığı modeli ile devletin tek taraflı olmaktansa özel sektörün yanına konumlanarak ilişki biçimini sürdürdüğü ve hizmet alanlarını özel sektör üzerinden finanse ederek Sağlıkta Dönüşüm Programı’nı uygulamak istediği ileri sürülmektedir.

Local or regional fast-moving consumer (FMCG) brands sold mostly in delimited geographic areas are a growing trend. This study aims to understand consumer attitudes towards such products and to identify factors critical to their success. The paper is a comparative study between developed (Germany) and emerging (South Africa) nations to identify differences between the preference criteria for FMCG. The methodology involved an online cross section survey in the two countries. Respondents from both countries preferred local brands and believe they are better quality and more supportive of, and connected to, local communities. South Africans feel this more strongly, show greater commitment, and are prepared to pay more than Germans. ‘Beliefs’ regarding quality, value for money, and trust in local brands are critical.

The public has put increased pressure on organizations providing public services to demonstrate the most productive use of resources, with due regard for value received. Education is no exception. This study focus on the presentation and evaluation of public organizations (public grammar schools in our case) in education on the basis of their economy, efficiency and effectiveness as one of the indicators of performance assessment. The methodology of Value For Money presented in this study can provide useful information about the situation of education for public forces and for public grammar schools themselves. Also, this methodology may help to gain a deeper insight into strengths of individual schools, as well as in which they can improve. A limitation of the concept of VFM is that performance evaluation is possible only between homogeneous services. The originality and value of the study are reflected in its focus on such topics as monitoring and measuring of performance for public service organizations (i.e., education services). It also provides a tool for districts and individual schools to gain information using indicators employed here for identifying and solving the performance problems that occur in education system of Slovakia.

Treatment and prevention efforts guided by psychological theory, research, and practice can have outcomes of greater value than the resources consumed by those efforts—and outcomes superior to those attainable by other means, often at lower costs. How can we make this hope true more often, for more of the clients who need our services, despite severe resource constraints? Routinely reporting the costs, effectiveness, and benefits of psychological interventions from client, practitioner, and societal perspectives is only a beginning. We also need to use descriptive and inferential statistics to measure, report, and analyze the cost-effectiveness and cost-benefit of our interventions to discover the strongest determinants of intervention costs and outcomes. The emerging literature on cost-inclusive research in psychology suggests that delivery systems are one primary determinant of costs and outcomes of most interventions, as are the psychological techniques applied.

With the suboptimal performance of the Jakarta-Surabaya corridor railway currently operating, the Government of Indonesia intends to upgrade the railway system in terms of speed performance as well as to engage the participation of both the public and private sectors in the upgrading project as mandated in Presidential Regulation Number 38/2015. Through this research, the type selection of the Public-Private Partnership (PPP) scheme and their implications on the Jakarta-Surabaya railway project will be demonstrated by conducting analysis to the alternative scenarios of the study on railway technology selection with an emphasis on economic and financial feasibility aspects to determine the suitable PPP type, which is validated through Value for Money (VfM) analysis, where the benefits of the selected PPP type in terms of economic, financial, and non-financial aspects were examined through numerical tests, the result of which indicated that with the VfM value of the actual data of IDR 224.51 trillion, and the most significant changes in VfM value for each variable change are in the 20-year concession period which reduces the VfM value by 4%. Of all the variable changes, there is no minus VfM value, indicating that public projects are in an improved condition with the PPP scheme.

This research is done to find out the relationship between consumer doubt and value for money on purchase intention. This research uses quantitative method by collecting data through questionnaires of 30 respondents, sample is done by purposive random sampling method. In this research, analysis of relationship was done between consumer doubt, and value for money on purchase intention to find out which variables affects purchase intention. What distinguishes this research from other researches is that there is a new product that has been owned yet by the more well-known brand of smartphones, namely the existence of the back screen that is used to take self- photographs by using the rear camera. Hypothesis is done to produces calculation statistics that the factor of purchase intention, that is consumer doubt affecting negatively on purchase intention, and value for money affecting positively on purchase intention.

Health economics is an integrated aspect of all phases of mission-oriented translational cancer research and should be considered an intrinsic component of any study aimed at improving outcomes for patients and intervention costs. Information about value and value for money of new options for prevention and treatment is needed for decisions about their adoption and use by healthcare systems.

