Abstract: Background: Chronic obstructive pulmonary disease (COPD) and asthma have a high prevalence and disease burden. Blended self-management interventions, which combine eHealth with face-to-face interventions, can help reduce the disease burden. Objective: This systematic review and meta-analysis aims to examine the effectiveness of blended self-management interventions on health-related effectiveness and process outcomes for people with COPD or asthma. Methods: PubMed, Web of Science, COCHRANE Library, Emcare, and Embase were searched in December 2018 and updated in November 2020. Study quality was assessed using the Cochrane risk of bias (ROB) 2 tool and the Grading of Recommendations, Assessment, Development, and Evaluation. Results: A total of 15 COPD and 7 asthma randomized controlled trials were included in this study. The meta-analysis of COPD studies found that the blended intervention showed a small improvement in exercise capacity (standardized mean difference [SMD] 0.48; 95% CI 0.10-0.85) and a significant improvement in the quality of life (QoL; SMD 0.81; 95% CI 0.11-1.51). Blended intervention also reduced the admission rate (relative ratio [RR] 0.61; 95% CI 0.38-0.97). In the COPD systematic review, regarding the exacerbation frequency, both studies found that the intervention reduced exacerbation frequency (RR 0.38; 95% CI 0.26-0.56). A large effect was found on BMI (d=0.81; 95% CI 0.25-1.34); however, the effect was inconclusive because only 1 study was included. Regarding medication adherence, 2 of 3 studies found a moderate effect (d=0.73; 95% CI 0.50-0.96), and 1 study reported a mixed effect. Regarding self-management ability, 1 study reported a large effect (d=1.15; 95% CI 0.66-1.62), and no effect was reported in that study. No effect was found on other process outcomes. The meta-analysis of asthma studies found that blended intervention had a small improvement in lung function (SMD 0.40; 95% CI 0.18-0.62) and QoL (SMD 0.36; 95% CI 0.21-0.50) and a moderate improvement in asthma control (SMD 0.67; 95% CI 0.40-0.93). A large effect was found on BMI (d=1.42; 95% CI 0.28-2.42) and exercise capacity (d=1.50; 95% CI 0.35-2.50); however, 1 study was included per outcome. There was no effect on other outcomes. Furthermore, the majority of the 22 studies showed some concerns about the ROB, and the quality of evidence varied. Conclusions: In patients with COPD, the blended self-management interventions had mixed effects on health-related outcomes, with the strongest evidence found for exercise capacity, QoL, and admission rate. Furthermore, the review suggested that the interventions resulted in small effects on lung function and QoL and a moderate effect on asthma control in patients with asthma. There is some evidence for the effectiveness of blended self-management interventions for patients with COPD and asthma; however, more research is needed. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019119894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=119894
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For the Dam tot damloop, a running event with 36,757 participants and 115,000 visitors, both an economic impact analysis (IEA) and a social cost benefit analysis (SCBA) are made to study the (broader) economic effects. Three overlapping geographical regions are studied and two new estimates of non-market goods are used. For the hosting cities the net social gain from the SCBA is at least three times the EIA’s economic impact. The larger the geographical area studied, the larger the differences between EIA and SCBA, because the EIA outcome falls and the SCBA outcome increases. A lower multiplier than 1 lowers the EIA much more than it lowers the SCBA. This study shows that an EIA is not suited for evaluating the welfare effects of public support for a sport event. The difference in outcome between EIA and SCBA is substantial. Valuing non-market effects is done infrequently but is crucial for understanding the welfare effects of policies supporting sport events. Organizing an event for social and city marketing benefits can be a better reason than organizing for the direct economic gains.
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The objective of this study is to evaluate the energetic, exergetic, sustainability, economic and environmental performances of a 4-cylinder turbodiesel aviation engine (TdAE) used on unmanned aerial vehicles for the take-off operation mode to assess the system with large aspects. Energy efficiency of the system is found as 43.158%, while exergy efficiency 40.655%. Thermoeconomic analysis gives information about the costs of the inlet and outlet energy and exergy flows of the engine. Hourly levelized total cost flow of the TdAE is found as 21.036 $/h, when the hourly fuel cost flow of the engine is found as 30.328 $/h. The waste exergy cost parameter is determined as 0.0144 MJ/h/$ from exergy cost-energy-mass (EXCEM) analysis, while it is estimated as 14.043 MJ/$ from modified-EXCEM analysis. Environmental damage cost analysis evaluates the cost formation of the exhaust emissions. The total environmental damage cost of the TdAE is computed as 12.895 $/h whilst specific environmental damage cost is determined as 0.054 $/MJ for 494.145 MJ/h TdAE power production. It is assessed that the main contributors to the environmental impact rate of the TdAE are the fuel consumption and the formation pollutants of combustion reaction.
