Hormone-based reproductive management programs can be beneficial to improve dairy cow\'s reproductive performance. This study aimed to compare the economic impact of reproductive management programs using systematic hormonal treatments to individual cows with a specific DIM range with a reproductive management program using cow-specific hormonal treatment based on a veterinary diagnosis of ovarian dysfunction during a fertility check. An existing individual cow-based, dynamic, and stochastic bio-economic simulation model, mimicking the production dynamics of a 200 cow-herd in daily time steps, was extended with ovarian dysfunction and fertility inputs. Four hormone-based reproductive management programs were modeled. In the default reproductive management program, reflecting the current reproductive management of Dutch herds, lactating dairy cows are inseminated based on detection of estrus and non-cyclic dairy cows are treated with hormones based on a veterinary diagnosis of ovarian dysfunction during a fertility check. Hormone treatments prescribed by the veterinarian for anestrus, cystic, and sub-estrus cows were an 8-d progesterone-releasing intravaginal device (PRID)-Synch protocol (PRIDsynch), an Ovsynch protocol, and a PGF2⍺ treatment, respectively. The 3 other reproductive management programs reflected systematic hormonal treatments to cows at specific DIM and included a 1) Double-Ovsynch protocol for TAI with nonpregnant cows submitted to a resynchronization protocol (FTAI), 2) Double-Ovsynch protocol for TAI with nonpregnant cows detected in estrus or submitted to a resynchronization protocol (FTAI+ED), and 3) detection of estrus with cows not detected submitted to a PRIDsynch protocol (ED+TAI). All nonpregnant cows were submitted to a resynchronization protocol based on the absence (PRIDsynch) or presence (Ovsynch protocol) of a corpus luteum (CL). The annual mean net economic return (NER) was calculated for all reproductive management programs. Compared with the default reproductive management program, the highest NER was observed for the FTAI+ED reproductive management program with €23,764 higher net revenues, followed by the FTAI and the ED+TAI reproductive management programs with €19,550 and €14,314 higher net revenues, respectively. Overall, systematic hormone-based reproductive management programs gave higher costs due to more hormones administered and higher calving and feed costs due to more pregnant cows. Nevertheless, the additional revenues of milk and calves in the systematic hormone-based reproductive management programs outweighed the total cost. For instance, the FTAI+ED reproductive management program gave €8,953 higher total cost per year compared with the default but with €32,654 higher revenues. In summary, reproductive management programs where hormones were systematically used gave economic advantages over the current default reproductive management program in which hormones are administered to individual cows based on a veterinary diagnosis of ovarian dysfunction during a fertility check.

BACKGROUND: Child mental health has become an increasingly important issue in the UK, especially in the context of significant welfare reforms. Universal Credit (UC) has introduced substantial changes to the UK\'s social security system, significantly impacting low-income families. Our aim was to assess the effects of UC\'s introduction on children\'s mental health for families eligible for UC versus a comparable non-eligible sample.
METHODS: Using Understanding Society data from 5806 observations of 4582 children (aged 5 or 8 years) in Great Britain between 2012 and 2018, we created two groups: children whose parents were eligible for UC (intervention group) and children whose parents were ineligible for UC (comparison group). Child mental health was assessed using a parent-reported Strengths and Difficulties Questionnaire. The OR and percentage point change in the prevalence of children experiencing mental health difficulties between the intervention group and the comparison group following the introduction of UC were analysed. We also investigated whether the utilisation of childcare services and changes in household income were mechanisms by which UC impacted children\'s mental health.
RESULTS: Logistic regression results demonstrated that the prevalence of mental health problems among eligible children whose parents were unemployed increased by an OR of 2.18 (95% CI 1.14 to 4.18), equivalent to an 8-percentage point increase (95% CI 1 to 14 percentage points) following the introduction of UC, relative to the comparison group. Exploring potential mechanisms, we found neither reduced household income nor increased use of childcare services, which served as a proxy for reduced time spent with parents, significantly influenced children\'s mental health.
CONCLUSIONS: UC has led to an increase in mental health problems among recipient children, particularly for children in larger families and those aged 8. Policymakers should carefully evaluate the potential health consequences for specific demographics when introducing new welfare policies.