Background In self-regulated procedural simulation, learners practise on many simulators (e.g. paracentesis), self-regulating their choice of simulators, time and goals. Current needs assessments cannot predict the number of simulators needed to plan cost-effective self-regulated simulation. Knowing the ratios of simulators and participants would allow for better-informed purchase decisions to be made. Methods We designed 90-minute sessions of self-regulated procedural simulation for internal medicine residents. In Phase 1, 51 participants (8.5 per group) could use 22 simulators (US$69 925): ultrasound-guided central (n = 6) and peripheral (n = 2) venous catheterisation; thoracocentesis (n = 2); paracentesis (n = 2); lumbar puncture (n = 6); and arthrocentesis (n = 4). We calculated minimal numbers of simulators based on the time that participants used each simulator in order to design a resource-effective Phase 2, with 24 participants (with 12 per group) using 14 simulators (US$48 720) to meet their needs. Results Calculated from time of use (83 minutes in total), the optimal ratios of simulators expressed for 10 participants were 9.2: 3.7 for jugular and subclavian venous catheterisation (33 minutes); 1.5 for thoracocentesis (13 minutes), 1.0 for femoral venous catheterisation (9 minutes), 1.0 for lumbar puncture (9 minutes), 0.8 for peripheral venous catheterisation (8 minutes), 0.7 for paracentesis (6 minutes) and 0.5 for arthrocentesis (5 minutes). In Phase 2, the usage rate of simulators increased from 35.5% to 76.6%, maintaining the total time of use at 80.4 minutes. Conclusions We present a replicable method for the cost-effective planning of self-regulated simulation by measuring the use of simulators. Expressed as ratios of simulators per participant, this information can support purchase decisions and be shared with similar programmes.

Szabadidejükben vagy a nyári üdülések alkalmával az emberek szeretnének pihenni, kikapcsolódni, ellazulni, feltöltődni. A hasznos szabadidő-eltöltés, az élményszerzés, a kikapcsolódás és az egészségtudatosság egyre inkább megjelenik az emberek üdülőhely-megválasztását befolyásoló tényezőinél. Mivel ezek az üdülések során mint igény jelennek meg, ennek hatása a turisztikai desztinációk megválasztásakor is érvényesül. Kutatásunkban azt vizsgáltuk, hogy az emberek a nyári üdüléseik alkalmával milyen mértékben részesítik előnyben az egyes szolgáltatásokat (különféle vizes szolgáltatásokat, az egészségjavító, az orvosi, a szabadidős, és egyéb szolgáltatásokat), és mi alapján választják meg a helyszínt. Célunk megvizsgálni, hogy ezen elemek megléte milyen mértékben befolyásolja a válaszadók döntéseit az üdülések alkalmával a desztináció megválasztásában. A kvantitatív eljárás során előtesztelt kérdőívet alkalmaztunk, melyben jelen kutatáshoz kapcsolódó kérdéseink csak egy kis részét képezték a komplex vizsgálatnak. A kutatásban kizárólag az Észak-Alföld régióban élő lakosok vettek részt, 270 fő. A minta 28,9 %-a férfi, a 71,1 %-a nő. Eredményeink azt mutatták, hogy a vizsgált személyek motivációi eltérőek ugyan, de ennek ellenére vannak közös pontotok. Egyik ilyen a víz és a vizes szolgáltatások megléte. A víz közelsége (tenger, gyógyvíz, strand stb.), az anyagiak, az ár-érték arány, látnivalók, az élmény, a kulturális programlehetőségek, a pihenés lehetősége és a szabadidős tevékenységek fontos szempont a desztináció választásában.

Background England's National Institute for Health and Care Excellence (NICE) and the US' Institute for Clinical and Economic Review (ICER) both conduct cost-effectiveness evaluations for new cancer drugs to help payers make drug coverage decisions. However, NICE and ICER assessments have been noted to reach different conclusions. We aim to better understand the degree to which their recommendations diverge and what drives these apparent differences. Methods We compared the methods and results of publicly available cost-effectiveness evaluations performed by ICER and NICE of similarly assessed cancer drugs. Assessments were compared based on incremental cost-effectiveness ratio, comparator treatment, price, recommendation, and the design of the economic evaluation. Findings Among 11 commonly assessed cancer drugs, ICER and NICE were in concordance for 7 evaluations and in discordance on the cost-effectiveness and coverage decisions for 4 drugs. Most new cancer drugs were not cost-effective in either the US (7/11) or England (7/11). Furthermore, NICE's capacity to negotiate price discounts and access schemes result in much lower cost per QALY valuations and more favourable recommendations than those of ICER for similarly assessed cancer drugs. Interpretations NICE and ICER employ similar health technology assessment (HTA) methodologies and were aligned with most recommendations, finding that many new and expensive cancer drugs are cost ineffective. Growing use of ICER assessments will continue to send stronger price signals to manufacturers that cancer drugs with low value for money will be viewed less favourably by private insurers. NICE provides an important reminder of how much lower other countries pay for drugs when comparative effectiveness and value-based pricing are integrated into public drug coverage decisions.

