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Cost-effectiveness of healthy eating and/or physical activity promotion in pregnant women at increased risk of gestational diabetes mellitus: economic evaluation alongside the DALI study, a European multicenter randomized controlled trial
Background
Gestational diabetes mellitus (GDM) is associated with perinatal health risks to both mother and offspring, and represents a large economic burden. The DALI study is a multicenter randomized controlled trial, undertaken to add to the knowledge base on the effectiveness of interventions for pregnant women at increased risk for GDM. The purpose of this study was to evaluate the cost-effectiveness of the healthy eating and/or physical activity promotion intervention compared to usual care among pregnant women at increased risk of GDM from a societal perspective.
Methods
An economic evaluation was performed alongside a European multicenter-randomized controlled trial. A total of 435 pregnant women at increased risk of GDM in primary and secondary care settings in nine European countries, were recruited and randomly allocated to a healthy eating and physical activity promotion intervention (HE + PA intervention), a healthy eating promotion intervention (HE intervention), or a physical activity promotion intervention (PA intervention). Main outcome measures were gestational weight gain, fasting glucose, insulin resistance (HOMA-IR), quality adjusted life years (QALYs), and societal costs.
Results
Between-group total cost and effect differences were not significant, besides significantly less gestational weight gain in the HE + PA group compared with the usual care group at 35–37 weeks (−2.3;95%CI:-3.7;-0.9). Cost-effectiveness acceptability curves indicated that the HE + PA intervention was the preferred intervention strategy. At 35–37 weeks, it depends on the decision-makers’ willingness to pay per kilogram reduction in gestational weight gain whether the HE + PA intervention is cost-effective for gestational weight gain, whereas it was not cost-effective for fasting glucose and HOMA-IR. After delivery, the HE + PA intervention was cost-effective for QALYs, which was predominantly caused by a large reduction in delivery-related costs.
Conclusions
Healthy eating and physical activity promotion was found to be the preferred strategy for limiting gestational weight gain. As this intervention was cost-effective for QALYs after delivery, this study lends support for broad implementation.
Trial registration
ISRCTN
ISRCTN70595832
. Registered 2 December 2011.
Journal Article
Measuring the performance of public services : principles and practice
\"Measuring the performance of public agencies and programmes is essential to ensure that citizens enjoy quality services and that governments can be sure that taxpayers receive value for money. As such, good performance measurement is a crucial component of improvement and planning, monitoring and control, comparison and benchmarking and also ensures democratic accountability. This book shows how the principles, uses and practice of performance measurement for public services differ from those in for-profit organisations, being based on the need to add public value rather than profit. It describes methods and approaches for measuring performance through time, for constructing and using scorecards, composite indicators, the use of league tables and rankings and argues that data-envelopment analysis is a useful tool when thinking about performance. This demonstrates the importance of allowing for the multidimensional nature of performance, as well as the need to base measurement on a sound technical footing\" -- Provided by publisher.
Book
The costs of Suaahara II, a complex scaled‐up multisectoral nutrition programme in Nepal
Limited evidence exists on the costs of scaled‐up multisectoral nutrition programmes. Such evidence is crucial to assess intervention value and affordability. Evidence is also lacking on the opportunity costs of implementers and participants engaging in community‐level interventions. We help to fill this gap by estimating the full financial and economic costs of the United States Agency for International Development‐funded Suaahara II (SII) programme, a scaled‐up multisectoral nutrition programme in Nepal (2016–2023). We applied a standardized mixed methods costing approach to estimate total and unit costs over a 3.7‐year implementation period. Financial expenditure data from national and subnational levels were combined with economic cost estimates assessed using in‐depth interviews and focus group discussions with staff, volunteers, community members, and government partners in four representative districts. The average annual total cost was US $908,948 per district, with economic costs accounting for 47% of the costs. The annual unit cost was US$ 132 per programme participant (mother in the 1000‐day period between conception and a child's second birthday) reached. Annual costs ranged from US $152 (mountains) to US$ 118 (plains) per programme participant. Personnel (63%) were the largest input cost driver, followed by supplies (11%). Community events (29%) and household counselling visits (17%) were the largest activity cost drivers. Volunteer cadres contributed significant time to the programme, with female community health volunteers spending a substantial amount of time (27 h per month) on SII activities. Multisectoral nutrition programmes can be costly, especially when taking into consideration volunteer and participant opportunity costs. This study provides much‐needed evidence of the costs of scaled‐up multisectoral nutrition programmes for future comparison against benefits. The average unit cost of Suaahara II, a scaled up multisectoral nutrition programme covering 42 of 77 districts in Nepal, was US $132 per programme participant (mother in the 1000‐day period) and US$ 76 per mother–child pair reached per year. Community events designed to improve access to and demand for nutritious foods accounted for the largest share of activity costs (29%). Opportunity costs of volunteer and participant time are high, accounting for 47% of total costs. Female Community Health Workers, already engaged in community nutrition activities, spent significant time on implementing Suaahara II activities at 27 h per month. Complex multisectoral programmes often require significant resources to ensure coordination and sufficient technical support at national and subnational levels.
Journal Article
Coordinating internet sales with other channels : a performance measurement model
\"Since the Internet has become a common tool of daily life, many companies have introduced e-commerce channels in addition to their traditional sales channels. Such e-commerce channels typically share the same markets with traditional channels which exposes them to a set of chances and challenges. In order to benefit from the chances and to master the challenges of e-commerce, an appropriate performance measurement is essential. Andreas Pinterits develops a performance measurement system to cope with the different requirements of offline and online sales channels. The author discusses different methods for measuring customer channel switching behaviour during the purchasing process. Finally, he demonstrates the practical use of the model by a showcase implementation\"--Page 4 of cover.
