This document discusses modelling the costs of antiretroviral therapy (ART) for HIV prevention. It summarizes a literature review of costing models for ART that included 45 publications. Few models considered the impact of ART on transmission. The review found that most models use simple cost accounting identities rather than flexible cost functions. Using flexible cost functions that account for factors like treatment characteristics, scale, experience and quality could provide more accurate long-term cost projections. An example shows how assuming increasing rather than constant returns to scale could increase projected costs of universal HIV testing and treatment in South Africa by up to 75%.
Cost profiles of colorectal cancer patients in Italy based on individual patt...Enrique Moreno Gonzalez
Due to changes in cancer-related risk factors, improvements in diagnostic procedures and treatments, and the aging of the population, in most developed countries cancer accounts for an increasing proportion of health care expenditures. The analysis of cancer-related costs is a topic of several economic and epidemiological studies and represents a research area of great interest to public health planners and policy makers. In Italy studies are limited either to some specific types of expenditures or to specific groups of cancer patients. Aim of the paper is to estimate the distribution of cancer survivors and associated health care expenditures according to a disease pathway which identifies three clinically relevant phases: initial (one year following diagnosis), continuing (between initial and final) and final (one year before death).
Graham was invited to the weekly seminar series by the Royal Brompton Hospital to deliver a presentation on health economics pertinent to Respiratory medicine. They care for a large number of patients with complex lung diseases at the institution and juggle the varied issues of resource (human, structural or financial). As one of many examples, high cost drugs for treating relatively unusual conditions comes up for debate all too frequently. The audience included consultant physicians, senior and junior trainees, nurses and other allied health professionals.
Date: 7 March 2019
Location: The Royal Brompton, London, UK
The document discusses challenges around access to medical devices from patients' perspectives across Europe. It notes a lack of transparency in pricing and reimbursement processes and criteria for medical devices. In Hungary specifically, prior to 2010 the reimbursement system for medical devices was non-transparent without clear criteria or patient involvement. A new regulation in 2010 introduced a point-based system for reimbursement decisions, but there is still no experience with how well it will work.
The European Science Foundation called for greater collaboration on medical imaging research across Europe. Medical imaging is a fast growing field but research is currently fragmented in Europe. Increased cooperation between universities, hospitals, imaging specialists, clinicians, and industry is needed. This would help realize the full potential of new technologies and improve patient care while keeping Europe competitive globally in medical imaging.
This study uses meta-regression analysis to estimate the optimal size of higher education institutions based on 21 previous studies. It finds an optimal institutional size of 24,954 students. The study also analyzes how institutional characteristics like being a public/private university, US/non-US, and sample size impact the optimal size. It suggests mergers could increase the size of some institution types but cautions that optimal sizes may vary in different contexts.
The author has been appointed as an Honorary Associate Professor at the MRC/Wits Developmental Pathways for Health Research Unit at the University of the Witwatersrand in Johannesburg, South Africa. This appointment will strengthen the ties between the research unit and the author's employer, Steno Health Promotion Research, where the author is a Senior Researcher part time. It will also allow the author to continue their engagement in research and research capacity building in low- and middle-income countries.
Dr René Uys has over 30 years of experience in academia and the private sector in South Africa. She holds a Doctorate in Business Administration and has held positions as a Dean, Professor, and Chief Director. Her areas of expertise include human resources management, organizational behavior, research methodology, and labour relations. She has authored several books and publications on these topics.
Ikegwuoha Chinenye Darlington provides their career profile, including educational background with degrees in civil/hydraulic engineering, job experience in engineering roles conducting design work, site inspections, and laboratory coordination, and personal skills including proficiency in design software, AutoCAD, Excel, and knowledge of structural design, hydraulics, and project management. They currently work as a technical officer and primary lecturer and seek to work in a productive firm relevant to societal development.
Cost profiles of colorectal cancer patients in Italy based on individual patt...Enrique Moreno Gonzalez
Due to changes in cancer-related risk factors, improvements in diagnostic procedures and treatments, and the aging of the population, in most developed countries cancer accounts for an increasing proportion of health care expenditures. The analysis of cancer-related costs is a topic of several economic and epidemiological studies and represents a research area of great interest to public health planners and policy makers. In Italy studies are limited either to some specific types of expenditures or to specific groups of cancer patients. Aim of the paper is to estimate the distribution of cancer survivors and associated health care expenditures according to a disease pathway which identifies three clinically relevant phases: initial (one year following diagnosis), continuing (between initial and final) and final (one year before death).
Graham was invited to the weekly seminar series by the Royal Brompton Hospital to deliver a presentation on health economics pertinent to Respiratory medicine. They care for a large number of patients with complex lung diseases at the institution and juggle the varied issues of resource (human, structural or financial). As one of many examples, high cost drugs for treating relatively unusual conditions comes up for debate all too frequently. The audience included consultant physicians, senior and junior trainees, nurses and other allied health professionals.
Date: 7 March 2019
Location: The Royal Brompton, London, UK
The document discusses challenges around access to medical devices from patients' perspectives across Europe. It notes a lack of transparency in pricing and reimbursement processes and criteria for medical devices. In Hungary specifically, prior to 2010 the reimbursement system for medical devices was non-transparent without clear criteria or patient involvement. A new regulation in 2010 introduced a point-based system for reimbursement decisions, but there is still no experience with how well it will work.
The European Science Foundation called for greater collaboration on medical imaging research across Europe. Medical imaging is a fast growing field but research is currently fragmented in Europe. Increased cooperation between universities, hospitals, imaging specialists, clinicians, and industry is needed. This would help realize the full potential of new technologies and improve patient care while keeping Europe competitive globally in medical imaging.
This study uses meta-regression analysis to estimate the optimal size of higher education institutions based on 21 previous studies. It finds an optimal institutional size of 24,954 students. The study also analyzes how institutional characteristics like being a public/private university, US/non-US, and sample size impact the optimal size. It suggests mergers could increase the size of some institution types but cautions that optimal sizes may vary in different contexts.
The author has been appointed as an Honorary Associate Professor at the MRC/Wits Developmental Pathways for Health Research Unit at the University of the Witwatersrand in Johannesburg, South Africa. This appointment will strengthen the ties between the research unit and the author's employer, Steno Health Promotion Research, where the author is a Senior Researcher part time. It will also allow the author to continue their engagement in research and research capacity building in low- and middle-income countries.