Background Icosapent ethyl (IPE) is approved for the prevention of major adverse cardiovascular events (MACE) in patients with hypertriglyceridemia. However, due to budget constraints, access to IPE will inevitably be limited to a fraction of eligible patients. To help maximize value for money spent, we estimated the number of preventable MACE when providing IPE for primary versus secondary prevention. Methods The number of preventable MACE was estimated by dividing the available budget by the cost needed to treat (CNT) to prevent one MACE. CNT was calculated as the product of the number needed to treat (NNT) to prevent 1 MACE by therapy cost. NNT values were determined according to the Reduction of Cardiovascular Events with Icosapent Ethyl–Intervention Trial (REDUCE-IT) results. The budget limit was set as the United States’ threshold suggested by the Institute for Clinical and Economic Review. Sensitivity analysis was performed regarding the cost of IPE in the United States. Results The NNT to prevent 1 MACE over 4.9 years in the Reduction of Cardiovascular Events with Icosapent Ethyl–Intervention Trial primary prevention cohort was 59 (95% confidence interval [CI]: 24-∞) versus 14 (11-21) for secondary prevention. At an annual IPE cost of $2915, the CNT to prevent 1 MACE was $842,726 (95% CI: $342,804-∞) and $199,969 ($157,118-$299,953) accordingly. A total of $819 million worth of IPE can avoid 4762 MACE (95% CI: 0-11,707) versus 20,069 (13,379-25,541), when provided as primary versus secondary prevention therapy; P Conclusions Prioritizing IPE therapy for patients with an established cardiovascular disease may provide significantly more value for money than primary prevention.

It is established good practice for histopathologists to obtain a second opinion in difficult cases. However, it is becoming more common for histology material to be reviewed either at the time of reporting (double-reporting) or as part of the preparation for multidisciplinary team meetings. Routine histological review does not provide ‘value for money’ and could even increase the risk of diagnostic error. The focus should be on error prevention as opposed to error detection. If pathologists get it right the first time, then there would be less need for ‘double checking’. Increased subspecialisation could increase diagnostic confidence and reduce error rates. Double-reporting and retrospective review should be limited to selected cases. We describe a protocol for clearly recording the process and outcome of such reviews.

Many dialysis patients rely on tunneled central venous catheters for long-term vascular access. Hemodialysis catheter dysfunction (HCD) caused by intraluminal thrombosis is a common problem often necessitating replacement. We have noticed increasing prescription of thrombolytic therapy for HCD across our health service in recent years. Thrombolytic agents are relatively costly and evidence for their use and cost-effectiveness in treating HCD is sparse. Given budgetary considerations in our health service, we sought to examine this subject by auditing our hospital records. We intended to observe local practices regarding HCD and evaluate whether adherence to standard guidelines improves the efficacy of thrombolysis.

Godlee’s call for the National Institute for Health and Care Excellence to keep close to its radical roots is interesting, not least because NICE has never claimed this for itself.1 Radical or not, NICE applies thorough and robust approaches to assessing health technologies. This helps patients access innovative treatments that help them live longer, better quality lives while providing value for money. The …

A shake-up in NHS leadership aims to deliver value for money, innovation, and efficiency, finds Gareth Iacobucci

This article outlines the historical development of health economics and its present role in oncology related health technology assessments (HTAs). Despite concerns about the prices and immediate costs of new anticancer medicines for indications such as breast cancer overall spending on such treatments is affordable and offers long term value for money in countries such as the US, Canada and those of Western Europe. Oncologists wishing to protect the interests of current and future patients with both advanced and earlier stage cancers may be regarded as having a responsibility to understand the nature of health economic evaluations, and to be actively involved in decisions affecting access to current treatments and future levels of investment in incrementally improving therapies.

Theaim of this study is to know the effect of accountability, transparency, andsupervision on budget performance in regional owned enterprises (BUMD) both simultaneouslyand partially. The design of this study is included in associative causalresearch. The population of this study is all Government employees in Riauprovince. The sample selection is by using the purposive sampling method, whichis included by the employees of The Accounting and The Internal SupervisoryDepartment (SPI). The collecting data technique is by using the questionnairesystem. The data analysis technique used is simple regression analysis andmultiple regression analysis. The results showed that the accountability,transparency, and supervision both partially and simultaneously has a positiveand significant effect on budget performance with the concept of value formoney in Regional Owned Enterprises (BUMD) of Riau province., The aim of this study is to know the effect ofaccountability, transparency, and supervision on budget performance in regional owned enterprises (BUMD)both simultaneously and partially. .Thedesign of this study is included in associative causal research. The population of this study is all Government employees in Riau province. The sample selection is by using the purposive sampling the method, which is included by theemployees of the accounting and the internalsupervisory department (SPI). Thecollecting data techniqueis by using the questionnaire system. The data analysis the technique used is a simple regression analysis and multiple regression analysis. The results showed that accountability,transparency and supervision both partially and simultaneously have a positive andsignificant effect on budget performance with the concept of value for money inregionalowned enterprises (BUMD)of Riauprovince.