BACKGROUND: In the early 2020s, nearly half of New Zealand adults reported that cost of treatment had prevented them from accessing dental care, with higher rates among Māori, Pasifika and individuals living in the most deprived areas. Unaffordable dental care may be explained by a rise in dental service fees over time relative to personal income, as documented in New Zealand between 1978 and 1993. However, there have been no contemporary estimates in New Zealand of how the affordability of dental care has changed. The aims of this study were to analyse the change in dental treatment fees and the personal income of New Zealanders from 1978 to 2023 and to explore differences in affordability of dental care by ethnicity.
METHODS: Average fees for dental treatments were sourced from surveys completed by practising New Zealand dentists. Earnings (from 1978) and personal income data (full population from 2000 and by ethnicity from 2008) were sourced from Statistics NZ and NZ Official Yearbooks. Inflation-adjusted changes in average fees, weekly personal earnings and income were calculated as a percentage change from 1978 levels for fees and earnings and from 2000 for personal income.
RESULTS: For the five dental treatments with data available from 1978 to 2023, fees increased in the range of 75%-236%, while earnings increased by 46% over the same period. Fees for other treatments (with data available from 1981 to 2009) similarly increased and mostly surpassed changes in earnings. From 2008 to 2023 the overall increase in personal income (about 21% across all ethnic groups) kept pace with the rising cost of most treatments. However, due to persistent income inequalities, in 2023, Māori and Pasifika would need to spend a higher proportion of their weekly income (approximately 16% and 23% respectively) to receive the same dental treatments as NZ Europeans.
CONCLUSIONS: Fees for dental treatments have risen markedly in recent decades, more sharply than the price of other goods and services.

Population-normalized indicators (e.g., GDP per capita), under the assumption of the indicators scaling linearly with population, are ubiquitously used in national development performance comparison. This assumption, however, is not valid because it may ignore agglomeration effect resulting from nonlinear interactions in socioeconomic systems. Here, we present extensive empirical evidence showing the sub-linear scaling rather than the presumed linear scaling between population and multiple indicators of national development performance. We then develop a theoretical framework based on the scaling rule observed in cities to explore the origin of scaling in countries. Finally, we demonstrate that urbanization plays a pivotal role in transforming national development from limited sub-linear growth to unlimited super-linear growth. This underscores the significance of urbanization in achieving sustained growth and elevating human living standards at the national level. Our findings have the potential to inform policies aimed at promoting equitable inter-country comparison and achieving sustainable development in countries.

Livestock provide meat, milk, draught labour, are used for breeding, and act as a store of value for smallholder farmers. High young stock mortality (YSM) has the potential to cause significant financial loss. The Young Stock Mortality Reduction Consortium collaborated on a project to deliver a package of basic health and husbandry interventions to reduce YSM for cattle and small ruminants in mixed and pastoral production systems in Ethiopia. Prior to the intervention, YSM rates ranged from 9.8% for calves in mixed systems, to 35.6% for small ruminants in pastoral systems. Proportional reductions YSM from the intervention ranged from 60% for calves and for small ruminants in mixed systems, to 72% for calves in pastoral systems. This brief research report assesses the costs and benefits of the intervention ex-poste to determine its efficiency. NPVs for the intervention (per household) were calculated for a range of benefit periods (from 1 to 20 years), based on the cost of training enumerators and farmers and the net annual household benefits realised within each benefit period. We found in both pastoral and mixed systems the net annual household benefit for the intervention was positive. For pastoral households the intervention achieves a positive NPV after 2 years. For mixed households the intervention achieves a positive NPV after 11 years. Overall, we found the benefits of the intervention exceed the costs, by a very large amount in pastoral systems, and that benefits were larger for households that kept larger numbers of breeding females.