Dr René Uys has over 30 years of experience in academia and the private sector in South Africa. She holds a Doctorate in Business Administration and has held positions as a Dean, Professor, and Chief Director. Her areas of expertise include human resources management, organizational behavior, research methodology, and labour relations. She has authored several books and publications on these topics.
Ikegwuoha Chinenye Darlington provides their career profile, including educational background with degrees in civil/hydraulic engineering, job experience in engineering roles conducting design work, site inspections, and laboratory coordination, and personal skills including proficiency in design software, AutoCAD, Excel, and knowledge of structural design, hydraulics, and project management. They currently work as a technical officer and primary lecturer and seek to work in a productive firm relevant to societal development.
Economic burden of periodontal disease management msp madphsUKM
This document summarizes a presentation on estimating the economic burden of periodontal disease in Malaysia. It finds that periodontal disease imposes a substantial cost on the healthcare system and economy. Treating the estimated 11.5 million Malaysian adults with periodontitis would cost approximately RM 32.5 billion annually, or 3.83% of Malaysia's GDP. Costs increase with disease severity and need for surgical treatment. The study aims to raise awareness of this neglected disease and its negative economic impacts to inform policymakers and encourage prevention and early treatment.
2 tool to estimate patient costs literature review_finalAira Bhabe
This document provides a literature review and conceptual framework for developing a tool to estimate patient costs of tuberculosis. It discusses approaches used to measure the cost of illness, including direct costs like medical expenses and indirect costs from lost income. The review found studies on patient costs in various stages: before diagnosis, during diagnosis/pre-treatment, and during treatment. Developing the cost estimation tool will help programs understand economic barriers patients face and design interventions to reduce costs and alleviate poverty. The tool aims to assess the impoverishing impact of tuberculosis and establish evidence for poverty reduction strategies.
The document discusses evaluating the cost-effectiveness of diagnostic tests through modeling. It provides an overview of how cost-effectiveness analyses are applied to determine if a diagnostic test represents value for money. The modeling requires estimating test accuracy, modeling patient outcomes for different test results, and calculating an incremental cost-effectiveness ratio to compare the new test to current practice. It provides an example of modeling different diagnostic strategies for deep vein thrombosis.
This document discusses key concepts in pharmacoeconomics and health economics. It explains that health economists evaluate health programs and treatments to determine their costs and benefits, including outcomes like quality-adjusted life years gained and incremental cost-effectiveness ratios. Health economists aim to maximize health benefits for populations within limited healthcare budgets. Their analyses can inform decisions around appropriate levels of healthcare spending and which interventions provide good value for money.
1) A study found that earlier antiretroviral therapy (ART) initiation significantly reduced HIV transmission between couples.
2) Modeling by the CDC showed that accelerating ART scale-up in Kenya to treat 900,000 people by 2015 could reduce new HIV infections by 31% and lower costs compared to the current approach.
3) For Kenya to achieve these benefits, guidelines and budgets need to be updated to accelerate treatment scale-up, including treating all serodiscordant couples and pregnant/nursing women, starting new and more effective drugs, and initiating ART earlier.
This document summarizes research on scaling up antiretroviral therapy (ART) in resource-limited countries. It discusses using cost-effectiveness analysis to evaluate the value of ART programs in Côte d'Ivoire, India, and South Africa. The research finds that providing both first-line and second-line ART is cost-effective in these countries. It also finds that earlier initiation of ART in South Africa increases survival and is cost-effective. Faster scale-up of ART programs can significantly reduce AIDS-related deaths.
Antiretroviral Therapy in Botswana: Comparing Costs, Service Utilization, and...HFG Project
Under Botswana’s ambitious Treat All Strategy, nearly 350,000 people living with HIV will require antiretroviral therapy (ART) by 2020. With almost half of Botswana’s health expenditure already allocated to HIV, the Ministry of Health (MOH) will need to mobilize additional resources and achieve efficient use of available resources to sustain successful ART coverage. To support the MOH, the USAID-funded Health Finance and Governance project (HFG) estimated costs and service utilization of adult outpatient ART care at Botswana’s public health facilities. With patient numbers already rising under “Treat All,” understanding the current cost variations is essential to identify opportunities to improve efficiency and for the future sustainability of Botswana’s ART programming.
Scaling up the economic life of PLHIV an Islamic microfinance approach by Kha...Hidzuan Hashim
This document summarizes the socioeconomic impacts of HIV/AIDS in Malaysia based on a study. It finds that HIV/AIDS has substantial economic impacts costing the country around 0.11% of GDP in 2007. This includes healthcare costs, patient out-of-pocket costs, and lost productivity. The study also finds psychosocial impacts like increased rates of non-marriage, children being prohibited from playing with patients' children, and internal migration of patients. It recommends establishing a research committee to guide further study and developing microfinance programs customized for HIV/AIDS households.
This document summarizes presentations and discussions from a working group meeting between the EU and US to propose standards for measuring antimicrobial use in hospitals. It was noted that while surveillance of hospital antimicrobial consumption is becoming more widespread, challenges remain in harmonizing measurement methods between regions. Key challenges include determining the best data sources, units of measurement, and ways to account for differences in patient case mix between hospitals. The group discussed various approaches used in the US and EU and potential standardized indicators, but recognized further work is still needed to develop truly comparable data across multiple healthcare settings and jurisdictions.
The past few years have heralded much excitement around the uses of Point of Care Testing (PoCT). With advancements in electronics, the miniaturization and digitization of technology has spilled over into the realm of medical diagnostics. Through portable, transportable and handheld instruments, PoCT is the ability to bring the diagnostic capabilities of a laboratory to the patients’ bedsides. It is effectively a potential solution to some of the health problems that India faces, especially in the context of the heavy burden of infectious diseases that plagues it and its large rural population with limited or no access to testing facilities.
Disease cost drivers hai apec hlm nusa dua 2013sandraduhrkopp
Healthcare-associated infections (HAIs) occur in hundreds of millions of patients each year globally, causing increased illness, death and costs. HAIs typically involve four types of infections and rates are usually higher in developing countries. HAIs prolong hospital stays by up to 3 weeks and increase costs by USD $4,888 to $11,591 per infection episode. It is estimated that 65-70% of HAIs are preventable. While preventing HAIs requires initial investment, it can free up hospital beds and resources in the long-run, improving outcomes and making more efficient use of limited healthcare funds.