It’s been five years since tuition fees shot up to £9000 a year. Anne Gulland explores whether medical students in the UK are getting good value for money and what effect the rise in fees has had on student expectations

Background Scientific conferences in the UK are attended by practising doctors and medical students for sharing research, networking and professional development. Student/trainee conferences are typically cheaper than professional conferences, but as they are not acknowledged in national scoring systems for medical and surgical training applications, they may have worse attendance than otherwise possible. We questioned whether student/trainee conferences are of a similar scientific quality to professional conferences, while being considerably cheaper. Methods In this cross-sectional database review, 162 conferences were identified through a systematic search of two conference databases by three independent researchers. χ2 tests were used to compare scientific quality between student/trainee and professional conferences and the likelihood of offering different types of discounts. Independent t-tests were employed to determine cost differences between the two categories of conferences. Results Our data revealed that there was no significant difference between student/trainee and professional conferences likelihood of declaring information on their abstract review processes (p=0.105). There was no difference in speaker seniority, determined by the tool the authors developed (p=0.172). Student/trainee conferences were significantly more likely to offer workshops (p Conclusion Our results show that student/trainee conferences offer a similar level of scientific quality to professional medical conferences in the UK at a fraction of the cost, which should be reflected within the national scoring systems.

Background Many treatments developed for rare diseases will have an Orphan Medicinal Product (OMP) designation, indicating that they are likely to deliver benefit in an area of high unmet need. Their approval may be based on a small or uncontrolled trial, as randomised controlled trials (RCTs) of sufficient size are often difficult to conduct, or repeat, as a result of the rarity of the condition, sparsity of patients, or for ethical reasons. Furthermore, many products are given a conditional marketing authorisation, requiring additional evidence to be collected after product launch. This is even more challenging with the advent of advanced therapeutic medicinal products, which use novel scientific approaches like gene or somatic cell therapy. Issue Given the high unmet need associated with these products, there is pressure for Health Technology Assessment (HTA)/reimbursement bodies to enable rapid access to effective treatments. However, there is often only limited evidence available for assessment. Methods TRUST4RD proposes an approach to identify uncertainties of most concern for decision-makers by developing an iterative and informed dialogue amongst stakeholders (including manufacturers, clinicians, patients, regulatory- and HTA agencies and payers), so that potential approaches to resolution can be discussed. As evidence is generated, uncertainties are reviewed and prioritised, and evidence-generation plans revised or clarified accordingly. The aim is to develop – both pre- and post HTA submission – a better understanding of evidence requirements versus evidence-generation trade-offs as an evidence base grows and the potential value of a product becomes clearer. Conclusion TRUST4RD presents guidance on defining uncertainties and evidence gaps in the assessment of value and value for money of specialised treatments for rare diseases. It also provides guidance on the potential of Real World Evidence (RWE) to help address such uncertainties, including the typology of evidence uncertainties, the importance of different uncertainties and the data sources available to address them before and after HTA submission. In making use of the guidance, authorisation and reimbursement discussions on such treatments can be embedded in an evidence-rich context, thereby ensuring value to all parties, particularly to patients.

In this paper we reflect on 15 years of experience in eHealth research and evaluation in the UK. An integrated, interroperable eHealth programme has yet to materialise. The initial promise that eHealth interventions can facilitate the shaping of the 21st century healthcare systems Stead et al. [1], has not been empirically demonstrated in the past decade. Although isolated cases of successful initiatives exist, the potential of eHealth remains largely unrealised Muuraiskangas et al. [2-4]. Investment in large programmes which aim to develop an integrated and interoperable platform across settings and levels of care, such as the NPfIT in the UK, may not have provided good value for money. Worse still, patient’s safety may have also been compromised Han et al. [5]. Similarly, to eCommerce, eGovernment and eLearning, eHealth (Table 1) was the result of both a demand by consumers and an initiative by government. It was therefore initially considered a paradox that it failed to deliver the much anticipated benefits. a paradox that it failed to deliver the muchanticipated benefits. A closer study of the various implementation programmes reveals the reasons for the relative failure of the UK to have a homogeneous and interoperable eHealth platform.