Book
Cost-effectiveness of adult vaccinations: A systematic review
•Published studies report favorable cost-effectiveness profiles for adult vaccinations.•Some influenza, pneumococcal, and Td/Tdap evaluations report cost-savings.•Adult vaccines can prevent substantial morbidity, disability and death.
Coverage levels for many recommended adult vaccinations are low. The cost-effectiveness research literature on adult vaccinations has not been synthesized in recent years, which may contribute to low awareness of the value of adult vaccinations and to their under-utilization. We assessed research literature since 1980 to summarize economic evidence for adult vaccinations included on the adult immunization schedule.
We searched PubMed, EMBASE, EconLit, and Cochrane Library from 1980 to 2016 and identified economic evaluation or cost-effectiveness analysis for vaccinations targeting persons aged ≥18 years in the U.S. or Canada. After excluding records based on title and abstract reviews, the remaining publications had a full-text review from two independent reviewers, who extracted economic values that compared vaccination to “no vaccination” scenarios.
The systematic searches yielded 1688 publications. After removing duplicates, off-topic publications, and publications without a “no vaccination” comparison, 78 publications were included in the final analysis (influenza = 25, pneumococcal = 18, human papillomavirus = 9, herpes zoster = 7, tetanus-diphtheria-pertussis = 9, hepatitis B = 9, and multiple vaccines = 1). Among outcomes assessing age-based vaccinations, the percent indicating cost-savings was 56% for influenza, 31% for pneumococcal, and 23% for tetanus-diphtheria-pertussis vaccinations. Among age-based vaccination outcomes reporting $/QALY, the percent of outcomes indicating a cost per QALY of ≤$100,000 was 100% for influenza, 100% for pneumococcal, 69% for human papillomavirus, 71% for herpes zoster, and 50% for tetanus-diphtheria-pertussis vaccinations.
The majority of published studies report favorable cost-effectiveness profiles for adult vaccinations, which supports efforts to improve the implementation of adult vaccination recommendations.
Journal Article
Economic evaluation of vitamin D and calcium food fortification for fracture prevention in Germany
The study evaluates the economic benefit of population-wide vitamin D and Ca food fortification in Germany.
Based on a spreadsheet model, we compared the cost of a population-wide vitamin D and Ca food-fortification programme with the potential cost savings from prevented fractures in the German female population aged 65 years and older.
The annual burden of disease and the intervention cost were assessed for two scenarios: (i) no food fortification; and (ii) voluntary food fortification with 20 µg (800 IU) of cholecalciferol (vitamin D3) and 200 mg of Ca. The analysis considered six types of fractures: hip, clinical vertebral, humerus, wrist, other femur and pelvis.
Subgroups of the German population defined by age and sex.
The implementation of a vitamin D and Ca food-fortification programme in Germany would lead to annual net cost savings of €315 million and prevention of 36 705 fractures in the target population.
Vitamin D and Ca food fortification is an economically beneficial preventive health strategy that has the potential to reduce the future health burden of osteoporotic fractures in Germany. The implementation of a vitamin D and Ca food-fortification programme should be a high priority for German health policy makers because it offers substantial cost-saving potential for the German health and social care systems.
Journal Article
Performance management in the public sector
\"In times of rising expectations and decreasing resources for the public sector, performance management is high on the agenda. Increasingly, the value of the performance management systems themselves is under scrutiny, with more attention being paid to the effectiveness of performance management in practice. This new edition of Performance Management in the Public Sector explores performance, as well as performance measurement, and making performance information useful for management. The book includes: - situates performance in some of the current public management debates, including some emerging discussions on the new public governance and neo-Weberianism; - discusses the many definitions of performance and how it has become one of the most contested agendas of public management; - examines the use as well as the non-use of performance information; - conveys a nuanced discussion of the so-called perverse effects of using performance indicators; - discusses the technicalities of performance measurement in a five step process: prioritising measurement, indicator development, data collection, analysis and reporting; and - explores the challenges and future directions of performance management Performance Management in the Public Sector 2nd edition offers an approachable insight into a complex theme for practitioners and students alike. For scholars, the book directs attention to key research issues, most pressingly the use of performance information\"-- Provided by publisher.
Book
Monitoring Movements in Development Aid
InMonitoring Movements in Development Aid, Casper Jensen and Brit Winthereik consider the processes, social practices, and infrastructures that are emerging to monitor development aid, discussing both empirical phenomena and their methodological and analytical challenges. Jensen and Winthereik focus on efforts by aid organizations to make better use of information technology; they analyze a range ofdevelopment aid information infrastructurescreated to increase accountability and effectiveness. They find that constructing these infrastructures is not simply a matter of designing and implementing technology but entails forging new platforms for action that are simultaneously imaginative and practical, conceptual and technical. After presenting an analytical platform that draws on science and technology studies and the anthropology of development, Jensen and Winthereik present an ethnography- based analysis of the mutually defining relationship between aid partnerships and infrastructures; the crucial role of users (both actual and envisioned) in aid information infrastructures; efforts to make aid information dynamic and accessible; existing monitoring activities of an environmental NGO; and national-level performance audits, which encompass concerns of both external control and organizational learning.Jensen and Winthereik argue that central to the emerging movement to monitor development aid is the blurring of means and ends: aid information infrastructures are both technological platforms for knowledge about aid and forms of aid and empowerment in their own right.
eBook