This document discusses healthcare-associated infections (HAIs) and presents information from AdvaMed. It notes that HAIs occur worldwide and affect hundreds of millions annually, increasing morbidity, mortality, and costs. Up to 90% of HAI deaths in the US are caused by multi-drug resistant organisms. Surveillance shows HAI incidence is 3 times higher in developing economies compared to EU/US. HAIs lead to prolonged hospital stays and increased costs. Prevention through evidence-based interventions could reduce HAIs by 65-70% and save resources. Strong infection control including surveillance is needed to combat HAIs and antimicrobial resistance.
What eHealth strategies work and do not work, and what should be implemented to effectively meet these healthcare “transformational” imperatives?. Crawford J. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
Validation studies are essential to accurately assess the sensitivity, specificity, and predictive values of point prevalence surveys (PPS) of healthcare-associated infections (HAI). Previous validation studies of PPS have shown varied results, underscoring the need for formal evaluations. Without validation, true HAI prevalence is unknown and differences between locations cannot be properly investigated. International organizations can help support national validation efforts to improve HAI surveillance.
The document discusses WHO and working for WHO. It begins by outlining that the views expressed are those of the individual presenter and not necessarily WHO's official views. It then provides an overview of WHO as an organization, including that it is a UN agency established in 1948 with 194 member states and headquarters in Geneva. The rest of the document discusses Universal Health Coverage (UHC), what it means to achieve UHC, and advice for those interested in global health careers.
11 economic evidence of interventions for acute myocardial infarction a revie...NPSAIC
The document reviews 14 studies that evaluate the cost-effectiveness of primary angioplasty (PPCI) versus thrombolysis (TL) for treating acute myocardial infarction (AMI). Most studies found PPCI to be cost-effective compared to TL, though some found it cost-saving or cost-neutral. The cost-effective evidence is mainly from randomized controlled trials with strict inclusion criteria and established catheter labs, which may limit generalizability. More real-world analyses evaluating multiple strategies for delivering PPCI are needed to better inform policymakers.
Impact and cost effectivene of rotavirus vaccine introduction in afghanistanNajibullah Safi
This document provides a summary of a cost-effectiveness analysis of introducing rotavirus vaccination in Afghanistan. The analysis finds that vaccination would be highly cost-effective compared to no vaccination. It estimates that over 10 years, vaccination could avert over 1 million cases, 661,000 outpatient visits, 49,000 hospitalizations and nearly 12,000 deaths. The incremental cost per disability-adjusted life year averted is estimated to be $103-$59 depending on perspective, below Afghanistan's GDP per capita threshold for cost-effectiveness. Sensitivity analysis showed results were robust to varying parameters like disease burden and vaccine price. The document discusses limitations and next steps to support government adoption of vaccination.
Therapeutic interchange in hemophilia aupdatedRoohee Peerzada
This document summarizes a study comparing the therapeutic interchange of plasma-derived factor VIII (pdFVIII) and recombinant factor VIII (rFVIII) for the treatment of Hemophilia A. The study analyzed the safety, efficacy, and costs of various pdFVIII and rFVIII products. It found that while rFVIII products had a slightly higher risk of inhibitor development, the cost difference between rFVIII and pdFVIII products could amount to over $4 million more for rFVIII over a patient's lifetime. However, both classes of products showed similar efficacy in clinical trials. The study concluded that therapeutic interchange between pdFVIII and rFVIII is a viable option to reduce costs while maintaining patient outcomes for
The document discusses the evolving pharmaceutical industry model and whether it is "fit for purpose or broken". It summarizes that while R&D costs per new drug are rising and productivity seems to be falling, the industry model is not truly broken but rather changing in response to challenges. Key changes include R&D shifting to diseases important to payers, industry consolidation, and adaptive pathways being developed between industry, payers, and regulators for patient access and evidence collection. While affordability issues arise from both a potentially broken model and successful adaptation, both high returns on R&D and reasonable drug prices must be addressed to sustain innovation.
The University of California San Francisco East Africa Office will host its 6th biannual scientific symposium in Kampala, Uganda on July 11-12, 2014 focused on translational science. Keynote speakers will discuss topics related to malaria, HIV, cancer, and pharmacokinetics. The symposium seeks oral presentation and research proposal abstracts on translational science projects addressing malaria, HIV, HIV comorbidities, and HIV pharmacokinetics. Abstracts are due by May 12, 2014, with prizes awarded for best presentation and proposal.
This document provides instructions for filling out an emergency card for international travel. It includes sections for emergency contact numbers in the destination country, travel insurance information, contacts at the destination institution and UCSF, personal medical information, and additional emergency contacts aware of the travel. The example card shows how to fill out each section with relevant details.
Economic burden of periodontal disease management msp madphsUKM
This document summarizes a presentation on estimating the economic burden of periodontal disease in Malaysia. It finds that periodontal disease imposes a substantial cost on the healthcare system and economy. Treating the estimated 11.5 million Malaysian adults with periodontitis would cost approximately RM 32.5 billion annually, or 3.83% of Malaysia's GDP. Costs increase with disease severity and need for surgical treatment. The study aims to raise awareness of this neglected disease and its negative economic impacts to inform policymakers and encourage prevention and early treatment.
2 tool to estimate patient costs literature review_finalAira Bhabe
This document provides a literature review and conceptual framework for developing a tool to estimate patient costs of tuberculosis. It discusses approaches used to measure the cost of illness, including direct costs like medical expenses and indirect costs from lost income. The review found studies on patient costs in various stages: before diagnosis, during diagnosis/pre-treatment, and during treatment. Developing the cost estimation tool will help programs understand economic barriers patients face and design interventions to reduce costs and alleviate poverty. The tool aims to assess the impoverishing impact of tuberculosis and establish evidence for poverty reduction strategies.
The document discusses evaluating the cost-effectiveness of diagnostic tests through modeling. It provides an overview of how cost-effectiveness analyses are applied to determine if a diagnostic test represents value for money. The modeling requires estimating test accuracy, modeling patient outcomes for different test results, and calculating an incremental cost-effectiveness ratio to compare the new test to current practice. It provides an example of modeling different diagnostic strategies for deep vein thrombosis.
This document discusses key concepts in pharmacoeconomics and health economics. It explains that health economists evaluate health programs and treatments to determine their costs and benefits, including outcomes like quality-adjusted life years gained and incremental cost-effectiveness ratios. Health economists aim to maximize health benefits for populations within limited healthcare budgets. Their analyses can inform decisions around appropriate levels of healthcare spending and which interventions provide good value for money.