At a time when British higher education’s relevance and value for money are increasingly being questioned, I argue that post-1992 universities should resist the temptation to emulate their ‘elite’ counterparts; and suggest some reasons why, and ways in which, they might do things differently. My analysis derives from experience of teaching social sciences (especially sociology) in a post-1992 institution, but may have wider validity.

In the conditions of a constant budget deficit allocated to the research and manufacturing complex, the problem of value for money take on particular significance. The solution to this problem largely depends on the scientific validity of planning budget expenditures for innovative development and, first of all, on the optimality of the plans being developed in the context of crises, pandemics or sanctions. In this connection, the article analyzes modern research and manufacturing complex development processes under fiscal stress. As a result, economic and mathematical tools based on the analytic hierarchy process will be scientifically substantiated and developed. This method is designed to build a model that allows to quantify and efficiently distribute funds allocated by the State. This is necessary for the formation of that part of the budget item, which refers to the innovative development of knowledge-based industry.

The purpose of this study was to find out the effect of the tender process on value for money in Tanzania public procurement. The study applies a cross-sectional survey design and quantitative approach. The data were collected from 164 entities in Tanzania. The analysis of data was mainly based on descriptive and inferential statistics. The findings show that tender advertising, tender evaluation, tender award, and tender negotiation are significant factors that enhance value for money in public procurement. Conversely, the tendering document was not a significant factor to predict the value for money. Procuring entities in Tanzania need to put more efforts to administer properly tender advertising, tender evaluation, tender award, and tender negotiation to achieve the best value for money. The study has enriched the institutional theory by showing that regulatory and normative pillars need to ensure that the organisations produce the best results.

BACKGROUND: Gastric cancer is a major health problem worldwide. Effectiveness of early oral feeding (EOF) following gastrectomy has been internationally evaluated, even though there is limited evidence available. In Japan, recently, a randomized controlled trial of EOF following total gastrectomy showed a decreased length of hospital stay, compared with conventional oral feeding (COF). To evaluate value for money of EOF following gastrectomy, cost-effective analysis was carried out based on this trial. METHODS: The analysis was carried out from a societal perspective as the base case. The subjects were randomly assigned to the EOF group (N=32) and the COF group (N=30). While the EOF group received a special diet (i.e., iEAT) from the postoperative day (POD) 1 to POD 3, the COF group received conventional diet (i.e., a liquid diet or rice gruel) on POD 4 and thereafter. The observation period was 3 weeks after total gastrectomy. As an effectiveness measure, quality-adjusted life days (QALDs) were estimated. Quality of life for health conditions was evaluated by using EuroQol-5Dimentions (EQ-5D)-3Levels among the subjects. Costs (e.g., nutritional support, hospitalization and treatment of adverse events) were estimated from trial data during observation. Qualitative and stochastic sensitivity analyses were performed to examine the robustness of the results. RESULTS: The mean QALDs per patient for the EOF and the COF groups were 14.93 and 14.19, respectively. Incremental effectiveness of the EOF group to the COF group was 0.74 QALDs (p=0.359, t-test). The mean total cost per patient in the EOF and the COF groups was $3,177.7 and $3,755.4, respectively. Incremental cost was -$577.7 (p=0.03, t-test, Welch). This means EOF is dominant (cost saving). The qualitative sensitivity analysis and the stochastic sensitivity analysis showed the relative robustness of these results. CONCLUSIONS: Economic evaluation of EOF following total gastrectomy showed that EOF was cost-saving, with non-significant increase in effectives (i.e., QALD), compared with COF. This result can contribute to strengthen the evidence for wide use of EOF.

Managing hyperphosphataemia in haemodialysis patients is resource-intensive. A search for cost-effective interventions in this field is needed to inform decisions on the allocation of healthcare resources. NHSEED, MEDLINE, EMBASE and CINAHL were searched for full economic evaluations of hyperphosphataemia-managing interventions in adult haemodialysis patients, published between 2004 and 2014, in English, French, Dutch or German. Incremental cost-effectiveness ratios of the interventions were up-rated to 2013US$ using Purchasing Power Parity conversion rates and Consumer Price Indices. The quality of included studies was assessed using the Extended Consensus on Health Economic Criteria List. Twelve out of the 1681 retrieved records fulfilled the inclusion criteria. They reported only on one aspect of hyperphosphataemia management, which is the use of phosphate binders (calcium-based and calcium-free, in first-line and sequential use). No economic evaluations of other phosphorus-lowering interventions were found. The included articles derived from five countries and most of them were funded by pharmaceutical companies. The incremental cost-effectiveness ratios of phosphate binders ranged between US$11 461 and US$157 760 per quality-adjusted life-year gained. Calcium-based binders (especially calcium acetate) appear to be the optimal cost-effective first- and second-line therapy in prevalent patients, while the calcium-free binder, lanthanum carbonate, might provide good value for money, as second-line therapy, in incident patients. The studies' overall quality was suboptimal. Drawing firm conclusions was not possible due to the quality heterogeneity and inconsistent results. Future high-quality economic evaluations are needed to confirm the findings of this review and to address other interventions to manage hyperphosphataemia in this population.

