Background: Health resources are limited, which means spending should be focused on the people, places and programs that matter most. Choosing the mix of programs to maximize a health outcome is termed allocative efficiency. Here, we extend the methodology of allocative efficiency to answer the question of how resources should be distributed among different geographic regions.
Methods: We describe a novel geographical optimization algorithm, which has been implemented as an extension to the Optima HIV model. This algorithm identifies an optimal funding of services and programs across regions, such as multiple countries or multiple districts within a country. The algorithm consists of three steps: (1) calibrating the model to each region, (2) determining the optimal allocation for each region across a range of different budget levels, and (3) finding the budget level in each region that minimizes the outcome (such as reducing new HIV infections and/or HIV-related deaths), subject to the constraint of fixed total budget across all regions. As a case study, we applied this method to determine an illustrative allocation of HIV program funding across three representative oblasts (regions) in Ukraine (Mykolayiv, Poltava, and Zhytomyr) to minimize the number of new HIV infections.
Results: Geographical optimization was found to identify solutions with better outcomes than would be possible by considering region-specific allocations alone. In the case of Ukraine, prior to optimization (i.e. with status quo spending), a total of 244,000 HIV-related disability-adjusted life years (DALYs) were estimated to occur from 2016 to 2030 across the three oblasts. With optimization within (but not between) oblasts, this was estimated to be reduced to 181,000. With geographical optimization (i.e., allowing reallocation of funds between oblasts), this was estimated to be further reduced to 173,000.
Conclusions: With the increasing availability of region- and even facility-level data, geographical optimization is likely to play an increasingly important role in health economic decision making. Although the largest gains are typically due to reallocating resources to the most effective interventions, especially treatment, further gains can be achieved by optimally reallocating resources between regions. Finally, the methods described here are not restricted to geographical optimization, and can be applied to other problems where competing resources need to be allocated with constraints, such as between diseases.
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http://dx.doi.org/10.1186/s12889-019-7681-5 | DOI Listing |
Tsetse flies and trypanosomosis significantly impact bovine production and human health in sub-Saharan Africa, exacerbating underdevelopment, malnutrition, and poverty. Despite various control strategies, long-term success has been limited. This study evaluates the combined use of entomopathogenic fungi (EPF) and the sterile insect technique (SIT) to combat tsetse flies.
View Article and Find Full Text PDFEur J Clin Pharmacol
December 2024
Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran.
Purpose: This study aimed to systematically review the cost-effectiveness of rivaroxaban plus aspirin (RIV + ASA) versus aspirin (ASA) alone in patients with stable coronary artery disease (CAD) or peripheral artery disease (PAD).
Methods: A systematic review was conducted using leading databases including PubMed, Scopus, and Web of Science core collection. The search was carried out up to June 25, 2024, focusing on identifying full economic evaluation studies comparing the cost-effectiveness of RIV + ASA versus ASA alone in patients with stable cardiovascular diseases (CVDs).
Landsc Ecol
December 2024
Institute of Environment Sciences, University of Quebec at Montreal, Montreal, QC H3C 3P8 Canada.
Context: Trees play a vital role in reducing street-level particulate matter (PM) pollution in metropolitan areas. However, the optimal tree growth type for maximizing the retention of various sizes of PM remains uncertain.
Objectives: This study assessed the PM reduction capabilities of evergreen and deciduous broadleaf street trees, focusing on how leaf phenology influences the dispersion of pollutants across particle sizes.
Front Plant Sci
December 2024
School of Public Health, Shandong Second Medical University, Weifang, China.
Introduction: Astragali Radix is the dried root of Astragalus mongoliae or Astragalus membranaceus, a leguminous plant. Since ancient times, Astragali Radix has been widely used in Chinese traditional Chinese medicine. As people become more health-conscious, the market demand for Astragali Radix grows and its popularity is increasing in the international market.
View Article and Find Full Text PDFBMC Pediatr
December 2024
Independent Researcher, Pune, India.
Background: In recent years, the use of music as a therapeutic and developmental tool for infants, especially within neonatal intensive care units (NICUs), has seen a surge in interest. Despite a growing body of research underscoring the potential benefits of music therapy and music medicine in enhancing infant development and aiding medical practices, the specific characteristics of music that maximize these benefits remain poorly understood.
Objectives: This scoping review aims to provide a comprehensive foundation by mapping the existing literature on passive music listening and identifying gaps, trends, and patterns that are crucial precursors to the development of best practices.
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