1) A study found that earlier antiretroviral therapy (ART) initiation significantly reduced HIV transmission between couples.
2) Modeling by the CDC showed that accelerating ART scale-up in Kenya to treat 900,000 people by 2015 could reduce new HIV infections by 31% and lower costs compared to the current approach.
3) For Kenya to achieve these benefits, guidelines and budgets need to be updated to accelerate treatment scale-up, including treating all serodiscordant couples and pregnant/nursing women, starting new and more effective drugs, and initiating ART earlier.
This document summarizes research on scaling up antiretroviral therapy (ART) in resource-limited countries. It discusses using cost-effectiveness analysis to evaluate the value of ART programs in Côte d'Ivoire, India, and South Africa. The research finds that providing both first-line and second-line ART is cost-effective in these countries. It also finds that earlier initiation of ART in South Africa increases survival and is cost-effective. Faster scale-up of ART programs can significantly reduce AIDS-related deaths.
Antiretroviral Therapy in Botswana: Comparing Costs, Service Utilization, and...HFG Project
Under Botswana’s ambitious Treat All Strategy, nearly 350,000 people living with HIV will require antiretroviral therapy (ART) by 2020. With almost half of Botswana’s health expenditure already allocated to HIV, the Ministry of Health (MOH) will need to mobilize additional resources and achieve efficient use of available resources to sustain successful ART coverage. To support the MOH, the USAID-funded Health Finance and Governance project (HFG) estimated costs and service utilization of adult outpatient ART care at Botswana’s public health facilities. With patient numbers already rising under “Treat All,” understanding the current cost variations is essential to identify opportunities to improve efficiency and for the future sustainability of Botswana’s ART programming.
Scaling up the economic life of PLHIV an Islamic microfinance approach by Kha...Hidzuan Hashim
This document summarizes the socioeconomic impacts of HIV/AIDS in Malaysia based on a study. It finds that HIV/AIDS has substantial economic impacts costing the country around 0.11% of GDP in 2007. This includes healthcare costs, patient out-of-pocket costs, and lost productivity. The study also finds psychosocial impacts like increased rates of non-marriage, children being prohibited from playing with patients' children, and internal migration of patients. It recommends establishing a research committee to guide further study and developing microfinance programs customized for HIV/AIDS households.
This document summarizes presentations and discussions from a working group meeting between the EU and US to propose standards for measuring antimicrobial use in hospitals. It was noted that while surveillance of hospital antimicrobial consumption is becoming more widespread, challenges remain in harmonizing measurement methods between regions. Key challenges include determining the best data sources, units of measurement, and ways to account for differences in patient case mix between hospitals. The group discussed various approaches used in the US and EU and potential standardized indicators, but recognized further work is still needed to develop truly comparable data across multiple healthcare settings and jurisdictions.
The past few years have heralded much excitement around the uses of Point of Care Testing (PoCT). With advancements in electronics, the miniaturization and digitization of technology has spilled over into the realm of medical diagnostics. Through portable, transportable and handheld instruments, PoCT is the ability to bring the diagnostic capabilities of a laboratory to the patients’ bedsides. It is effectively a potential solution to some of the health problems that India faces, especially in the context of the heavy burden of infectious diseases that plagues it and its large rural population with limited or no access to testing facilities.
Disease cost drivers hai apec hlm nusa dua 2013sandraduhrkopp
Healthcare-associated infections (HAIs) occur in hundreds of millions of patients each year globally, causing increased illness, death and costs. HAIs typically involve four types of infections and rates are usually higher in developing countries. HAIs prolong hospital stays by up to 3 weeks and increase costs by USD $4,888 to $11,591 per infection episode. It is estimated that 65-70% of HAIs are preventable. While preventing HAIs requires initial investment, it can free up hospital beds and resources in the long-run, improving outcomes and making more efficient use of limited healthcare funds.
This document discusses healthcare-associated infections (HAIs) and presents information from AdvaMed. It notes that HAIs occur worldwide and affect hundreds of millions annually, increasing morbidity, mortality, and costs. Up to 90% of HAI deaths in the US are caused by multi-drug resistant organisms. Surveillance shows HAI incidence is 3 times higher in developing economies compared to EU/US. HAIs lead to prolonged hospital stays and increased costs. Prevention through evidence-based interventions could reduce HAIs by 65-70% and save resources. Strong infection control including surveillance is needed to combat HAIs and antimicrobial resistance.
What eHealth strategies work and do not work, and what should be implemented to effectively meet these healthcare “transformational” imperatives?. Crawford J. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
Validation studies are essential to accurately assess the sensitivity, specificity, and predictive values of point prevalence surveys (PPS) of healthcare-associated infections (HAI). Previous validation studies of PPS have shown varied results, underscoring the need for formal evaluations. Without validation, true HAI prevalence is unknown and differences between locations cannot be properly investigated. International organizations can help support national validation efforts to improve HAI surveillance.
The document discusses WHO and working for WHO. It begins by outlining that the views expressed are those of the individual presenter and not necessarily WHO's official views. It then provides an overview of WHO as an organization, including that it is a UN agency established in 1948 with 194 member states and headquarters in Geneva. The rest of the document discusses Universal Health Coverage (UHC), what it means to achieve UHC, and advice for those interested in global health careers.
11 economic evidence of interventions for acute myocardial infarction a revie...NPSAIC
The document reviews 14 studies that evaluate the cost-effectiveness of primary angioplasty (PPCI) versus thrombolysis (TL) for treating acute myocardial infarction (AMI). Most studies found PPCI to be cost-effective compared to TL, though some found it cost-saving or cost-neutral. The cost-effective evidence is mainly from randomized controlled trials with strict inclusion criteria and established catheter labs, which may limit generalizability. More real-world analyses evaluating multiple strategies for delivering PPCI are needed to better inform policymakers.
Impact and cost effectivene of rotavirus vaccine introduction in afghanistanNajibullah Safi
This document provides a summary of a cost-effectiveness analysis of introducing rotavirus vaccination in Afghanistan. The analysis finds that vaccination would be highly cost-effective compared to no vaccination. It estimates that over 10 years, vaccination could avert over 1 million cases, 661,000 outpatient visits, 49,000 hospitalizations and nearly 12,000 deaths. The incremental cost per disability-adjusted life year averted is estimated to be $103-$59 depending on perspective, below Afghanistan's GDP per capita threshold for cost-effectiveness. Sensitivity analysis showed results were robust to varying parameters like disease burden and vaccine price. The document discusses limitations and next steps to support government adoption of vaccination.