I agree with Moynihan and colleagues1 that the pandemic offers a “natural experiment in less medical care,” and that the results may help identify some interventions that do more harm than good to most people. I also agree that the financial crisis will focus our minds on the desirability of maximising value for money. I am, however, …

NHS England has approved routine funding for 14 new specialised treatments, including a heart implant to reduce risk of stroke, a surgical procedure that will improve the mobility of children with cerebral palsy, and drugs for cancer, haemophilia, osteoporosis, and familial hypercholesterolaemia.1 The treatments were assessed by the Clinical Priorities Advisory Group, chaired by Nick Partridge and made up of doctors, specialists, and patients’ representatives. The group assesses drugs, medical devices, and treatments according to their clinical effectiveness, benefit to patients, and value for money. It considers recommendations from clinical reference groups and teams covering specialised commissioning responsibilities. The group has approved funding for left atrial appendage occlusion, which is an alternative treatment for patients with atrial fibrillation who cannot take an oral anticoagulant. It …

Private finance initiative (PFI) schemes that are used to fund the building of hospitals and other infrastructure are not in the taxpayer’s interest, and the Treasury is unable to show that they provide value for money, a committee of MPs has said. The House of Commons Public Accounts Committee said in its report,1 “It is unacceptable that after more than 25 years the Treasury still has no data on benefits to show whether the PFI model provides value for money.” PFI is a way of getting infrastructure built by getting commercial companies to pay the costs up front. It results in repayments and associated charges for things such as maintenance, in contracts that typically run for decades and have proved to be an increasing burden on the NHS. …

Introduction: Cost-effectiveness thresholds (CETs) are used to judge if an intervention represents sufficient value for money to merit adoption in healthcare systems. The study was motivated by the Brazilian context of HTA, where meetings are being conducted to decide on the definition of a threshold. Areas covered: An electronic search was conducted on Medline (via PubMed), Lilacs (via BVS) and ScienceDirect followed by a complementary search of references of included studies, Google Scholar and conference abstracts. Cost-effectiveness thresholds are usually calculated through three different approaches: the willingness-to-pay, representative of welfare economics; the precedent method, based on the value of an already funded technology; and the opportunity cost method, which links the threshold to the volume of health displaced. An explicit threshold has never been formally adopted in most places. Some countries have defined thresholds, with some flexibility to consider other factors. An implicit threshold could be determined by research of funded cases. Expert commentary: CETs have had an important role as a ‘bridging concept’ between the world of academic research and the ‘real world’ of healthcare prioritization. The definition of a cost-effectiveness threshold is paramount for the construction of a transparent and efficient Health Technology Assessment system.

There is increasing evidence that the portion sizes of many foods have increased and in a laboratory at least this increases the amount eaten. The conclusions are, however, limited by the complexity of the phenomenon. There is a need to consider meals freely chosen over a prolonged period when a range of foods of different energy densities are available. A range of factors will influence the size of the portion size chosen: amongst others packaging, labeling, advertising, and the unit size rather than portion size of the food item. The way portion size interacts with the multitude of factors that determine food intake needs to be established. In particular, the role of portion size on energy intake should be examined as many confounding variables exist and we must be clear that it is portion size that is the major problem. If the approach is to make a practical contribution, then methods of changing portion sizes will need to be developed. This may prove to be a problem in a free market, as it is to be expected that customers will resist the introduction of smaller portion sizes, given that value for money is an important motivator.

Regulation criteria for licensing pharmaceuticals and medical devices (MDs) are asymmetric. This has affected the type, quantity and quality of the evidence produced in support of MDs. This paper has three objectives: to examine the reasons behind the current licensing criteria for MDs; to identify key methodological challenges associated with pre- and post-market evaluation of MDs and to assess the extent to which existing methods for the economic evaluation of pharmaceuticals can be applied to the evaluation of MDs. The belief that MDs cannot be properly evaluated stems from a combination of historical events and complexities in implementing rigorous RCTs in this field. Existing challenges to conduct sound economic evaluation of MDs have begun to be addressed in medical research using mixed research methods. While more challenging to implement, robust evaluations of therapeutic MDs can and need to be carried out to safeguard individual's wellbeing.

