What: An argumentative groupware approach for organizing and documenting research activities

The topic of this paper is a process‐vs.‐product design method representation called Argumentative Writing (AW). Argumentative writing is a multi‐representation approach for conducting and reporting research projects. AW has at least two representations: one for structuring the problem‐understanding/solving process and one for communicating its product to others. We discuss WHAT, a hypertext‐based tool for AW. In WHAT (Writing with a Hypermedia‐based Argumentative Tool), the design process is captured using Rittel's Issue Based Information Systems (IBIS) method (Conklin, 1988; Hashim, 1990a; Rittel, 1980). The product of the design process is represented in WHAT using a general document‐representation scheme. In the Introduction we raise four major issues that we explore in the rest of the paper. Also in the Introduction, we show the impact the WHAT approach can have on organizational computing applications such as business education and training (Hashim, Rathnam, & Whinston, 1991) and the design of dialectical organizational information systems. The section “A Methodological Basis for AW Tools”; deals with the rationale behind choosing the IBIS method in capturing the design process. The section after that explains WHAT, and the section following it explores its use as a groupware tool. The applicability of WHAT and its pros and cons are discussed in two separate sections. In the Conclusion we outline the potentiality of the approach and present suggestions for its further development. Since our first reporting on WHAT (Hashim, 1990b), the AW approach was found applicable to educational, scientific, and business areas. One such application is for structuring case discussions in business schools (Hashim et al., 1991).     

A budget impact analysis of budesonide/formoterol in patients with mild asthma in Egypt

Abstract

Background: The aim of this study is to estimate the budget impact of budesonide/formoterol fixed dose combination (FDC) vs salbutamol, both used as needed, in mild asthma patients, from the perspective of the Health Insurance Organization (HIO).

Methods: A static budget impact model was developed to assess the impact of budesonide/formoterol FDC entry on HIO budget over a 3-year period in Egyptian settings. Direct medical costs, including the costs of asthma medications, exacerbations, and management of side-effects, were obtained from HIO cost data. Population data were obtained from the World Bank and supplemented with local studies, and the rates of exacerbations, adverse effects, and number of sick leave days were elicited from the SYGMA 1 trial. Scenario analyses from a societal perspective and deterministic sensitivity analyses were conducted.

Results: The total costs (drug and non-drug costs) for managing mild asthma patients from the HIO perspective were estimated to be EGP8.563 billion before budesonide/formoterol entry compared to EGP5.525 billion post-entry, leading to a total budget savings of EGP3.038 billion after 3?years. This total budget saving included an increase in drug costs (EGP104 million) and a decrease in non-drug costs (EGP3.143 billion). Drug costs were higher in the budesonide/formoterol group than in the salbutamol group, but this cost was offset by reductions in non-drug costs, resulting in a reduction in the total costs of healthcare resources. At the societal level, the total budget savings after including the indirect costs was expected to be EGP5.976 billion after 3?years of budesonide/formoterol entry.

Conclusion: Budesonide/formoterol in mild asthma instead of salbutamol produces better patient outcomes and decreases total costs, with increases in drug cost offset by reductions in non-drug costs due to fewer exacerbations. Budesonide/formoterol is a budget saving option for guideline-directed treatment, from the economic perspective of the payer and the health perspective of the patient.