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BACKGROUND: Blended physiotherapy, in which physiotherapy sessions and an online application are integrated, might support patients in taking an active role in the management of their chronic condition and may reduce disease related costs. The aim of this study was to evaluate the cost-effectiveness of a blended physiotherapy intervention (e-Exercise) compared to usual physiotherapy in patients with osteoarthritis of hip and/or knee, from the societal as well as the healthcare perspective.METHODS: This economic evaluation was conducted alongside a 12-month cluster randomized controlled trial, in which 108 patients received e-Exercise, consisting of physiotherapy sessions and a web-application, and 99 patients received usual physiotherapy. Clinical outcome measures were quality-adjusted life years (QALYs) according to the EuroQol (EQ-5D-3 L), physical functioning (HOOS/KOOS) and physical activity (Actigraph Accelerometer). Costs were measured using self-reported questionnaires. Missing data were multiply imputed and bootstrapping was used to estimate statistical uncertainty.RESULTS: Intervention costs and medication costs were significantly lower in e-Exercise compared to usual physiotherapy. Total societal costs and total healthcare costs did not significantly differ between groups. No significant differences in effectiveness were found between groups. For physical functioning and physical activity, the maximum probability of e-Exercise being cost-effective compared to usual physiotherapy was moderate (< 0.82) from both perspectives. For QALYs, the probability of e-Exercise being cost-effective compared to usual physiotherapy was 0.68/0.84 at a willingness to pay of 10,000 Euro and 0.70/0.80 at a willingness to pay of 80,000 Euro per gained QALY, from respectively the societal and the healthcare perspective.CONCLUSIONS: E-Exercise itself was significantly cheaper compared to usual physiotherapy in patients with hip and/or knee osteoarthritis, but not cost-effective from the societal- as well as healthcare perspective. The decision between both interventions can be based on the preferences of the patient and the physiotherapist.TRIAL REGISTRATION: NTR4224 (25 October 2013).
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In this article, we describe the emergence of a new Finance course in line with the concept of the Societal Cost-Benefit Analysis (SCBA). By means of an in-depth case study, we reconstruct the process of dissatisfaction and corresponding discussions among lecturers and students of the Master Integrated Care Design with regard to the learning aims and content of the Finance course, which is a study module of this master. During the period 2015-2021, the aims and content of this module were revised and remoulded several times in order to define a Finance course that was able to both sufficiently and creatively connect the domain of Integrated Care with that of Finance. In this process of reiterating revision both lectures and students played a crucial role. The ultimate result – the indicative Societal Cost-Benefit Analysis – was unexpected and unplanned, producing an outcome that surpassed the sum of its separate parts. In short, the process, as we describe in this case study, bears all the hallmarks of emergence. Moreover, the analysis shows how this process of emergence in combination with emergent leadership led to a practicable and encouraging outcome, which satisfied and committed all stakeholders, setting an example that is worth following.
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Summary Project objectives This study fits into a larger research project on logistics collaboration and outsourcing decisions. The final objective of this larger project is to analyze the logistics collaboration decision in more detail to identify thresholds in these decisions. To reach the overall objectives, the first step is to get a clearer picture on the chemical and logistics service providers industry, sectors of our study, and on logistics collaboration in these sectors. The results of this first phase are presented in this report. Project Approach The study consists of two parts: literature review and five case studies within the chemical industry. The literature covers three topics: logistics collaboration, logistics outsourcing and purchasing of logistics services. The five case studies are used to refine the theoretical findings of the literature review. Conclusions Main observations during the case studies can be summarized as follows: Most analyzed collaborative relationships between shippers and logistics service providers in the chemical industry are still focused on operational execution of logistics activities with a short term horizon. Supply management design and control are often retained by the shippers. Despite the time and cost intensive character of a logistics service buying process, shippers tendering on a very regular basis. The decision to start a new tender project should more often be based on an integral approach that includes all tender related costs. A lower frequency of tendering could create more stability in supply chains. Beside, it will give both, shippers and LSPs, the possibility to improve the quality of the remaining projects. Price is still a dominating decision criterion in selecting a LSP. This is not an issue as long as the comparison of costs is based on an integral approach, and when shippers balance the cost criterion within their total set of criteria for sourcing logistics services. At the shippers' side there is an increased awareness of the need of more solid collaboration with logistics service providers. Nevertheless, in many cases this increased awareness does not actually result in the required actions to establish more intensive collaboration. Over the last years the logistics service providers industry was characterized by low profit margins, strong fragmentation and price competition. Nowadays, the market for LSPs is changing, because of an increasing demand for logistics services. To benefit from this situation a more pro-active role of the service providers is required in building stronger relationships with their customers. They should pay more attention on mid and long term possibilities in a collaborative relation, in stead of only be focused on running the daily operation.
