Comparing the cost-effectiveness of simulation modalities: a case study of peripheral intravenous catheterization training

While the ultimate goal of simulation training is to enhance learning, cost-effectiveness is a critical factor. Research that compares simulation training in terms of educational- and cost-effectiveness will lead to better-informed curricular decisions. Using previously published data we conducted a cost-effectiveness analysis of three simulation-based programs. Medical students (n = 15 per group) practiced in one of three 2-h intravenous catheterization skills training programs: low-fidelity (virtual reality), high-fidelity (mannequin), or progressive (consisting of virtual reality, task trainer, and mannequin simulator). One week later, all performed a transfer test on a hybrid simulation (standardized patient with a task trainer). We used a net benefit regression model to identify the most cost-effective training program via paired comparisons. We also created a cost-effectiveness acceptability curve to visually represent the probability that one program is more cost-effective when compared to its comparator at various ‘willingness-to-pay’ values. We conducted separate analyses for implementation and total costs. The results showed that the progressive program had the highest total cost (p < 0.001) whereas the high-fidelity program had the highest implementation cost (p < 0.001). While the most cost-effective program depended on the decision makers’ willingness-to-pay value, the progressive training program was generally most educationally- and cost-effective. Our analyses suggest that a progressive program that strategically combines simulation modalities provides a cost-effective solution. More generally, we have introduced how a cost-effectiveness analysis may be applied to simulation training; a method that medical educators may use to investment decisions (e.g., purchasing cost-effective and educationally sound simulators).     

What is the value of explicit priority setting for health interventions? A simulation study

Health Care Management Science - Many countries seek to secure efficiency in health spending through establishing explicit priority setting institutions (PSIs). Since such institutions divert...     

Home-based subcutaneous immunoglobulin therapy vs hospital-based intravenous immunoglobulin therapy: A prospective economic analysis

Background

Home-based subcutaneous immunoglobulin (SCIg) administration used for immunoglobulin replacement therapy for patients with primary immunodeficiency has been demonstrated to have benefits compared with hospital-based intravenous immunoglobulin (IVIg) therapy.

Impact of the 2004 Tsunami on Self-Reported Physical Health in Thailand for the Subsequent 2 Years

Objectives. We examined self-reported physical health during the first 2 years following the 2004 tsunami in Thailand.Methods. We assessed physical health with the revised Short Form Health Survey. We evaluated 6 types of tsunami exposure: personal injury, personal loss of home, personal loss of business, loss of family member, family member’s injury, and family’s loss of business. We examined the relationship between tsunami exposure and physical health with multivariate linear regression.Results. One year post-tsunami, we interviewed 1931 participants (97.2% response rate), and followed up with 1855 participants 2 years after the tsunami (96.1% follow-up rate). Participants with personal injury or loss of business reported poorer physical health than those unaffected (P < .001), and greater health impacts were found for women and older individuals.Conclusions. Exposure to the tsunami disaster adversely affected physical health, and its impact may last for longer than 1 year, which is the typical time when most public and private relief programs withdraw.At the end of Boxing Day in 2004, more than 5 million people were affected by one of the world’s worst natural disasters.1–3 An earthquake triggered a tsunami that affected 14 countries. In Thailand, the geographical focus of this study, more than 60 000 people in 6 southern provinces (Phuket, Phang Nga, Krabi, Ranong, Trang, and Satun) were directly affected.2,3 There were 3980 deaths and 6065 injuries.3,4Studies of the impact of a tsunami have focused primarily on mental health of those affected,5–10 with limited information on health service utilization11–13 and physical health.8,14 Previous investigations of physical health have focused on general physical health status, mortality, and nutritional status.14–19 Of those, there were 2 studies conducted in post-tsunami settings of Thailand.14,15 Two months after the tsunami, one study found that displaced individuals (those whose homes were affected by the disaster) reported significantly poorer physical health than unaffected individuals.14 The other study focused on Scandinavian tourists (from Norway, Denmark, and Sweden) who were in Thailand during the tsunami.15 The results indicated that, 14 months post-tsunami, being directly affected by the tsunami led to increased risk of musculoskeletal, cardiorespiratory, neurologic, and gastrointestinal health problems.The longer-term impact of the tsunami on Thai residents has not been previously examined. Hence, it is unclear whether the impacts of the tsunami on health are similar for those living in Thailand as for those who visited, and how long such physical impacts last. We report, here, the findings of a comparative study of self-reported physical health of those directly affected and those unaffected 1 and 2 years following the 2004 tsunami. Our findings could help public health officials in Thailand as well as add to the limited literature on the impacts of a disaster more than 1 year after it occurred.8,20–22     

Growth and capacity for cost‐effectiveness analysis in Africa

As economic evaluation becomes increasingly essential to support universal health coverage (UHC), we aim to understand the growth, characteristics, and quality of cost‐effectiveness analyses (CEA) conducted for Africa and to assess institutional capacity and relationship patterns among authors. We searched the Tufts Medical Center CEA Registries and four databases to identify CEAs for Africa. After extracting relevant information, we examined study characteristics, cost‐effectiveness ratios, individual and institutional contribution to the literature, and network dyads at the author, institution, and country levels. The 358 identified CEAs for Africa primarily focused on sub‐Saharan Africa (96%) and interventions for communicable diseases (77%). Of 2,121 intervention‐specific ratios, 8% were deemed cost‐saving, and most evaluated immunizations strategies. As 64% of studies included at least one African author, we observed widespread collaboration among international researchers and institutions. However, only 23% of first authors were affiliated with African institutions. The top producers of CEAs among African institutions are more adherent to methodological and reporting guidelines. Although economic evidence in Africa has grown substantially, the capacity for generating such evidence remains limited. Increasing the ability of regional institutions to produce high‐quality evidence and facilitate knowledge transfer among African institutions has the potential to inform prioritization decisions for designing UHC.