Successful implementation of the Kunming-Montreal Global Biodiversity Framework requires identifying a process for measuring and valuing changes in biodiversity that build on the recognition that economics and valuation must play a key role in \"halting and reversing\" biodiversity loss. Here, we discuss considerations for a practical path to valuing changes in biodiversity. Framing changes in the value of biodiversity as a summary of changes in certain natural assets enables leveraging existing approaches and international standards associated with environmental-economic accounting. We discuss why an approach that builds from individual species, evolutionary groups, or functional groups into a practical, hierarchical statistical classification system is better than the development of any one biodiversity index. We merge techniques from ecology and other natural sciences, national and environmental-economic accounting, and economics, which are all on the cusp of making measurement of the change in the value of biodiversity possible. The focus should be on scaling and integrating these approaches. The path forward appears to begin with imperfect but useful measures, grounded in robust concepts, while establishing ambition to further scale-up measurements-just like the past evolution of many other official statistical series.

OBJECTIVE: We aimed to estimate health state utility values (HSUVs) for the key health states found in opioid use disorder (OUD) cost-effectiveness models in the published literature.
METHODS: Data obtained from six trials representing 1,777 individuals with OUD. We implemented mapping algorithms to harmonize data from different measures of quality of life (the SF-12 Versions 1 and 2 and the EQ-5D-3 L). We performed a regression analysis to quantify the relationship between HSUVs and the following variables: days of extra-medical opioid use in the past 30 days, injecting behaviors, treatment with medications for OUD, HIV status, and age. A secondary analysis explored the impact of opioid withdrawal symptoms.
RESULTS: There were statistically significant reductions in HSUVs associated with extra-medical opioid use (-0.002 (95% CI [-0.003,-0.0001]) to -0.003 (95% CI [-0.005,-0.002]) per additional day of heroin or other opiate use, respectively), drug injecting compared to not injecting (-0.043 (95% CI [-0.079,-0.006])), HIV-positive diagnosis compared to no diagnosis (-0.074 (95% CI [-0.143,-0.005])), and age (-0.001 per year (95% CI [-0.003,-0.0002])). Parameters associated with medications for OUD treatment were not statistically significant after controlling for extra-medical opioid use (0.0131 (95% CI [-0.0479,0.0769])), in line with prior studies. The secondary analysis revealed that withdrawal symptoms are a fundamental driver of HSUVs, with predictions of 0.817 (95% CI [0.768, 0.858]), 0.705 (95% CI [0.607, 0.786]), and 0.367 (95% CI [0.180, 0.575]) for moderate, severe, and worst level of symptoms, respectively.
CONCLUSIONS: We observed HSUVs for OUD that were higher than those from previous studies that had been conducted without input from people living with the condition.
Thus far, health-related quality of life estimates for patients with opioid use disorder in the United States are limited, and importantly, they were not generated from studies among people living with the condition. This study extracted data from six clinical trials providing data among 1,777 people with opioid use disorder, made publicly available by the National Institutes of Health, to produce estimates of health-related quality of life. Our study found higher health-related quality of life estimates as compared to previous studies, modest impact of medications for opioid use disorder and strong impact of withdrawal symptoms on this outcome. These higher values among people with opioid use disorder might reflect the very negative perception of this condition among members of the general population (among whom these estimates have been generated previously). However, these relatively high estimates could also reflect an adaptation to the condition or a lack of awareness of associated-health damage in the context of dependence. The low number of observations providing data on medications for opioid use disorder led to high uncertainty around related estimates of health-related quality of life, but our findings could also reflect real experiences by patients in the absence of the positive effects of non-medication opioids, which deserve more attention in clinical practice. Our study suggests that systematically measuring withdrawal symptoms and representing these in health economic models might provide a more accurate representation of health-related quality of life among people with opioid use disorder and therefore of the impact and cost-effectiveness of interventions.