Therapeutic interchange in hemophilia aupdatedRoohee Peerzada
This document summarizes a study comparing the therapeutic interchange of plasma-derived factor VIII (pdFVIII) and recombinant factor VIII (rFVIII) for the treatment of Hemophilia A. The study analyzed the safety, efficacy, and costs of various pdFVIII and rFVIII products. It found that while rFVIII products had a slightly higher risk of inhibitor development, the cost difference between rFVIII and pdFVIII products could amount to over $4 million more for rFVIII over a patient's lifetime. However, both classes of products showed similar efficacy in clinical trials. The study concluded that therapeutic interchange between pdFVIII and rFVIII is a viable option to reduce costs while maintaining patient outcomes for
The document discusses the evolving pharmaceutical industry model and whether it is "fit for purpose or broken". It summarizes that while R&D costs per new drug are rising and productivity seems to be falling, the industry model is not truly broken but rather changing in response to challenges. Key changes include R&D shifting to diseases important to payers, industry consolidation, and adaptive pathways being developed between industry, payers, and regulators for patient access and evidence collection. While affordability issues arise from both a potentially broken model and successful adaptation, both high returns on R&D and reasonable drug prices must be addressed to sustain innovation.
The University of California San Francisco East Africa Office will host its 6th biannual scientific symposium in Kampala, Uganda on July 11-12, 2014 focused on translational science. Keynote speakers will discuss topics related to malaria, HIV, cancer, and pharmacokinetics. The symposium seeks oral presentation and research proposal abstracts on translational science projects addressing malaria, HIV, HIV comorbidities, and HIV pharmacokinetics. Abstracts are due by May 12, 2014, with prizes awarded for best presentation and proposal.
This document provides instructions for filling out an emergency card for international travel. It includes sections for emergency contact numbers in the destination country, travel insurance information, contacts at the destination institution and UCSF, personal medical information, and additional emergency contacts aware of the travel. The example card shows how to fill out each section with relevant details.
The document provides information for LGBTQ students, staff, faculty, and trainees at UCSF regarding studying and working abroad. It outlines additional campus resources and lists the mission statement of the UCSF LGBT Resource Center. The main section discusses taking time to research support resources, laws, attitudes, and gender roles in the host country to stay safe when traveling abroad. It provides several university and additional LGBT travel-related links for resources and guidance.
Comparative Effectiveness: UCSF East Africa Global Health -Kisumu 2014GlobalResearchUCSF
The document describes an upcoming cost-effectiveness analysis workshop to be held in Kisumu, Kenya on January 20, 2014. The purpose of the workshop is to provide participants with a basic understanding of cost-effectiveness analysis concepts and methods and allow them to apply these concepts to an issue of their choosing. The workshop will cover core CEA approaches such as calculating incremental cost per standardized unit of health gain compared to alternative interventions and key metrics like the incremental cost-effectiveness ratio. The workshop aims to provide participants with a foundation for further developing CEA ideas and projects.
The UCSF East Africa Interest Group aims to foster cross-disciplinary collaborations in East Africa through bimonthly workshops. The workshops will focus on topics like biospecimen banking, educational programs, the SEARCH community health study, and non-HIV diseases. The goal is to identify joint project opportunities at the intersection of disease focus areas and program areas, while maintaining a balance across countries, research types, and HIV/non-HIV topics. The planning committee for 2013 includes faculty from different disciplines.
This document discusses navigating international partnerships for the UC system and provides a roadmap for compliance. It outlines the scale of international research activities at UCSF, including the large number of countries and faculty involved and associated risks. It also summarizes steps already taken, such as establishing insurance coverage and databases to facilitate collaboration. Additionally, it identifies further actions needed, like finalizing medical evacuation policies and registering UC foreign affiliate offices in countries like Tanzania and Kenya to legally support operations abroad.
This document discusses the work of GlobalResearch at UCSF after their meetings adjourn. It focuses on four areas: 1) Creating community through forums, newsletters, interest groups, and social media; 2) Creating resources and support through consultation services, working groups, databases, and ensuring systems support global research; 3) Supporting early career faculty through identifying interests and addressing career hurdles; 4) Ways IRAC members can help by referring others to resources and providing expertise to address questions and participate in working groups.
The document provides brief profiles of several UCSF colleagues working in global health and HIV research. It includes their research interests,
keywords and countries they have worked in. The profiles highlight a wide range of research areas including infectious diseases like HIV, TB and
malaria, non-communicable diseases, diagnostics, epidemiology, implementation science and more. Countries of focus include Uganda, Kenya,
South Africa, Tanzania and others. The purpose is to introduce colleagues with shared interests in global health and HIV research.
UCSF researchers have been active in 97 countries, with 175 funded global health projects in 2011. UCSF works to improve health and reduce disease burden through partnerships with organizations worldwide. Key areas of focus include maternal health, HIV/AIDS, malaria, tobacco control, and eye care. Researchers develop best practices for resource-limited settings, train local health workers, and aim to strengthen developing countries' health systems and research capacity.
Dr Paul Volberding addressing the GHS/CFAR retreat, identifying opportunities for GHS to support and abut the research undertaken by UCSF faculty in an international context.
The document summarizes evidence on integrating tuberculosis (TB) and HIV services from a systematic review conducted for the World Health Organization guidelines on antiretroviral therapy. The review found very low quality evidence suggesting that when TB clinics provide antiretroviral therapy (ART), ART uptake and timeliness of ART initiation may improve, while TB treatment outcomes are mixed. Similarly, the review found very low quality evidence that when HIV clinics provide TB treatment, TB screening and diagnosis may improve while ART uptake and TB treatment outcomes show mixed results. The review highlights considerations for integrating TB and HIV services including patient costs and barriers, training of healthcare workers, and epidemiological factors.
The document discusses challenges and opportunities in disseminating and implementing research findings to other populations and settings. It notes that the biggest challenges are closing the gap between what policymakers need and what research provides, and reforming tendencies in peer review. The biggest opportunities are extending community-based participatory research principles to work with stakeholders, and combining pragmatic randomized controlled trials with multi-site studies to improve external validity.
This document discusses several implementation frameworks that can be used for health interventions in global contexts. It begins by noting that many evidence-based innovations fail when transferred to other settings, largely due to untested, unsuitable, or incomplete implementation. Effective implementation requires engagement with stakeholders over time through an adaptive and reflective process.
