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Purpose This paper aims to investigate the usage of electronic resources within the Consortium of Academic and Research Libraries in Ghana (CARLIGH) in order to support subscription and budget decisions. This has become necessary because of the difficulty faced by institutions in paying subscription fee as a result of the continuous increase in subscription fee, financial constraints and high exchange rates. Design/methodology/approach The study is a quantitative research of electronic resource use covering six years. Full-text download statistics of ten most used electronic resources accessed by an average of 33 institutions were sampled from 27 databases and analysed to investigate level of usage. Six out of the ten electronic resources were analysed to evaluate cost per use over four years. Sampling was purposive. Data analysis and presentation were conducted using a descriptive method of analysis of simple frequency count, mean and percentages, while Microsoft Excel was used to organise data into tables and graphs. Findings Findings revealed an improved usage of CARLIGH-facilitated electronic resources. However, the rate of improvement declined by the year. Also, October and November recorded high usage, while January and May-August recorded low patronage. Finally, using a mean as a benchmark, it was ascertained that costs per use/article was less than $0.98. Research limitations/implications Because of limited data evaluated, the research results may lack generalisation; hence, there is a need for further research. Originality/value This study will be useful in supporting librarians’ decisions on continuous subscription, budget justification and promotion.

INTRODUCTION Libraries frequently support their open access (OA) fund using money from their collections budget. Interest in assessment of OA funds is arising. Cost per use is a common method to assess library collections expenditures. OA article processing charges (APCs) are a one-time cost for global, perpetual use. Article level metrics provide data on global, cumulative article level usage. This article examines a method and discusses the limitations and implications of using article level metrics to calculate cost per use for OA APCs. METHODS Using different APC models from two publishers, PLOS and BioMed Central, this article presents a cost per use formula for each model. RESULTS The formula for each model is demonstrated with available data. The examples suggest a very low cost per use for OA APCs after only three years. DISCUSSION Several limitations exist to obtaining article level data currently, including the nature of open access and accessibility of the data. OA articles’ usage levels are high and include use from altruistic access. Cost per use comparison with traditional publishing models is possible; however, comparison between different OA expenditures with very low costs per use may not be helpful. CONCLUSION Article level metrics can provide a means to measure cost per use of OA APCs. Libraries need increased access to article level usage data. They will also need to develop new benchmarks and expectations to evaluate APC payments, given higher usage levels for OA articles and considering altruistic access.

Publishing is changing rapidly, though these changes are concealed from academics, who are presented the appearances of the old world of print. The economic incentives and consequently the strategies of publishers have, however, changed. Where quality was once the road to profit, content now is, and novel digital delivery systems are the key to sales. Academic libraries have become storefronts for digital sales. Editors have become content collectors. At the same time publishing has attempted to mimic the accessibility of the web, shrinking the gap between \"publication\" and posting. This raises the question of what value is added by journal publication, and whether there is a justification for the huge cost. Some shorter and longer term perspectives suggest that the current value-added is linked to policies of evaluation, but that these may change.

Purpose The aim of this paper is to know the cost of per use, to analyze the cost per use in different subjects, to analyze the most economical as well as expensive electronic database being subscribed by the University of Delhi, to identify the database(s) for cancellation and to highlight issues related to usage statistics. Design/methodology/approach Usage statistics have been collected from the publishers for the period under study of full-text databases in the counting online usage of networked electronic resource (COUNTER) JR1 excluding downloads from an archive and Indian databases not providing COUNTER compliance usage. Usages of foreign databases have been analyzed through different parameters like yearly average cost per down load, subject-wise average cost per down, most economical databases and most expensive databases have been identified. A total approximation cost has also been worked by adopting standards practice to know the saving of University of Delhi by subscribing these databases. Findings The study concludes that in case of foreign databases, the cost per use has increased by 41.77 per cent in the past 10 years and the cumulative average cost per use has been Rs.55.07 less than $1 if converted into US$. In case of subject, the cheapest cost per use has been from the databases providing statistical data (Rs.26.50) and the costliest cost per use has been from discipline social science (99–196.61), followed by management (Rs.37.33), general databases (Rs.40.58), science (Rs.41.66), humanities (Rs.48.73), technology (Rs.93.22) and computer science (Rs.102.09) per use. It has also been found that the Britannica Online has been the most economical database costing Rs.2.33 and World Intellectual Property Search as most expensive costing Rs.14,902.19 per use. The study concludes that University of Delhi have saved substantial amount by subscribing these databases instead of purchasing these article from open market. The study concluded that though the usage statistics is an important parameter for renewal or cancellation, it should not be the only criteria. Research limitations/implications This study could not able to work out the cost per use of Indian databases, as they were not able to provide COUNTER statistics. Practical implications On the basis of the study, University of Delhi and institute may decide on renewal of these databases. The institute may take necessary action to promote these databases through information literacy program. On the basis of the study, University of Delhi and institute may decide on renewal of these databases. The institute may take necessary action to promote these databases through information literacy program. Originality/value This study is an empirical research based on original usage statistics provided by the publishers in COUNTER format. Earlier literature has also been studied and used. Proper citation and reference have been acknowledged. The study has been checked through plagiarism detecting software.

