Schizophrenia is associated with a high familiar, social and economic burden. During the recent years early and specific intervention for first psychotic episodes has been suggested to improve the long term outcome of the disease. Despite the promising results obtained so far, early intervention is still scarcely applied. One major problem arises from the translation of research findings into stakeholder policies. In fact very few analyses of cost reductions obtained with early intervention have been reported. In the present paper we present a simulation of direct cost reduction that can be obtained with early intervention programmes. We based our analysis on available data about schizophrenia care costs in Italy and the expected cost reduction with the use of early intervention. We observed that the increase in costs due to the more intensive early intervention is largely compensated by the reduction of inpatient admissions with a reduction of direct costs of 6.01%. Despite the apparently small economic gain, early intervention offers more clinical and social benefits as it seems to be effective also in decreasing relapse rates, in improving the patients' quality of life and disability associated with psychosis and in increasing employment rates. Those indirect costs however are difficult to estimate and were not included in our model.

In conclusion, our study supports the use of early intervention in schizophrenia, which could allow an outcome improvement with lower direct and indirect costs.

The net benefit from investing in any technology is a function of the cost of implementation and the expected return in revenue. The objective of the present study was to quantify, using deterministic equations, the net monetary benefit from investing in genotyping of commercial females. Three case studies were presented reflecting dairy cows, beef cows and ewes based on Irish population parameters; sensitivity analyses were also performed. Parameters considered in the sensitivity analyses included the accuracy of genomic evaluations, replacement rate, proportion of female selection candidates retained as replacements, the cost of genotyping, the sire parentage error rate and the age of the female when it first gave birth. Results were presented as an annualised monetary net benefit over the lifetime of an individual, after discounting for the timing of expressions. In the base scenarios, the net benefit was greatest for dairy, followed by beef and then sheep. The net benefit improved as the reliability of the genomic evaluations improved and, in fact, a negative net benefit of genotyping was less frequent when the reliability of the genomic evaluations was high. The impact of a 10% point increase in genomic reliability was, however, greatest in sheep, followed by beef and then dairy. The net benefit of genotyping female selection candidates reduced as replacement rate increased. As genotyping costs increased, the net benefit reduced irrespective of the percentage of selection candidates kept, the replacement rate or even the population considered. Nonetheless, the association between the genotyping cost and the net benefit of genotyping differed by the percentage of selection candidates kept. Across all replacement rates evaluated, retaining 25% of the selection candidates resulted in the greatest net benefit when genotyping cost was low but the lowest net benefit when genotyping cost was high. Genotyping breakeven cost was non-linearly associated with the percentage of selection candidates retained, reaching a maximum when 50% of selection candidates were retained, irrespective of replacement rate, genomic reliability or the population. The genotyping breakeven cost was also non-linearly associated with replacement rate. The approaches outlined within provide the back-end framework for a decision support tool to quantify the net benefit of genotyping, once parameterised by the relevant population metrics.

In the above publication by Chen et al. (2017), the authors neglected to include that Dr. Zhang was supported by the 111 Project (Grant Number B16031) as part of their financial support and conflicts of interest. The complete corrected conflicts of interest section is provided below:

The authors report grants from the National Natural Science Foundation of China, grants from the National Science & Technology Pillar Program during the Twelfth Five-year Plan Period, and grants from the Key Discipline in Shanghai during the conduct of the study. Dr. Zhang was supported by the 111 Project (Grant Number B16031).

Regulatory impact analyses (RIAs) weigh the benefits of regulations against the burdens they impose and are invaluable tools for informing decision makers. We offer 10 tips for nonspecialist policymakers and interested stakeholders who will be reading RIAs as consumers.

1. 1. Core problem: Determine whether the RIA identifies the core problem (compelling public need) the regulation is intended to address.

2. 2. Alternatives: Look for an objective, policy-neutral evaluation of the relative merits of reasonable alternatives.

3. 3. Baseline: Check whether the RIA presents a reasonable “counterfactual” against which benefits and costs are measured.

4. 4. Increments: Evaluate whether totals and averages obscure relevant distinctions and trade-offs.

