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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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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OBJECTIVES: Knee osteoarthritis (OA) is characterized by its heterogeneity, with large differences in clinical characteristics between patients. Therefore, a stratified approach to exercise therapy, whereby patients are allocated to homogeneous subgroups and receive a stratified, subgroup-specific intervention, can be expected to optimize current clinical effects. Recently, we developed and pilot tested a model of stratified exercise therapy based on clinically relevant subgroups of knee OA patients that we previously identified. Based on the promising results, it is timely to evaluate the (cost-)effectiveness of stratified exercise therapy compared with usual, "nonstratified" exercise therapy.METHODS: A pragmatic cluster randomized controlled trial including economic and process evaluation, comparing stratified exercise therapy with usual care by physical therapists (PTs) in primary care, in a total of 408 patients with clinically diagnosed knee OA. Eligible physical therapy practices are randomized in a 1:2 ratio to provide the experimental (in 204 patients) or control intervention (in 204 patients), respectively. The experimental intervention is a model of stratified exercise therapy consisting of (a) a stratification algorithm that allocates patients to a "high muscle strength subgroup," "low muscle strength subgroup," or "obesity subgroup" and (b) subgroup-specific, protocolized exercise therapy (with an additional dietary intervention from a dietician for the obesity subgroup only). The control intervention will be usual best practice by PTs (i.e., nonstratified exercise therapy). Our primary outcome measures are knee pain severity (Numeric Rating Scale) and physical functioning (Knee Injury and Osteoarthritis Outcome Score subscale daily living). Measurements will be performed at baseline, 3-month (primary endpoint), 6-month (questionnaires only), and 12-month follow-up, with an additional cost questionnaire at 9 months. Intention-to-treat, multilevel, regression analysis comparing stratified versus usual care will be performed.CONCLUSION: This study will demonstrate whether stratified care provided by primary care PTs is effective and cost-effective compared with usual best practice from PTs.
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Long-term care facilities are currently installing dynamic lighting systems with the aim to improve the well-being and behaviour of residents with dementia. The aim of this study was to investigate the implementation of dynamic lighting systems from the perspective of stakeholders and the performance of the technology. Therefore, a questionnaire survey was conducted with the management and care professionals of six care facilities. Moreover, light measurements were conducted in order to describe the exposure of residents to lighting. The results showed that the main reason for purchasing dynamic lighting systems lied in the assumption that the well-being and day/night rhythmicity of residents could be improved. The majority of care professionals were not aware of the reasons why dynamic lighting systems were installed. Despite positive subjective ratings of the dynamic lighting systems, no data were collected by the organizations to evaluate the effectiveness of the lighting. Although the care professionals stated that they did not see any large positive effects of the dynamic lighting systems on the residents and their own work situation, the majority appreciated the dynamic lighting systems more than the old situation. The light values measured in the care facilities did not exceed the minimum threshold values reported in the literature. Therefore, it seems illogical that the dynamic lighting systems installed in the researched care facilities will have any positive health effects.
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Background: To facilitate adherence to adaptive pain management behaviors after interdisciplinary multimodal pain treatment, we developed a mobile health app (AGRIPPA app) that contains two behavior regulation strategies. Objective: The aims of this project are (1) to test the effectiveness of the AGRIPPA app on pain disability; (2) to determine the cost-effectiveness; and (3) to explore the levels of engagement and usability of app users. Methods: We will perform a multicenter randomized controlled trial with two parallel groups. Within the 12-month inclusion period, we plan to recruit 158 adult patients with chronic pain during the initial stage of their interdisciplinary treatment program in one of the 6 participating centers. Participants will be randomly assigned to the standard treatment condition or to the enhanced treatment condition in which they will receive the AGRIPPA app. Patients will be monitored from the start of the treatment program until 12 months posttreatment. In our primary analysis, we will evaluate the difference over time of pain-related disability between the two conditions. Other outcome measures will include health-related quality of life, illness perceptions, pain self-efficacy, app system usage data, productivity loss, and health care expenses. Results: The study was approved by the local Medical Research Ethics Committee in October 2019. As of March 20, 2020, we have recruited 88 patients. Conclusions: This study will be the first step in systematically evaluating the effectiveness and efficiency of the AGRIPPA app. After 3 years of development and feasibility testing, this formal evaluation will help determine to what extent the app will influence the maintenance of treatment gains over time. The outcomes of this trial will guide future decisions regarding uptake in clinical practice.