The accountancy profession subscribes to the values of accountability, integrity, honesty, accuracy among others and that is the reason accountants are required in any field of work to provide an independent report of how the resources are deployed to bring the outcome and assess if indeed the outcome from the use of such resources is as it had been expected by all the stakeholders. This requirement is common to all sectors of the economy, whether in the public or private sector. The paper discusses the changing role of the accountant in the public sector in response to the growing concerns of public resource abuse. Africa, Malawi in particular, has been a victim of gross resource abuse by public officers through among others fraud, corruption, theft and gross mismanagement. Malawi has recently been rated highly in terms of corrupt practices with the public sector taking a leading position leading to gross mismanagement of public resources since the dawn of democracy in 1994. The study takes a look at the changing roles of an accountant in the public sector where the control environment in the financial management system, and the political will of those in charge of the public sector, are not the same as those in the private sector. The accounting weaknesses or challenges as revealed by the reviewed audit reports are scrutinised and the role of the accountant with respect to each challenge is reviewed and recommendations suggested which if implemented, may block the future recurrence of such weaknesses in the financial management systems in the public sector.

Procurement route structures adequate for governmental megaprojects and commonly used worldwide are to be appraised in the paper. Effectiveness of construction projects’ delivery is vastly dependent upon the form of relationship between the parties involved, and hence liabilities imposed on one another with particular emphasis on the risk distribution. Latter implied a necessity of a diligent assessment of procurement alternatives as a prerequisite to assure the value for money for the project. The paper aims to demonstrate a development of a strategic approach to procurement on the basis of the large scale governmental investment such as the Olympic Village in Krakow which was planned to be delivered as a part of Krakow Olympic Games 2022. Factors that influence the choice of delivery scheme are to be further specified. The latter will set grounds for the critical analyze of alternative procurement types applicable for the proposed project which, in turn, will be supported by the pairs comparison matrix of client's value drivers together with further evaluation of strengths and weaknesses of procurement systems. Since the Krakow Olympic Games 2022 project failed to embark, the availability of relevant data was quite restricted. Nonetheless, what was found out is that one of the main issues encountered at the inception stage was lack of the linkage between the construction project and the governmental core activity that certainly ought to be oriented on enhancing the life of tax-payers. Bearing in mind the importance of meeting stakeholders’ requirements the paper will suggest relevant solutions oriented on the attainment of a long-term profitability for the assets through the implementation of integrated delivery process. After examination of relevant alternatives for the project procurement schemes, the Design Build Operate Maintain (DBOM) is to be analyzed as a procurement route worth adopting in order to ensure an alignment of discussed project with the governmental principles set beforehand based on the efficiency of project performance in the long-run.

We thank Barsuk et al. for their letter, "Telling the whole story about simulation-based education" (1). We acknowledge that our paper, "The cost of local, multi-professional obstetric emergencies training"(2), focussed on the cost of training and did not elaborate on cost savings, value for money or return on investment (ROI). The authors' call for a ROI analysis is welcome. Others have estimated the potential savings of obstetric training (3).

The National Institute for Health and Care Excellence (NICE) has announced proposals for a “fast track” appraisal process for drugs and other health technologies that offer “exceptional” value for money, together with clearer guidance on automatic NHS funding for any treatments it approves for very rare conditions.1 The proposals, which are part of a joint consultation by NICE and NHS England, would mean that treatments likely to have a cost per quality adjusted life year (QALY) of less than £10 000 (€11 065; $12 160) would be assessed using a …

Many clinical commissioning groups and hospital trusts are failing to show that the money they spend is good value, the parliamentary public spending watchdog has said. It has called for greater transparency from all public bodies that provide local services and said that the government must demand more so that citizens can hold their services to account. MPs on the Public Accounts Committee found that more than 20% of local public bodies, including local authorities and fire and police services as …

Auditors’ “red flag” warnings about financial instability in NHS and other public bodies are being met with “inadequate or complacent responses,” the financial watchdog has said. The National Audit Office (NAO) said the number of organisations in England with “significant weaknesses” in their arrangements for delivering value for money was “unacceptably high and increasing.” Aymas Morse, who heads the NAO, said, “I am shocked by the persistent high level of qualified audit reports at local public bodies. A qualification is a judgment that something is seriously wrong.” He said local and national bodies must take seriously, and act appropriately, when local auditors highlight weaknesses or concerns to maintain public confidence. A NAO report on …

Based on the products of Ling Xian company in Shen Zhen, by using document research and field research, the essay analyzes the design for stadium with movable seating and its structure which includes: the standard of the design, materials and the base of the seating, fittings, technology applied in the system control, standard of choosing seats, assembling model, data sheet, fast assemble. The essay attempts to analyze its humanized design and the state-of-art products; summarize features and strengths of the design and reach into the conclusion that the system of movable seating is the most advanced and it is highly competitive in the market due to its good value for money.