The document then defines theories and planning models. It presents three frameworks for discussion: PRECEDE-PROCEDE, the Consolidated Framework for Implementation Research (CFIR), and the Promoting Action on Research Implementation in Health Services (PARIHS) framework. Each framework is explained, including its constructs and how it can be applied. The document emphasizes that multiple frameworks are often needed and the choice depends on
UCSF Research Admin Board Presentation on CTSI Global Health ProgramGlobalResearchUCSF
Given by Paul Volberding 9/4/12. Describes the Global Research Support Program, a CTSI program to define and address barriers to international research activities undertaken by UCSF researchers.
UCSF Research Admin Board Presentation on CTSI Global Health Program
Meyer
1. Modelling the cost of ART for
prevention
Gesine Meyer-Rath1,2, Mead Over3, Lawrence Long2
1 Center for Global Health and Development, Boston University, Boston, US.
2 Health Economics and Epidemiology Research Office, University of
Witwatersrand, Johannesburg, South Africa.
3 Center for Global Development, Washington DC, US.
Health Economics and Epidemiology Research Office
HE RO
2
Wits Health Consortium
University of the Witwatersrand
2. Prevention
Things are changing
=
Prevention
Health Economics and Epidemiology Research Office
HE RO
2
Health Economics and Epidemiology Research Office Wits Health Consortium
University of the Witwatersrand
3. What’s in a projection model?
• Epidemiological function
– captures the impact of medical policies on the
biological consequences, both beneficial and
adverse
• Cost function
– captures the economic consequences of the
policy
Kahn, Marseille, Bennett, Williams & Granich, October 14, 2011
Health Economics and Epidemiology Research Office
HE RO
2
Health Economics and Epidemiology Research Office Wits Health Consortium
University of the Witwatersrand
4. Identities vs. functions
• Cost accounting identity
– Too rigid to model large scale changes over
periods of more than a few years
– Not appropriate to model ART as prevention
• Cost function
– More plausible characterisation and projection
of cost
Health Economics and Epidemiology Research Office
HE RO
2
Health Economics and Epidemiology Research Office Wits Health Consortium
University of the Witwatersrand
5. The cost accounting identity tends to
over-estimate costs at different prices on
Economizing
Total Cost accounting the higher
Cost identity priced input
saves costs
TCAI
TCF
TC0
Cost
function
Price of i’th input
(e.g. Tenofovir)
6. The cost accounting identity tends to
under-estimate costs at different scales
Total Diminishing
Cost Cost returns
function eventually
increase costs
TCF
TCAI
TC0
Cost
accounting
Fixed identity
cost
Annual output
(e.g. patient-years)
7. Use of cost functions in the
literature
• Reviewed 8 literature databases
from1988-2011 + References + Grey
literature for ART costing
• Included all with a modelled cost
• Compared by: economic evaluation
method, type of model, time
horizon, outcome metric, input cost
Health Economics and Epidemiology Research Office
HE RO
2
Health Economics and Epidemiology Research Office Wits Health Consortium
University of the Witwatersrand
8. Results: Literature Review
• 45 published articles, 1 conference
abstract and 4 reports
– 38 for single countries
– 4 for wider regions
– 8 were global
• 5, all for single countries, considered the
impact of ART on transmission
Health Economics and Epidemiology Research Office
HE RO
2
Health Economics and Epidemiology Research Office Wits Health Consortium
University of the Witwatersrand
9. Results: Literature Review -
including transmission
Paper, year (country) Analysis
Over 2004 (India) HIV/AIDS treatment and prevention in India: Modelling the
costs and consequences
Granich 2009 (South Africa) Impact of universal voluntary testing and immediate treatment
(UTT) on HIV incidence and prevalence and annual cost
Long EF 2010 (United States) The cost effectiveness and population outcomes of expanded
HIV screening and ART in the US
Hontelez 2011 (South Africa) Incremental cost benefit of ART initiation at CD4 cell count
threshold < 200 vs. <350
Schwartländer 2011 (Int.) Incremental cost effectiveness of “investment approach” to
achieving universal access to HIV prevention, treatment, care
and support by 2015
Granich 2012 (South Africa) Expanding ART for Treatment and Prevention of HIV in South
Africa: Estimated Cost and Cost-Effectiveness 2011-2050
Health Economics and Epidemiology Research Office
HE RO
2
Health Economics and Epidemiology Research Office Wits Health Consortium
University of the Witwatersrand
10. Factors influencing cost
Paper Factors influencing input cost (Including in sensitivity analysis, SA)
Over (2004) Time on treatment (first 3 years vs. year before death); health state (symptomatic,
non-AIDS | AIDS); unstructured vs. structured treatment provision; SA: Cost not
included
Granich (2009) Drug cost by FL/ SL, otherwise constant unit cost; No SA
Long EF (2010) One regimen cost only; health state (untreated symptomatic | untreated symptomatic
| treated symptomatic | untreated AIDS | treated AIDS); SA: Cost not included
Hontelez (2011) On ART cost by baseline CD4 cell count (100|200|350) for first 3 years, then uniform;
drug cost by FL/ SL; SA: Cost varied by +/- 33%
Schwartländer (2011) “Average cost per patient of antiretroviral therapy is assumed to decline by about 65%
between 2011 and 2020, with a large proportion of the cost savings after 2015
coming from an increasing shift to
primary care and community-based approaches and cheaper point-of-care
diagnostics”; No SA
Granich (2012) Drug cost by FL/SL; Laboratory cost by first year on regimen or > 1 year; Inpatient /
outpatient cost based on treatment status; SA: Varied ART, monitoring, inpatient
costs based on data available for South Africa.
Health Economics and Epidemiology Research Office
HE RO
2
Health Economics and Epidemiology Research Office Wits Health Consortium
University of the Witwatersrand
11. Potential determinants of a cost
function
• Most modelled estimates of ART to date
use cost accounting identities, with
minimal use of cost functions
• If a more flexible cost function where to be
used, which variables should be included?