Purpose - This paper seeks to provide evidence that patron-driven acquisition is a successful collection development tool.Design methodology approach - The study used cost, usage, and cost per use as measurements to compare patron-driven acquired print and electronic books with traditionally acquired print and electronic books to determine the success of five different patron-driven methods.Findings - The study found that usage is much higher and the cost and cost per use is lower for patron-driven acquisition methods than for traditional collection development methods.Originality value - Collection development and acquisitions librarians can benefit from this research comparing traditional collection development methods with multiple patron-driven acquisitions methods to better manage their resources.

Many countries use the cost-effectiveness thresholds recommended by the World Health Organization's Choosing Interventions that are Cost-Effective project (WHO-CHOICE) when evaluating health interventions. This project sets the threshold for cost-effectiveness as the cost of the intervention per disability-adjusted life-year (DALY) averted less than three times the country's annual gross domestic product (GDP) per capita. Highly cost-effective interventions are defined as meeting a threshold per DALY averted of once the annual GDP per capita. We argue that reliance on these thresholds reduces the value of cost-effectiveness analyses and makes such analyses too blunt to be useful for most decision-making in the field of public health. Use of these thresholds has little theoretical justification, skirts the difficult but necessary ranking of the relative values of locally-applicable interventions and omits any consideration of what is truly affordable. The WHO-CHOICE thresholds set such a low bar for cost-effectiveness that very few interventions with evidence of efficacy can be ruled out. The thresholds have little value in assessing the trade-offs that decision-makers must confront. We present alternative approaches for applying cost-effectiveness criteria to choices in the allocation of health-care resources.

Ciltacabtagene autoleucel (cilta-cel) is a chimeric antigen receptor T-cell therapy approved for patients with relapsed/refractory multiple myeloma (RRMM). In the phase 3 trial, CARTITUDE-4 (NCT04181827), cilta-cel demonstrated improved efficacy vs. standard of care (SOC; daratumumab plus pomalidomide and dexamethasone [DPd] or pomalidomide plus bortezomib and dexamethasone [PVd]) with a ≥ complete response (≥CR) rate of 73.1% vs. 21.8%. A cost-per-responder model was developed to assess the value of cilta-cel and SOC (87% DPd and 13% PVd) based on the CARTITUDE-4 trial data from a US mixed payer perspective (76.7% commercial, 23.3% Medicare). The model was developed using progression-free survival (PFS), overall survival (OS), and ≥CR endpoints from CARTITUDE-4 over a period of 25.4 months. Inpatient stays, outpatient visits, drug acquisition, administration, and monitoring costs were included. The base-case model assumed an inpatient setting for each cilta-cel infusion; another scenario included 30% outpatient and 70% inpatient infusions. Costs of managing grade 3-4 adverse events (AEs) and grade 1-4 cytokine release syndrome and neurotoxicity were included. Subsequent therapy costs were incurred after disease progression; terminal care costs were considered upon death events. Outcomes included total cost per treated patient, total cost per complete responder, and cost per month in PFS between cilta-cel and SOC. Costs were adjusted to 2024 US dollars. Total cost per treated patient, total cost per complete responder, and total cost per month in PFS were estimated at $704,641, $963,941, and $30,978 for cilta-cel, respectively, and $840,730, $3,856,559, and $42,520 for SOC over the 25.4-month period. Cost drivers included treatment acquisition costs before progression and subsequent treatment costs ($451,318 and $111,637 for cilta-cel; $529,795 and $265,167 for SOC). A scenario analysis in which 30% of patients received an outpatient infusion (assuming the same payer mix) showed a lower cost per complete responder for cilta-cel ($956,523) than those with an infusion in the inpatient setting exclusively. This analysis estimated that cost per treated patient, cost per complete responder, and cost per month in PFS for cilta-cel were remarkably lower than for DPd or PVd, highlighting the substantial clinical and economic benefit of cilta-cel for patients with RRMM.