5. 5. Uncertainty: Recognize that all estimates involve uncertainty, and ask what effect key assumptions, data, and models have on those estimates.

6. 6. Transparency: Look for transparency and objectivity of analytical inputs.

7. 7. Benefits: Examine how projected benefits relate to stated objectives.

8. 8. Costs: Understand what costs are included.

9. 9. Distribution: Consider how benefits and costs are distributed.

10. 10. Symmetrical treatment: Ensure that benefits and costs are presented symmetrically.

Objectives: The aim of this study was to evaluate the universal newborn hearing screening (UNHS) and intervention program in Shanghai, China.

Methods: This study included the quantitative analyses of the UNHS-Shanghai database in 2002–12 and qualitative assessment of the program. The Otoacoustic Emissions and the Automated Auditory Brainstem Evoked Responses tests were conducted in screening. The costs and benefits were calculated based on the number of participants in each stage. The short-term and long-term periods were defined as from birth to 15 years of age or to death (82-year-olds), respectively. Sensitivity analyses were conducted.

Results: A total 1,574,380 newborns were included, representing 93.6 percent of all eligible babies in Shanghai during the study period. The prevalence of newborn hearing loss was 1.66‰. The short-term/long-term program costs were ¥488.5 million (US$75.52 million)/¥1.08 billion (US$167.12 million), and the short-term/long-term program benefit was ¥980.1 million (US$151.53 million)/¥8.13 billion (US$1.26 billion). The program benefit was greater than its cost if the proportion of hearing-loss children enrolled in regular schools was no less than 41.4 percent of all hearing impaired children, as well as if the wage growth rate ranged from 3 percent to 8 percent. Qualitative results also suggested that stakeholders strongly supported this program.

Conclusions: The universal newborn hearing screening and intervention program in Shanghai is justified in terms of the resource input in the long run, although there is still room for further improvement with respect to educational rehabilitation and a better infrastructure system.

Numerous regulatory reform proposals would require federal agencies to conduct more thorough economic analysis of proposed regulations or expand the resources and influence of the Office of Information and Regulatory Affairs (OIRA), which currently reviews executive branch regulations. Such reforms are intended to improve the quality of economic analysis agencies produce when they issue major regulations. We employ newly gathered data on variation in current administrative procedures to assess the likely effects of proposed regulatory process reforms on the quality of agencies’ regulatory impact analyses (RIAs). Our results suggest that greater use of advance notices of proposed rulemakings for major regulations, advance consultation with regulated entities, use of advisory committees, and expansion of OIRA’s resources and role would improve the quality of RIAs. They also suggest pre-proposal public meetings with stakeholders are associated with lower quality analysis.

The increasing number of invasive species and their effects on wildlife conservation, together with a lack of public resources, make it necessary to prioritize management actions. In practice, management decisions are often reached on the basis of subjective reasoning rather than scientific evidence. To develop a more evidence-based and efficient management of biological invasions, decision tools (e.g. multi-criteria frameworks) that help managers prioritize actions most efficiently are key. In this paper we review to what degree such decision tools are currently available. We used a literature search to identify relevant studies. Our analysis indicates that available studies are largely biased towards risk analysis and that only a few authors have proposed cost-benefit or multi-criteria frameworks for decision making. Until now, these frameworks have only been applied at limited regional scales but they could be applied more widely. Our review also shows critical biases in the geographical focus, habitats, and taxonomic groups of available studies. Most studies have focused on Europe, North America or Australia; other continents have largely been ignored. The majority of studies have focused on terrestrial plants; other habitats and taxonomic groups have been poorly covered. Most studies have focused on a single invasive species but practical management tools should consider a wide variety of invaders. We conclude with suggestions for developing improved decision tools.