UNASSIGNED: Routine histopathologic examination of orthopaedic surgical specimens is a standard practice at many institutions. Previous studies have demonstrated that this practice seldom altered patient management for several orthopaedic procedures. As a result, the value of such practices has come into question. The purpose of this study is to determine the cost-effectiveness of routine histopathologic analysis of specimens obtained during total ankle arthroplasty (TAA).
UNASSIGNED: A retrospective analysis was performed of patients who underwent uncomplicated primary TAA at a large, academic, health system between January 2015 and December 2021. The postoperative histopathologic diagnoses were compared with the respective patient\'s preoperative clinical and intraoperative diagnoses. The prevalence of concordant, discrepant, and discordant diagnoses was determined. Cost-effectiveness analysis was conducted to assess the financial implications of obtaining routine specimens for histopathologic examination for TAA.
UNASSIGNED: A total of 85 TAAs were identified in 85 individual patients and were included in the present study. A total of 172 specimens were sent for routine histopathologic review. On histopathologic analysis, a final diagnosis was confirmed in 82 (96.5%) of the total specimens reviewed. A discrepant diagnosis was discovered in 3 (3.5%; 2 cases of gout/pseudogout and 1 case of osteonecrosis) cases and 0 (0%) discordant diagnoses were discovered, corresponding to positive and negative predictive values of 97% and 100%, respectively The total estimate of costs incurred for the routine analysis of all specimens included in the study was between $12 299.20 and 17 846.00. The estimated cost to establish each discrepant diagnosis ranged between $4099.73 and $5948.67, and the cost for a discordant diagnosis was unable to be established.
UNASSIGNED: Routine histopathologic analysis of specimens obtained during TAA rarely revealed a discordant diagnosis and resulted in no alterations to patients\' plan of care. Furthermore, the additional costs of routine histopathologic examination are significant. As such, it is recommended that such interventions in TAA should be performed on a per-case basis at the operating surgeon\'s discretion.

People approaching end of life account disproportionately for health care costs, and the majority of these costs accrue in hospitals. The economic evidence base to improve value of care to this population is thin. Natural experiment methods may be helpful in bridging evidence gaps with credible causal estimates from routine data, but these methods have seldom been applied in this field. This study aimed to evaluate the association between timely palliative care consultation and length of stay for adults with serious illness admitted to acute hospital in Ireland.
In primary analysis we evaluated if timely palliative care receipt following emergency hospital inpatient admission impacted length of stay (LOS); in secondary analysis we verified if palliative medicine service (PMS) implementation co-occurred with any changes in in-hospital mortality, and we estimated cost differences associated with any change in LOS. This was a secondary analysis on routinely collected data for acute admissions to public hospitals in Ireland. We used difference-in-differences analysis to exploit the staggered implementation of PMS teams at acute public hospitals in Ireland between 2010 and 2015. We identified palliative care receipt following PMS implementation using ICD-10 codes, and we matched admissions involving a palliative care interaction to admissions in years prior to PMS implementation using propensity score weights.
Our primary analytic sample included 4,314 observations, of whom 608 (14%) received timely palliative care. We estimated that the intervention reduced LOS by nearly two days, with an estimated associated saving per admission of €1,820. These analyses were robust to multiple sensitivity analyses on regression specification, weighting strategy and site selection. Proportion of admissions ending in death did not change following PMS implementation.
Prompt interaction between suitable patients and palliative care can improve the quality and efficiency of care to this population. Many patients receive palliative care later in the hospital stay, which does not yield cost-savings. Future studies can extend and strengthen our approach with better data, as well as using different methods to understand how to trigger palliative care early in a hospital admission and realise available gains.

In the United Kingdom, demand on the social care sector is rising coupled with a significant reduction in funding making it difficult to meet these needs. The aim of this two-part commentary is to provide a critical evaluation of the evidence base in relation to solutions to tackle the growing demands on health and social care. Part 1 focuses on the evidence from a systematic review around the association between the availability and supply of social care and healthcare on utilisation for older adults in high income countries.
UNASSIGNED: An evidence summary based on the following systematic review:Spiers G, Matthews FE, Moffatt S, Barker RO, Jarvis H, Stow D, Kingston A, Hanratty B (2019) Impact of social care supply on healthcare utilisation by older adults: a systematic review and meta-analysis. Age and Ageing 48(1):57-66. https://doi.org/10.1093/ageing/afy147.