Aim: This review summarizes the discounting approaches recommended in current economic evaluation (EE) guidelines for healthcare programs and interventions. Materials & methods: A systematic review of EE guidelines for healthcare, published up to July 2022, was conducted. Results: A total of 52 EE guidelines were reviewed. The majority of these guidelines recommend equal discounting (80.8%) rather than differential discounting (9.6%). The rationale for equal discounting includes recommendations by the government, consistency with other countries, and economic development. However, the rationale for differential discounting is based on the interest in short-term government bonds and anticipated budget changes. Discussion: This review demonstrates variation in both discounting approaches and rates across EE guidelines and underscores the need for a global consensus on discounting approaches.

Objective: To describe patterns and predictors of perinatal prescription stimulant use. Methods: We used MarketScan (R) commercial claims data (2013-2018) and a repeated cross-sectional study design to assess perinatal use of prescription stimulants. Clinical/demographic characteristics were compared across cohorts of women who continued versus discontinued stimulant treatment at various stages of pregnancy. Associations were tested for significance using chi-square tests (categorical variables) and independent t-tests (continuous variables). Results: Out of 612,001 pregnancies, 15,413 involved pre-pregnancy stimulant use. Of these, stimulant treatment was discontinued prior to conception in 6,416 (42%), discontinued during trimester I in 5,977 (39%), and continued into later trimesters in 3,020 (19%). Compared with pregnancies involving stimulant discontinuation prior to conception, those that continued into pregnancy occurred in women who were older (29.9 vs. 28.9years) and had more severe ADHD (3.1 vs. 1.8 ADHD-related billing claims). Conclusions: There is considerable heterogeneity in the management of ADHD during pregnancy.

Background: This study aimed to evaluate the cost-effectiveness of camrelizumab versus chemotherapy as second-line treatment for patients with advanced/metastatic esophageal squamous cell carcinoma (ESCC) from the perspective of the Chinese healthcare system. Methods: A trial-based Markov model was constructed using Excel to integrate clinical and economic data in a hypothetical cohort of advanced/metastatic ESCC patients with a 5-year time horizon. Clinical inputs were derived directly from the ESCORT trial (NCT03099382). Weibull distribution was used to fit transition probabilities extracted from the Kaplan-Meier curves. Cost inputs were estimated from the Beijing Medicine Sunshine Purchasing official website, local charges, publications and expert opinions. Deterministic and probabilistic sensitivity analyses were performed to test the robustness of the model results. Results: At 5 years, camrelizumab had higher quality-adjusted life years (QALYs) (0.782 vs. 0.499) and higher cost (US$31,537 vs. US$6,998) than chemotherapy. The incremental cost-effectiveness ratio (ICER) was estimated to be US$86,745 per QALY gained. The two primary parameters upon which this result was most sensitive were median overall survival of camrelizumab and camrelizumab cost. At a willingness-to-pay threshold of three times per capita gross domestic product (US$30,094 per QALY gained), the probability of camrelizumab being cost-effective was 33.7%. Conclusions: Camrelizumab was not cost-effective as a second-line treatment for advanced/metastatic ESCC patients in China compared with chemotherapy.