ObjectivesHealthcare budgets are limited, and therefore, research funds should be wisely allocated to ensure high-quality, useful and cost-effective research. We aimed to critically review the criteria considered by major Australian organisations in prioritising and selecting health research projects for funding.MethodsWe reviewed all grant schemes listed on the Australian Competitive Grants Register that were health-related, active in 2017 and with publicly available selection criteria on the funders’ websites. Data extracted included scheme name, funding organisation, selection criteria and the relative weight assigned to each criterion. Selection criteria were grouped into five representative domains: relevance, appropriateness, significance, feasibility (including team quality) and cost-effectiveness (ie, value for money).ResultsThirty-six schemes were included from 158 identified. One-half of the schemes were under the National Health and Medical Research Council. The most commonly used criteria were research team quality and capability (94%), research plan clarity (94%), scientific quality (92%) and research impact (92%). Criteria considered less commonly were existing knowledge (22%), fostering collaboration (22%), research environment (19%), value for money (14%), disease burden (8%) and ethical/moral considerations (3%). In terms of representative domains, relevance was considered in 72% of the schemes, appropriateness in 92%, significance in 94%, feasibility in 100% and cost-effectiveness in 17%. The relative weights for the selection criteria varied across schemes with 5%–30% for relevance, 20%–60% for each appropriateness and significance, 20%–75% for feasibility and 15%–33% for cost-effectiveness.ConclusionsIn selecting research projects for funding, Australian research organisations focus largely on research appropriateness, significance and feasibility; however, value for money is most often overlooked. Research funding decisions should include an assessment of value for money in order to maximise return on research investment.

The requesting of radiological investigations is frequently devolved to the ward-based doctors in training. In a National Health Service system that is regularly over capacity, radiological investigations are an expensive commodity often overused or poorly targeted by doctors. By considering the following ‘Commandments of Radiology’; doctors could target imaging more appropriately, resulting in higher quality information and hence, better patent care and value for money. ### Thou shalt give an accurate history Good quality information should be given to the radiologist to facilitate a good quality report. Ward-based clinicians have the benefit of reviewing the patient history, completing a full examination and understanding the clinical background. The radiologist benefits from this information to target their assessment and consequently their report. ### Thou shalt put the patient first When requesting …

Provision of electrical infrastructure in emerging economies, like Indonesia, is very challenging post the 2008 Global Financial Crisis (GFC). Constrained lending via international finance markets has led to a reduction in the number of investors and shorter lending periods for public private partnerships (PPPs) projects. While domestic Indonesian investors and banks have begun to be involved in such projects, the scale of budgetary requirements for the delivery of power plant projects generally exceeds the financial capacity of both the public sector and local financial markets. This paper presents the findings of a Delphi style survey and proposes implementation strategies that may overcome current investment constraints and still attain Value for Money (VfM) from the delivery of Indonesian PPP power projects post the 2008 GFC. Initially, qualitative data was acquired from two industry seminars to establish the context of Indonesian PPP power projects. This was followed by two rounds of the Delphi technique to develop consensus among a panel of industry experts about realizing VfM from Indonesian PPPs. The results show that (i) export credit agencies from regional Asian countries have increased their roles to support PPP power projects (ii) structural deficiencies of local power industry manufacturing has created barriers for greater roles of local finances in the projects (iii) enhanced contractual risk allocation between the public and private sector can potentially improve project outcomes; these involve greater transparency and accountability of project guarantee processes. This study adapted key implementation features for attaining VfM into short, medium, and long term development strategies that are suitable for Indonesia. It has been concluded that a sustainable energy system can be realized when there is alignment of interests between the government, project sponsors, fuel suppliers, and lenders.

This paper proposes a benchmarking model useful to rank and select aircraft used in the freight industry. The decision-making problem of aircraft ranking and selection is addressed by implementing an extension of Data Envelopment Analysis (DEA), i.e. the cross-efficiency calculation. DEA efficiency is a useful indicator to evaluate the value for money of an aircraft in the freight industry and its extension - the cross-efficiency measurement makes it possible to rank aircraft according to this value for money measurements. A sample of 22 air freighters is used to analyze the model validity. DEA scores show that 4 aircraft models only are evaluated as being full 100% efficient, and some old models (i.e., DC 9-10F) are as efficient as the recent aircraft models sold in the market (A300F and A330-200F).

A clear consensus exists today in Canada, that we need major health system reform to improve quality, safety and value for money. However, we remain polarized on one critical issue: Is the way in which the practice of medicine in Canada is governed and remunerated a structural impediment to major