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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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The importance of teaching engineering students innovation development is commonly clearly understood. It is essential to achieve products which are attractive and profitable in the market. To achieve this, an institute of engineering education has to provide students with needed knowledge, skills and attitudes including both technical and business orientation. This is important especially for SME’s. Traditionally, education of engineering provides students with basic understanding how to solve common technical problems. However companies need wider view to achieve new products. Universities of applied Sciences in Oulu and Eindhoven want to research what is the today’s educational situation for this aim, to find criteria to improve the content of the educational system, and to improve the educational system. Important stakeholders are teachers and students within the institute but also key-persons in companies. The research is realized by questionnaires and interviews from which a current situation can be found. The research will also include the opinion of management who give possibilities to change the curriculum. By this research more insight will be presented about how to re-design a current curriculum. The research will act as basis for this discussion in SEFI-conference about formulating a curriculum that includes elements for wide-ranging knowledge and skills to achieve innovations especially in SME’s.
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The importance of teaching engineering students innovation development is commonly clearly understood. It is essential to achieve products which are attractive and profitable in the market. To achieve this, an institute of engineering education has to provide students with needed knowledge, skills and attitudes including both technical and business orientation. This is important especially for SME’s. Traditionally, education of engineering provides students with basic understanding how to solve common technical problems. However companies need wider view to achieve new products. Universities of applied Sciences in Oulu and Eindhoven want to research what is the today’s educational situation for this aim, to find criteria to improve the content of the educational system, and to improve the educational system. Important stakeholders are teachers and students within the institute but also key-persons in companies. The research is realized by questionnaires and interviews from which a current situation can be found. The research will also include the opinion of management who give possibilities to change the curriculum. By this research more insight will be presented about how to re-design a current curriculum. The research will act as basis for this discussion in SEFI-conference about formulating a curriculum that includes elements for wide-ranging knowledge and skills to achieve innovations especially in SME’s.
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Knowledge valorisation is the transfer of knowledge from one party to another for economic benefit. The concept of valorisation is based on the underlying metaphor of KNOWLEDGE AS A THING. It is the same metaphor that makes it possible to talk about the value of knowledge. If knowledge is like a ‘thing’, then that ‘ thing’ must have a specific value. Value can be defined as the degree of usefulness or desirability of something, especially in comparison with other things, and is by definition subjective. Value is in the eye of the beholder. Any valuation method therefore needs to take into account this subjective nature by deliberately choosing the appropriate ‘standard of value’ (value to whom?) and ‘premise of value’ (value under what circumstances?). There are three ways to determine the value of something of which financial valuation is the most used. In turn financial valuation can be done using a cost approach, a market approach or an income approach. In most cases the income approach is the most appropriate. However, this approach requires a number of assumptions to be made; most of which are impossible to validate. The formulas that are used in the process can be intimidating to non-experts with the danger of disguising the inherent subjective and speculative nature of any valuation of knowledge as a ‘thing’.
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The circular economy (CE) is heralded as reducing material use and emissions while providing more jobs and growth. We explored this narrative in a series of expert workshops, basing ourselves on theories, methods and findings from science fields such as global environmental input-output analysis, business modelling, industrial organisation, innovation sciences and transition studies. Our findings indicate that this dominant narrative suffers from at least three inconvenient truths. First, CE can lead to loss of GDP. Each doubling of product lifetimes will halve the related industrial production, while the required design changes may cost little. Second, the same mechanism can create losses of production jobs. This may not be compensated by extra maintenance, repair or refurbishing activities. Finally, ‘Product-as-a-Service’ business models supported by platform technologies are crucial for a CE transition. But by transforming consumers from owners to users, they lose independence and do not share in any value enhancement of assets (e.g., houses). As shown by Uber and AirBNB, platforms tend to concentrate power and value with providers, dramatically affecting the distribution of wealth. The real win-win potential of circularity is that the same societal welfare may be achieved with less production and fewer working hours, resulting in more leisure time. But it is perfectly possible that powerful platform providers capture most added value and channel that to their elite owners, at the expense of the purchasing power of ordinary people working fewer hours. Similar undesirable distributional effects may occur at the global scale: the service economies in the Global North may benefit from the additional repair and refurbishment activities, while economies in the Global South that are more oriented towards primary production will see these activities shrink. It is essential that CE research comes to grips with such effects. Furthermore, governance approaches mitigating unfair distribution of power and value are hence essential for a successful circularity transition.
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