Abstract Background To compare illness characteristics, treatment history, response and durability, and suicidality scores over a 5-year period in patients with treatment-resistant bipolar depression participating in a prospective, multicenter, open-label registry and receiving Vagus Nerve Stimulation Therapy (VNS Therapy) plus treatment-as-usual (VNS + TAU) or TAU alone. Methods Response was defined as ≥ 50% decrease from baseline Montgomery–Åsberg Depression Rating Scale (MADRS) total score at 3, 6, 9, or 12 months post-baseline. Response was retained while MADRS score remained ≥ 40% lower than baseline. Time-to-events was estimated using Kaplan–Meier (KM) analysis and compared using log-rank test. Suicidality was assessed using the MADRS Item 10 score. Results At baseline (entry into registry), the VNS + TAU group (N = 97) had more episodes of depression, psychiatric hospitalizations, lifetime suicide attempts and higher suicidality score, more severe symptoms (based on MADRS and other scales), and higher rate of prior electroconvulsive therapy than TAU group (N = 59). Lifetime use of medications was similar between the groups (a mean of 9) and was consistent with the severe treatment-resistant nature of their depression. Over 5 years, 63% (61/97) in VNS + TAU had an initial response compared with 39% (23/59) in TAU. The time-to-initial response was significantly quicker for VNS + TAU than for TAU (p < 0.03). Among responders in the first year after implant, the KM estimate of the median time-to-relapse from initial response was 15.2 vs 7.6 months for VNS + TAU compared with TAU (difference was not statistically significant). The mean reduction in suicidality score across the study visits was significantly greater in the VNS + TAU than in the TAU group (p < 0.001). Conclusions The patients who received VNS + TAU included in this analysis had severe bipolar depression that had proved extremely difficult to treat. The TAU comparator group were similar though had slightly less severe illnesses on some measures and had less history of suicide attempts. Treatment with VNS + TAU was associated with a higher likelihood of attaining a response compared to TAU alone. VNS + TAU was also associated with a significantly greater mean reduction in suicidality. Limitations In this registry study, participants were not randomized to the study treatment group, VNS Therapy stimulation parameters were not controlled, and there was a high attrition rate over 5 years. Trial registration ClinicalTrials.gov NCT00320372. Registered 3 May 2006, https://clinicaltrials.gov/ct2/show/NCT00320372 (retrospectively registered)

Adherence to renin angiotensin system antagonists (RASA), non-insulin diabetes medications (NIDM) and statins has been included in the Medicare Star Ratings program since 2012. The long-term use of these measures emphasizes adherence to a limited number of chronic medications and may present opportunities for Part D plan sponsors to misuse the measures to influence their Medicare Part D Star Rating. It also does not capture the adherence needs of high-risk patients with multiple chronic conditions. The objective of this study was to describe the development of a new measure to capture adherence to multiple medications for chronic conditions (MMCC). The MMCC measure captures adherence to 71 different therapeutic categories of medication and was constructed using North Carolina Medicaid prescription claims data from 2015 to 2017. This measure was validated against the existing RASA, NIDM and statin adherence measures. This new measure was highly correlated with Star Rating measures, captured a greater number of eligible patients than these existing measures and had a lower proportion of patients meet the adherence threshold than the existing Star Ratings adherence measures. There is an opportunity to develop new measures, which include adherence to multiple medications in populations with multiple chronic conditions.

As discussed in Section 5.1, it is increasingly common today to use clusters of commodity hard-ware for large-scale ML. Advances in cloud computing have made it easier than ever to access computing resources. For example, a public cloud such as Amazon EC2 allows users to acquire a cluster on demand and pay only for its actual usage. There is a blossoming ecosystem of tools, libraries, and platforms for ML in the cloud and cluster computing settings. While it is beyond the scope of this book to survey this field in depth, we shall provide an overview of some key challenges and how ideas from the database research community have contributed to their solutions. With this overview, we hope to illustrate the various optimization possibilities enabled by different levels of abstraction, and in particular, opportunities that become possible by having declarative specifications in the spirit of database systems.

Apart from physical rewrites like caching or partitioning, and data representations discussed so far, there are several existing techniques for efficient data access in ML systems. These techniques bear strong similarity with corresponding data access methods in database systems, with the difference of focusing on dense and sparse matrices or tensors, as well as specific access patterns of ML workloads. In this chapter, we survey existing techniques for caching and buffer pool management (what to keep in memory), compression and data types (how to represent the data), Non-Uniform Memory Access (NUMA)-aware partitioning and replication (where to place the data), index structures (how to access the data), as well as side effects between these techniques.

This chapter explores various options for performing ML using a database system. Before we start, a valid question is why—at first glance, the relational model and query language seem to be a poor fit with ML, as most ML algorithms look very different from and oftentimes far more complicated than database queries. Thus, database systems have traditionally served as a data store for ML; the ML algorithm would pull the data out from the database, transform it into the appropriate format (e.g., matrices, tensors, or dataframes), and then analyze it using programs written in a different programming language. On the other hand, there are a number of compelling arguments for doing ML inside a database system.