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Background: The purpose of this study was to investigate the cost-effectiveness and budget impact of the Boston University Approach to Psychiatric Rehabilitation (BPR) compared to an active control condition (ACC) to increase the social participation (in competitive employment, unpaid work, education, and meaningful daily activities) of individuals with severe mental illnesses (SMIs). ACC can be described as treatment as usual but with an active component, namely the explicit assignment of providing support with rehabilitation goals in the area of social participation. Method: In a randomized clinical trial with 188 individuals with SMIs, BPR (n = 98) was compared to ACC (n=90). Costs were assessed with the Treatment Inventory of Costs in Patients with psychiatric disorders (TIC-P). Outcome measures for the cost-effectiveness analysis were incremental cost per Quality Adjusted Life Year (QALY) and incremental cost per proportional change in social participation. Budget Impact was investigated using four implementation scenarios and two costing variants. Results: Total costs per participant at 12-month follow-up were e 12,886 in BPR and e 12,012 in ACC, a non-significant difference. There were no differences with regard to social participation or QALYs. Therefore, BPR was not cost-effective compared to ACC. Types of expenditure with the highest costs were in order of magnitude: supported and sheltered housing, inpatient care, outpatient care, and organized activities. Estimated budget impact of wide BPR implementation ranged from cost savings to e190 million, depending on assumptions regarding uptake. There were no differences between the two costing variants meaning that from a health insurer perspective, there would be no additional costs if BPR was implemented on a wider scale in mental health care institutions. Conclusions: This was the first study to investigate BPR cost-effectiveness and budget impact. The results showed that BPR was not cost-effective compared to ACC. When interpreting the results, one must keep in mind that the cost-effectiveness of BPR was investigated in the area of social participation, while BPR was designed to offer support in all rehabilitation areas. Therefore, more studies are needed before definite conclusions can be drawn on the cost-effectiveness of the method as a whole.
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Background: Impaired upper extremity function due to muscle paresis or paralysis has a major impact on independent living and quality of life (QoL). Assistive technology (AT) for upper extremity function (i.e. dynamic arm supports and robotic arms) can increase a client’s independence. Previous studies revealed that clients often use AT not to their full potential, due to suboptimal provision of these devices in usual care. Objective: To optimize the process of providing AT for impaired upper extremity function and to evaluate its (cost-)effectiveness compared with care as usual. Methods: Development of a protocol to guide the AT provision process in an optimized way according to generic Dutch guidelines; a quasi-experimental study with non-randomized, consecutive inclusion of a control group (n = 48) receiving care as usual and of an intervention group (optimized provision process) (n = 48); and a cost-effectiveness and cost-utility analysis from societal perspective will be performed. The primary outcome is clients’ satisfaction with the AT and related services, measured with the Quebec User Evaluation of Satisfaction with AT (Dutch version; D-QUEST). Secondary outcomes comprise complaints of the upper extremity, restrictions in activities, QoL, medical consumption and societal cost. Measurements are taken at baseline and at 3, 6 and 9 months follow-up.
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Abstract: Teledentistry offers possibilities for improving efficiency and quality of care and supporting cost-effective healthcare systems. This umbrella review aims to synthesize existing systematic reviews on teledentistry and provide a summary of evidence of its clinical- and cost-effectiveness. A comprehensive search strategy involving various teledentistry-related terms, across seven databases, was conducted. Articles published until 24 April 2023 were considered. Two researchers independently reviewed titles, abstracts and full-text articles. The quality of the included reviews was critically appraised with the AMSTAR-2 checklist. Out of 749 studies identified, 10 were included in this umbrella review. Two reviews focusing on oral-health outcomes revealed that, despite positive findings, there is not yet enough evidence for the long-term clinical effectiveness of teledentistry. Ten reviews reported on economic evaluations or costs, indicating that teledentistry is cost-saving. However, these conclusions were based on assumptions due to insufficient evidence on cost-effectiveness. The main limitation of our umbrella review was the critically low quality of the included reviews according to AMSTAR-2 criteria, with many of these reviews basing their conclusions on low-quality studies. This highlights the need for high-quality experimental studies (e.g., RCTs, factorial designs, stepped-wedge designs, SMARTs and MRTs) to assess teledentistry’s clinical- and cost-effectiveness.
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Several studies show that logistics facilities have spread spatially from relatively concentrated clusters in the 1970s to geographically more decentralized patterns away from urban areas. The literature indicates that logistics costs are one of the major influences on changes in distribution structures, or locations and usage of logistics facilities. Quantitative modelling studies that aim to describe or predict these phenomena in relation to logistics costs are lacking, however. This is relevant to design more effective policies concerning spatial development, transport and infrastructure investments as well as for understanding environmental consequences of freight transport. The objective of this paper is to gain an understanding of the responsiveness of spatial logistics patterns to changes in these costs, using a quantitative model that links production and consumption points via distribution centers. The model is estimated to reproduce observed use of logistics facilities as well as related transport flows, for the case of the Netherlands. We apply the model to estimate the impacts of a number of scenarios on the spatial spreading of regional distribution activity, interregional vehicle movements and commodity flows. We estimate new cost elasticities, of the demand for trade and transport together, as well as specifically for the demand for the distribution facility services. The relatively low cost elasticity of transport services and high cost elasticity for the distribution services provide new insights for policy makers, relevant to understand the possible impacts of their policies on land use and freight flows.
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