Objective This study evaluated the budget impact of sacubitril/valsartan for treating heart failure with reduced ejection fraction compared with enalapril and assessed alternative funding mechanisms under decision uncertainty. Methods The study comprised 3 components. First, a decision tree and a Markov model were used to estimate the budget impact over a 5-year time horizon. The base-case adopted a payer perspective, including direct medical costs, whereas a scenario analysis incorporated direct non-medical and indirect costs. Second, a situation analysis identified key decision uncertainties. Third, an economic impact analysis evaluated alternative funding mechanisms relative to the current reimbursement system. Results In the base-case, the cumulative net budget impact was United States dollars (USD) 18.40 million. For the scenario analysis, the net economic impact decreased to USD 15.72 million, indicating a partial offset of the additional drug expenditure. The new treatment mix was estimated to avoid 300 heart failure hospitalizations and 146 cardiovascular deaths over 5 years. Key uncertainties included high budget requirements, limited epidemiological data, and variability in clinical outcomes. To address these, 2 funding mechanisms were explored: coverage with evidence development to reduce clinical uncertainty and a price-volume agreement with a capped budget to manage financial risk. Conclusion Sacubitril/valsartan increased total expenditure compared with the current treatment; however, savings from reduced hospitalizations and broader societal costs partially offset the additional drug cost. Sacubitril/valsartan may be a manageable option when implemented with coverage with evidence development and price-volume agreements, supporting financial sustainability and long-term health outcomes.
The World Health Organisation Resolution on Oral Health, the WHO Global Strategy and Action Plan on Oral Health 2023–2030, and the Bangkok Declaration of 2024 together mark an unprecedented convergence of global policy commitment, professional responsibility, and opportunity for oral health system reform. These instruments position oral health within the broader agendas of noncommunicable disease, primary health care, Sustainable Development Goal 3, and universal health coverage, and call for oral health systems that are integrated, prevention-oriented, equitable, accountable, and environmentally sustainable. The principal challenge now is implementation: translating these commitments into sustained action across diverse health system contexts. This review argues that implementation science provides the methodological and strategic foundation required to translate global oral health policy into sustained action. By distinguishing between evidence-based interventions and the strategies needed to adopt, adapt, scale, sustain, and, where necessary, de-implement them, implementation science can bridge the persistent evidence–practice gap in dentistry. It offers tools for strengthening governance, integrating oral health into primary health care, reallocating resources away from low-value care, embedding implementation outcomes in monitoring systems, accelerating translation through hybrid effectiveness–implementation designs, and ensuring that equity is measured rather than merely asserted. Advancing universal health coverage for oral health by 2030, requires context-sensitive, evidence-informed, and accountable execution. Implementation science should therefore be regarded as a core discipline for transforming global oral health policy into practice.
Ammonia (NH3) emissions from poultry production raise environmental and welfare concerns. This study developed porous clay–zeolite ceramic composite pellets using rice husk ash (RHA), ball clay, and zeolite NaX to mitigate the NH3 release from broiler bedding. Pellets with various RHA to ball clay weight ratios (60:40, 65:35 and 70:30) and additional zeolite (0–20 g into 100 g of the RHA/ball clay mix) were prepared and tested for NH3 gas adsorption in a sealed desiccator and verified by temperature-programmed desorption (TPD) and BET analysis. The pellet with the RHA: ball clay: zeolite weight ratio of 60:40:20 exhibited the highest specific surface area (102.10 m2/g) and achieved approximately 80% NH3 removal efficiency. Experimental results showed that the specific surface area of the prepared pellets increased significantly with higher zeolite and ball clay contents. Although higher RHA and zeolite contents slightly reduced mechanical strength and maintained water absorption, all pellets remained structurally stable and suitable for bedding purposes. These findings demonstrated the potential of porous clay-zeolite ceramics as effective bedding amendment for reducing NH3 emission in poultry production.