OBJECTIVES: Despite data suggesting that patient-centered medical homes (PCMHs) improve preventive service use, limited nationally representative evidence exists. This study compared preventive service use between patients with and without a usual source of care (USC) and, of the patients with a USC, between those in practices with and without PCMH status. STUDY DESIGN: This study used a cross-sectional study design. METHODS: We constructed general and disease-specific preventive service indicators using the 2015 Medical Expenditure Panel Survey. Preventive service rates were compared between patients reporting a USC versus no USC and between patients whose USC practices were PCMH certified versus not PCMH certified. Unadjusted outcomes were tested using chi(2) tests. Multivariable logistic regression was used to test differences between groups, controlling for predisposing, enabling, and need variables. RESULTS: Using multivariable logistic regression, respondents with a USC reported higher rates of screening for breast cancer (odds ratio [OR], 2.40; 95% CI, 1.81-3.17) and cervical cancer (OR, 1.99; 95% CI, 1.61-2.471 than respondents with no USC. Diabetes respondents with a USC had higher odds of an annual eye exam (OR, 2.05; 95% CI, 1.26-3.33) than respondents with no USC. Diabetes respondents with a USC that was PCMH certified reported higher rates of annual foot screenings (OR, 2.01; 95% CI, 1.31-3.08) and lower rates of annual cholesterol screenings (OR, 0.30; 95% CI, 0.11-0.83) than those with a USC that was not PCMH certified. CONCLUSIONS: Having a USC was associated with higher rates of several preventive screening measures. However, there were fewer significant preventive screening relationships by PCMH status among individuals with a USC. Our results suggest that improving access to a USC may be as important as the application of PCMH principles to a USC practice.

So far, we primarily discussed compilation techniques in terms of rewrites and optimizations. A second major aspect of ML systems—but especially of large-scale ML systems—is the under-lying execution strategy. Generally, there are three categories. There are also hybrid approaches, which combine forms of these execution strategies. In this chapter, we provide an overview of these execution strategies, classify existing ML systems accordingly, and discuss interesting runtime techniques, including special runtime optimizers. Finally, in the context of deep learning, there is a trend toward exploiting accelerators such as GPUs, FPGAs, and custom ASICs for training and scoring, which is another specific hybrid execution strategy.

The present study is conducted on 70 tourists (35 Indian and 35 Foreign) in Haridwar and Rishikesh (Uttrakhand). The aims of the present study are to examine the level of spiritual intelligence and religiosity and to observe the relationship between these two variables. And also to identify the differences between Indian and foreign tourists at spiritual and religious level. Purposive sampling technique is used to select the sample from Haridwar and Rishikesh. Integrated Spiritual Intelligence Scale (ISIS) and general religiosity scale were used to observe the level of these variables among the tourists. The statistical analyses were done with the help of computer software SPSS. To observe relationship Pearson correlation and to find out the significance of the differences, t-test was used. Findings of the study revealed that there is no significant difference in level of spirituality in Indian and foreign tourists but there is difference in level of religiosity in Indian and foreign tourists. Indians were found to be significantly high on religiosity. No significant correlation has been found between spiritual intelligence and religiosity.

ABSTRACT Hydropower development on gravity-based drinking water supply pipelines in India has not been widely practiced, even at the micro-hydropower (MHP) scale. Site visits including measurements of pipeline flow and pressure were conducted at 12 schemes in Uttarakhand, and 3 were chosen for detailed analysis. Due to a complete lack of existing pressure control, the available drinking water flow would have to be reduced to enable retrofitting with MHP turbines. Technical and economic calculations were performed for a hypothetical 20% flow reduction, but showed electric power yields between just 1.2 and 3.9 kW and long payback periods between 8 and 24 years. The favoured alternative proposal is to incorporate the planning of MHP facilities into the inevitably necessary renovation and/or expansion of pipelines to both (1) meet future water demand and (2) enable the development of MHP. This hypothetical improved case showed an increase in electric power yield by a factor of 5 over the retrofitting case, and was recommended to the state water utility Uttarakhand Jal Sansthan.