Health Economics and Epidemiology Research Office
HE RO
2
Health Economics and Epidemiology Research Office Wits Health Consortium
University of the Witwatersrand
12. Treatment characteristics
• Regimens, health states and time on
treatment
• More complex = higher treatment costs
• Distribution into first and second line
• Distribution across CD4 count strata
• Time on treatment dictating likelihood of an
event
Health Economics and Epidemiology Research Office
HE RO
2
Health Economics and Epidemiology Research Office Wits Health Consortium
University of the Witwatersrand
13. Factor prices
The development of the price of d4T+3TC+NVP 2000 - 2008
MSF Campaign for Access to Essential Medicines: Untangling the Web of Antiretroviral Price
Reductions. 11th edition, July 2008
Health Economics and Epidemiology Research Office
HE RO
2
Health Economics and Epidemiology Research Office Wits Health Consortium
University of the Witwatersrand
14. Scale
• Marginal and average cost for
hygiene outreach in 2000 Int’l $
• Adjustment for scale used in WHO-
CHOICE generalized CEA
• Modelled on world-wide GPS data
(clinic and population density)
• Calculated transport cost of
goods, fixed and supervision costs;
health centre cost excluded
Johns B, Baltussen R: Accounting for the cost of scaling-
up health interventions.
Health Econ. 13: 1117–1124 (2004)
Health Economics and Epidemiology Research Office
HE RO
2
Health Economics and Epidemiology Research Office Wits Health Consortium
University of the Witwatersrand
15. Experience of facility and program
Menzies et al, 2011, PEPFAR data.
Health Economics and Epidemiology Research Office
HE RO
2
Health Economics and Epidemiology Research Office Wits Health Consortium
University of the Witwatersrand
16. Scope and distribution
• Analysis of cost of
ART provision
amongst different
models of care
• 4 settings in South
Africa (GP/ MP/
EC)
• Annual per patient Rosen et al: The outcomes and outpatient costs of different models
cost in each of antiretroviral treatment
delivery in South Africa. Trop Med Intern Health 13(8):1005-15
setting (2008)
Health Economics and Epidemiology Research Office
HE RO
2
Health Economics and Epidemiology Research Office Wits Health Consortium
University of the Witwatersrand
17. Quality of care
• “In care and (not)
responding”
defined by VL, CD4
and new WHO
stage 3/ 4
conditions
• “No longer in
care” pt died or
was lost to follow-
up in the first 12
months Rosen et al: The outcomes and outpatient costs of different models of
antiretroviral treatment
delivery in South Africa. Trop Med Intern Health 13(8):1005-15 (2008)
Health Economics and Epidemiology Research Office
HE RO
2
Health Economics and Epidemiology Research Office Wits Health Consortium
University of the Witwatersrand
18. Technical efficiency
• Production of good/service without waste
• Incentives: Salaries (private vs. public)
• Non financial incentives: Encouragement
and supervision
• Technical changes: take into account
things not currently used / invented
Health Economics and Epidemiology Research Office
HE RO
2
Health Economics and Epidemiology Research Office Wits Health Consortium
University of the Witwatersrand
19. Worked example of how a flexible
function can alter cost projections
• Use the example of Granich et al’s 1999
article on Universal Test and Treat in South
Africa
• Change only one assumption:
– Instead of constant returns to scale, allow for
increasing returns to scale at the facility level
• Requires data or theory on the size
distribution of ART facilities
Health Economics and Epidemiology Research Office
HE RO
2
Health Economics and Epidemiology Research Office Wits Health Consortium
University of the Witwatersrand
20. Steps in the analysis
• Use empirical size-rank distribution of South
African ART treatment facilities in 2010
• Project the size-rank distribution of facilities
to expand to full-coverage and then to shrink
as need declines
• Generate a family of facility-specific average
cost functions scale elasticities < 1.0
• Project future cost at each scale elasticity
Health Economics and Epidemiology Research Office
HE RO
2
Health Economics and Epidemiology Research Office Wits Health Consortium
University of the Witwatersrand
21. Current and projected size
distributions of ART facilities in SA
Health Economics and Epidemiology Research Office
HE RO
2
Health Economics and Epidemiology Research Office Wits Health Consortium
University of the Witwatersrand
22. Health Economics and Epidemiology Research Office
HE RO
2
Health Economics and Epidemiology Research Office Wits Health Consortium
University of the Witwatersrand
23. Family of South African facility-specific average
cost curves with scale-elasticities from 0.5 to 1.0
Health Economics and Epidemiology Research Office
HE RO
2
Health Economics and Epidemiology Research Office Wits Health Consortium
University of the Witwatersrand
24. With a scale–elasticity of 0.7, peak costs
and cumulated costs will be 40% greater
Health Economics and Epidemiology Research Office
HE RO
2
Health Economics and Epidemiology Research Office Wits Health Consortium
University of the Witwatersrand
25. Conclusions on the potential value
of flexible cost functions
• A flexible cost function can give very different cost
projections over the long run
• Depending on the elasticity of scale alone, the
cost of UTT could be up to 75% greater than
projected under the constant returns assumption
• It behooves modelers to pay as much attention to
their cost specifications as to their epidemiologic
ones.
Health Economics and Epidemiology Research Office
HE RO
2
Health Economics and Epidemiology Research Office Wits Health Consortium
University of the Witwatersrand
27. Peak costs and cumulated costs vary with
the assumed scale-elasticity
Health Economics and Epidemiology Research Office
HE RO
2
Health Economics and Epidemiology Research Office Wits Health Consortium
University of the Witwatersrand
28. Calibration of the average cost function to
South African data for 2010/11:
How we fit the family of average cost functions
Value of σ Value of (σ – 1)
Percent increase in total Percent decrease Cost of using an entire ART facility to treat a
cost associated with a in average total single patient
1% increase in output cost associated
(Scale elasticity) with a 1%
increase in Derived from Meyer- Deflated to match
output Rath et al Granich et al costs
Constant returns
1.0 0 $924 $800
to scale
0.9 -0.1 $1,976 $1,711
0.8 -0.2 $4,187 $3,625
Increasing returns
0.7 -0.3 $8,791 $7,611
to scale
0.6 -0.4 $18,296 $15,840
0.5 -0.5 $37,763 $32,695
Health Economics and Epidemiology Research Office
HE RO
2
Health Economics and Epidemiology Research Office Wits Health Consortium
University of the Witwatersrand
29. Impact on peak-year and cumulated cost of a Universal Test and
Treat policy in South Africa of alternative assumptions regarding
economies of scale in ART service delivery
Value of σ Costs of Universal Test and Treat policy
Total cumulated cost without discounting in
Per cent increase in total cost constant 2010 USD
associated with a one per cent Per cent of total
increase in output (Scale Peak cost in billions Total cost in billions above constant
elasticity) of USD of USD returns to scale
Constant returns to
1.0 $3.5 $74.6 0.0%
scale
0.9 $83.6 12.0%
$3.8
0.8 $93.6 25.4%
$4.1
Increasing returns to
0.7 $104.8 40.4%
scale $4.4
0.6 $117.2 57.0%
$4.7
0.5 $131.0 75.4%
$5.1
Health Economics and Epidemiology Research Office
HE RO
2
Health Economics and Epidemiology Research Office Wits Health Consortium
University of the Witwatersrand
Editor's Notes
Presenting this work on behalf of Gesine Meyer-Rath Mead Over will take the second half of the presentation
Things in the world of HIV prevention have been changing for a number of years – no longer ABCCurrently treatment is being touted as one of the best prevention methods with the chance of stopping the disease in its tracks and being cost effective
Epi: Biological consequences of early treatment initiation can be beneficial (reduced transmission) and adverse (more resistance); Recent review summarizes epidemiological considerations.Eco: The cost of recruiting and retaining people is likely to suffer from diseconomies of large scale and tenuous accountability. Focus of this presentation is on the cost function.