Background Approximately 97% of global deaths due to RSV occur in low- and middle-income countries (LMICs). Until recently, the only licensed preventive intervention has been a shortacting monoclonal antibody (mAb), palivizumab (PVZ) that is expensive and intensive to administer, making it poorly suited for low-resource settings. Currently, new longer acting RSV mAbs and maternal vaccines are emerging from late-stage clinical development with promising clinical effectiveness. However, evidence of economic value and affordability must also be considered if these interventions are to be globally accessible. This systematic review’s objective was to summarise existing evidence on the cost-of-illness (COI) and cost-effectiveness of RSV prevention interventions in LMICs. Methods We conducted a systematic literature review using the Embase, MEDLINE, and Global Index Medicus databases for publications between Jan 2000 and Jan 2022. Two categories of studies in LMICs were targeted: cost-of-illness (COI) of RSV episodes and cost-effectiveness analyses (CEA) of RSV preventive interventions including maternal vaccines and long-acting mAbs. Of the 491 articles reviewed, 19 met the inclusion criteria. Results COI estimates varied widely: for severe RSV, the cost per episode ranged from $92 to $4114. CEA results also varied—e.g. evaluations of long-acting mAbs found ICERs from $462/DALY averted to $2971/DALY averted. Study assumptions of input parameters varied substantially and their results often had wide confidence intervals. Conclusions RSV represents a substantial disease burden; however, evidence of economic burden is limited. Knowledge gaps remain regarding the economic value of new technologies specifically in LMICs. Further research is needed to understand the economic burden of childhood RSV in LMICs and reduce uncertainty about the relative value of anticipated RSV prevention interventions. Most CEA studies evaluated palivizumab with fewer analyses of interventions in development that may be more accessible for LMICs.

We aimed to investigate the cost-effectiveness of tislelizumab plus chemotherapy compared to chemotherapy alone as a first-line treatment for advanced or metastatic oesophageal squamous cell carcinoma (OSCC). A partitioned survival model was developed to evaluate the cost-effectiveness of tislelizumab plus chemotherapy versus chemotherapy alone in patients with advanced or metastatic OSCC over a 10-year lifetime horizon from the perspective of the Chinese healthcare system. Costs and utilities were derived from the drug procurement platform and published literature. The model outcomes comprised of costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were conducted to address uncertainty and ensure the robustness of the model. Tislelizumab plus chemotherapy yielded an additional 0.337 QALYs and incremental costs of $7,117.007 compared with placebo plus chemotherapy, generating an ICER of $21,116.75 per QALY, which was between 1 time ($12,674.89/QALY) and 3 times GDP ($38,024.67/QALY) per capita. In one-way sensitivity analysis, the ICER is most affected by the cost of oxaliplatin, paclitaxel and tislelizumab. In the probabilistic sensitivity analysis, when the willingness-to-pay threshold was set as 1 or 3 times GDP per capita, the probability of tislelizumab plus chemotherapy being cost-effective was 1% and 100%, respectively. Tislelizumab plus chemotherapy was probably cost-effective compared with chemotherapy alone as the first-line treatment for advanced or metastatic OSCC in China.

Background For hypertensive patients without a history of stroke or myocardial infarction (MI), the China Stroke Primary Prevention Trial (CSPPT) demonstrated that treatment with enalapril-folic acid reduced the risk of primary stroke compared with enalapril alone. Whether folic acid therapy is an affordable and beneficial treatment strategy for the primary prevention of stroke in hypertensive patients from the Chinese healthcare sector perspective has not been thoroughly explored. Methods We performed a cost-effectiveness analysis alongside the CSPPT, which randomized 20,702 hypertensive patients. A patient-level microsimulation model based on the 4.5-year period of in-trial data was used to estimate costs, life years, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) for enalapril-folic acid vs. enalapril over a lifetime horizon from the payer perspective. Results During the in-trial follow-up period, patients receiving enalapril-folic acid gained an average of 0.016 QALYs related primarily to reductions in stroke, and the incremental cost was $706.03 (4553.92 RMB). Over a lifetime horizon, enalapril-folic acid treatment was projected to increase quality-adjusted life years by 0.06 QALYs or 0.03 life-year relative to enalapril alone at an incremental cost of $1633.84 (10,538.27 RMB), resulting in an ICER for enalapril-folic acid compared with enalapril alone of $26,066.13 (168,126.54 RMB) per QALY gained and $61,770.73 (398,421.21 RMB) per life-year gained, respectively. A probabilistic sensitivity analysis demonstrated that enalapril-folic acid compared with enalapril would be economically attractive in 74.5% of simulations at a threshold of $37,663 (242,9281 RMB) per QALY (3x current Chinese per capita GDP). Several high-risk subgroups had highly favorable ICERs < $12,554 (80,976 RMB) per QALY (1x GDP). Conclusions For both in-trial and over a lifetime, it appears that enalapril-folic acid is a clinically and economically attractive medication compared with enalapril alone. Adding folic acid to enalapril may be a cost-effective strategy for the prevention of primary stroke in hypertensive patients from the Chinese health system perspective.