A public plan for eradicating Salmonella in Danish table-egg production was implemented in 1996. During 2002, the poultry industry took over the responsibility of the programme. The proportion of infected layer flocks was reduced from 13·4% in 1998 to 0·4% in 2006. The public-health impact of the plan has been quite marked. In 1997, 55–65% of the 5015 cases of human salmonellosis were estimated to be associated with eggs. In 2006, these figures were reduced to 1658 and 5–7%, respectively. Based on an assessment of the number of human cases attributable to table eggs, we used probabilistic modelling to estimate the avoided societal costs (health care and lost labour), and compared these with the public costs of control. The probable avoided societal costs during 1998–2002 were estimated to be 23·3 million euros (95% CI 16·3–34·9), and the results showed a continuous decreasing cost–benefit ratio reaching well below 1 in 2002. Further reductions in the primary production based on effective surveillance and control are required to ensure continued success.

The ultimate goal of an organism is to maximise its inclusive fitness, and an important sub-goal must be the optimisation of the lifetime pattern of food intake, in order to meet the nutrient demands of survival, growth and reproduction. The conventional assumption that fitness is maximised by maximising daily food intake, subject to physical and physiological constraints, has been challenged recently. Instead, it can be argued that fitness is maximised by balancing benefits and costs over the organism's lifetime. The fitness benefits of food intake are a function of its contribution to survival, growth (including necessary body reserves) and reproduction. Against these benefits must be set costs. These costs include not only extrinsic foraging costs and risks, such as those due to predation, but also intrinsic costs associated with food intake, such as obesity and oxidative metabolism that may reduce vitality and lifespan. We argue that the aggregate of benefits and costs form the fitness function of food intake and present examples of such an approach to predicting optimal food intake.

Objective: To determine if a pre-assessment can be used to establish whether cost-effectiveness results would meet the actual information needs of Dutch healthcare decision makers.

Methods: Two recent studies in rehabilitation medicine served as study material. Based on Wholey, a limited pre-assessment was performed in which the potential impact of cost-effectiveness analysis (CEA) results on intended users' decision making was assessed. Desk research and semi-structured interviews with several intended users of CEA results were performed. These included general practitioners, representatives of health insurance companies, the Health Care Insurance Board (CvZ), and medical guidelines committees.

Results: In day-to-day decision making of the interviewed decision makers, a cost-effectiveness criterion seemed to be of limited importance. Instead, results from clinical effectiveness studies and budget impact studies appeared to be sufficient. CvZ, however, preferred relative cost-effectiveness to be a criterion for inclusion in future reimbursement guidelines. In both cases the limited pre-assessments changed the expectations of the investigators regarding decision-making impact of an economic evaluation.

Conclusion: This study revealed that the use of CEA results for Dutch micro- and meso-level healthcare decision making is not self-evident. The main purpose of CEA results is to support health policy making and planning at a macroeconomic level. Pre-assessment can be a valuable tool in designing a CEA to support the actual information needs of the decision makers.

Multiple myeloma is a disorder of the bone marrow that is associated with bone pain and osteolytic lesions. These complications can lead to the development of pathologic fractures and severe patient morbidity. However, the results of a recent randomized trial in patients with multiple myeloma demonstrated that single 90 mg monthly doses of pamidronate as an adjunct to chemotherapy reduced the incidence of skeletal-related events and improved patients' quality of life. A cost-benefit analysis using an ex-ante insurance willingness-to-pay (WTP) approach was conducted from a Canadian societal perspective to estimate the net cost or benefit of prophylactic pamidronate therapy for patients with multiple myeloma. This included direct costs for drug administration and hospital savings secondary to avoiding skeletal-related events. One hundred Canadian taxpayers were then interviewed to ascertain their maximum WTP for the benefits of pamidronate. The WTP survey instrument was simple to administer and easily understood by participants. Respondents stated that they would be willing to pay an average of Can $3,364 (95% CI: $2,096, $4,632) as an income tax increase to be paid over their lifetime for the value offered by the product. The benefit was then subtracted from the overall cost of nine monthly doses of pamidronate ($4,153) producing a net societal cost of $789 per patient (95% CI: (−$479, $2,057). The administration of monthly pamidronate therapy in multiple myeloma patients produces a situation of cost neutrality (societal benefits = costs). Additional clinical trials to identify high-risk patient subgroups that would most benefit from the drug are needed.