Cost accounting identity: assume a single constant unit cost per patient year / per patient year by regimen across a large population and many years.Cost function: Can handle substituting one input for another, changing scale and scope of operations, eligibility criteria, task shifting etc. Feedback mechanism to unit cost which may change.
Excluded those that looked at PMTCT onlyExcluded editorials, letters, articles without quantitative data or those without a modelled estimateInput cost – determined whether it was constant or had been varied by determinants such as type of regimen, health state, time on treatment and mode of delivery, either in main or sensitivity
Although not included in the original literature review the most recent publication on treatment as prevention should be included – Granich 2012
Argue – these are not the only variables that should affect input cost and in some instances their impact on total costs may be overwhelmed in situations of rapid scale up or large scale changes to program delivery such as task shifting to lower levels of facilities and healthcare cadres
The prices of factors of production, including labour, supplies, utilities, transportation, equipment and buildings, clearly affect the cost of health services. By varying the cost of treatment regimen and / or lab prices they have taken into account factor prices.ARV – largest component of cost and varied dramatically over the last ten years.Chart shows the cost of the most common 1st line dropped 13 fold from $10,439 to $331 between June 2000 and Sept 2001; further drop of 120% between 2001 and 2008. Scope for further drops limited.Target other factors: service delivery, lab tests and overheads – targets by UNAIDS treatment 2.0 initiative
None of the reviewed papers considered the impact of scale – in particular those looking at treatment as prevention which often model dramatic increases in scaleMost economic theory suggests use shaped relationship between scale and average cost – this may be the case in ART clinics: increasing the number of patients generates a less than proportionate increase in cost Economies of scale have been found in HIV prevention: Marseille 2007 HIV prevention and program scale – PANCEA project; Guinness 2007 Does scale matter – sex workers in Inda; Guinness Cost function of HIV prevention services: is there a U shape.Modelled cost of hygiene outreach interventions in this slide – u shaped relationship between average or marginal cost.
Usually assume that there is a benefit from “learning by doing” resulting in a decrease in avg cost.Often coincides with scale up and so it is difficult to untangle the exact cause of reduction in cost.Menzies examined data from PEPFAR ART sites and found that the median per patient cost decreased with each successive 6 month period from the start of the ART program biggest decrease between 1st and 2nd.Facility experience was not considered in any of the published papers.
Cost will also be determined by scope (PHC vs. specialised ART clinics at 2nd hospitals) and distribution (public or private sector – for profit + not for profit)Generally large facilities like hospitals can achieve economics of scope – spread the cost of infrastructure across the production of multiple health services-Rosen et al – 12 months on treatment compared public hospital, private GP, NGO HIV and NGO PHC, costs varied significantly between sites as a result of differences in service delivery. Since patient mix was comparable across the 4 sites only a small portion of the difference could be attributed to differences in disease severity-None of those papers examining treatment as prevention considered differences in level of care and only 3 of all those reviewed included it. -Future costing should include the distribution of population across different delivery models particularly where rapid scale up will require this spread in order to handle the volume of patients
QoC difficult to measure – in ART retention in care and improvement in health indicators seems reasonable proxySame analysis by Rosen et al. – cost per quality adjusted output – used routinely collected data to determine retention in care and response to treatmentDepending on the quality of care in each clinic and the resulting levels of loss to followup and treatment failure , the production cost per patient in care and responding was 22% and 48% higher because of the resources spent on patient either leaving care or not responding to care
Technical efficiency: production of good or service without wastePublic and private face constraints in the availability and quality of staffi.e. StaffingPublic sector: suffers from lower wages, low morale and staff absenteeismPrivate sector: fee for service which deters patientAs donor programs give control back to NGOs and government management will become an even bigger player in technical efficiencyBest approach may be to use a function that improves technical efficiency over time
The solid dark green piecewise linear curve accurately matches the observed size-rank distribution of the largest 800 ART facilities in South Africa in 2010.The other solid line slightly modifies the observed distribution to characterize the full set of 1,095 facilities in 2010 which were used to deliver the actual amount of ART services in that year.The dashed lines are the authors’ projections of the size-rank distributions that are consistent with the total number of patient-years that are consistent with the amount of ART that will be required for UTT 6 years after scale-up (2016) and in the years 2030 and 2050
The authors’ projections of the time-path of size-rank distributions can also be characterized by the total number of facilities in each year and by the number of patient-years of ART delivered in the smallest facility in each year. Both the number of facilities and the size of the smallest one increase at first to accommodate the year of maximum treatment delivery approximately six years after the beginning of scale up. Then both the number of facilities and the size of the smallest one decline as need declines.
In our model, economies of scale are a characteristic of the individual treatment facility. A simple characterization of economies of scale is given by a log-linear average cost function. Any such log-linear function can be characterized by its slope and its intercept. By assuming a constant average cost of $800, Granich et al implicitly assumed the flat average cost function in this slide, which has an intercept of $800 and a a slope of zero. Slide 28 (one of the Annex slides) gives the intercept associated with each of a range slopes between 0 and -0.5 (i.e. scale elasticities between 1.0 and 0.5). This slide plots this family of average cost functions. In the worked example, we focus on the average cost function with scale elasticity of 0.7 (i.e. slope in log-log space of -0.3).