Chronic lymphocytic leukemia (CLL) is an incurable disease affecting approx. 1 per 100,000 persons in mainland China. Ibrutinib has been recently compared with Rituximab in a clinical trial (Clinicaltrials.gov ID: NCT01973387) among the Chinese population with relapsed or refractory CLL. Ibrutinib has also been approved in China, but to the best of our knowledge, no economics evaluation of this treatment in the Chinese population has been carried out yet. Therefore, the objective of this study was to conduct the cost-effectiveness of Ibrutinib and Rituximab for the adult Chinese population with relapsed or refractory CLL. We constructed a decision tree analysis for a short-term time horizon (1 year), involving 3 health states: disease progression free, progressive disease, and death. A Chinese payer perspective was used for this analysis. Medication prices were obtained from the Chinese government system of centralized bidding procurement. All costs were inflated to the 2017 Chinese Yuan value. All other inputs and the probabilities for decision tree were calculated from the randomized controlled trial comparing Ibrutinib and Rituximab among the adult patients with relapsed or refractory CLL. The analysis was performed using TreeAge Pro 2017. One-year expenditure for Ibrutinib was 700,766 Chinese Yuan, compared to 95,611 Chinese Yuan of Rituximab. Incremental cost of Ibrutinib to reduce one event of death for one year was found to be 480,715 Chinese Yuan in this analysis. Based on the results of this analysis, the cost to prevent one death event for one year by Ibrutinib might be debatable.

OBJECTIVE:To evaluate the utilization of mobile phone technology for treatment adherence, prevention, education, data collection, monitoring long-term management of HIV/AIDS and TB patients.METHODS:Articles published in English language from January 2005 until now from PubMed/MEDLINE, EMBASE, Web of Science, WHO databases, and clinical trials were included. Data extraction is based on medication adherence, quality of care, prevention, education, motivation for HIV test, data collection from HIV lab test results and patient monitoring. Articles selected for the analysis cover RCTs and non RCTs related to the use of mobile phones for long-term care and treatment of HIV/AIDS and TB patients.RESULTS:Out of 90 articles selected for the analysis, a large number of studies, 44 (49%) were conducted in developing countries, 24 (26%) studies from developed countries, 12 (13%) are systematic reviews and 10 (11%) did not mention study location. Forty seven (52.2%) articles focused on treatment, 11 (12.2%) on quality of care, 8 (9%) on prevention, 13 (14.4%) on education, 6 (6.6%) on data collection, and 5 (5.5%) on patient monitoring. Overall, 66 (73%) articles reported positive effects, 21 (23%) were neutral and 3 (4%) reported negative results.CONCLUSIONS:Mobile phone technology is widely reported to be an effective tool for HIV/AIDS and TB long-term care. It can substantially reduce disease burden on health care systems by rendering more efficient prevention, treatment, education, data collection and management support.

Objectives: Elderly patients seem vulnerable to digoxin toxicity because of their diminished organ functions and tendency to encounter drug interactions. The aim of this research was to explore the extent of the concurrent use of digoxin with Chinese medications (CMs), its contributing factors, and the relevant consequences. Methods: A retrospective population-based cohort study was conducted using Longitudinal Health Insurance databases in Taiwan. Those elderly patients being prescribed with digoxin in outpatient settings in 2006 were evaluated for the incidence, prevalence, and duration of concurrent use with concentrated CMs in 2006. After 1:1 random matching to select the corresponding digoxin-only elderly users, univariate and multivariate logistic regression analyses were performed to explore factors associated with concomitant incident digoxin-CM use and incident digoxin-specific CM use. The relevant clinical and economic outcomes for a 3-month follow-up period from the initial exposure of incident digoxin-CM use were compared. Results: Of 185,076 elderly, 6,374 were prescribed with digoxin and 789 were CM-digoxin users in 2006. The prevalence and incidence of concomitant CM use among digoxin elderly users were 0.43% and 0.22%, respectively. Although the other factors were not statistically significantly associated with incident CM-digoxin use, patients with heart diseases and with benign prostate hypertrophy had an increased likelihood of incident CM-digoxin use of 115% and 102%, respectively. Almost all the concerned clinical and economic outcomes were not statistically significantly different between incident exposure or not, except for the use of potassium-sparing and nonsteroidal antiinflammatory drugs. Conclusions: There was a relatively low incidence of digoxin-CM use among the elderly in Taiwan. Although no significant effects on clinical and economic outcomes occurred, it is necessary to monitor potential side effects of digoxin more aggressively for those vulnerable elderly using digoxin with CMs, especially for those who tended to expose to incident digoxin-CM use elderly patients.