Cost-effectiveness of targeted screening for the identification of patients with atrial fibrillation: evaluation of a machine learning risk prediction algorithm

Abstract

Aims: As many cases of atrial fibrillation (AF) are asymptomatic, patients often remain undiagnosed until complications (e.g. stroke) manifest. Risk-prediction algorithms may help to efficiently identify people with undiagnosed AF. However, the cost-effectiveness of targeted screening remains uncertain. This study aimed to assess the cost-effectiveness of targeted screening, informed by a machine learning (ML) risk prediction algorithm, to identify patients with AF.

Methods: Cost-effectiveness analyses were undertaken utilizing a hybrid screening decision tree and Markov disease progression model. Costs and outcomes associated with the detection of AF compared traditional systematic and opportunistic AF screening strategies to targeted screening informed by a ML risk prediction algorithm. Model analyses were based on adults ≥50?years and adopted the UK NHS perspective.

Results: Targeted screening using the ML risk prediction algorithm required fewer patients to be screened (61 per 1,000 patients, compared to 534 and 687 patients in the systematic and opportunistic strategies) and detected more AF cases (11 per 1,000 patients, compared to 6 and 8?AF cases in the systematic and opportunistic screening strategies). The targeted approach demonstrated cost-effectiveness under base case settings (cost per QALY gained of £4,847 and £5,544 against systematic and opportunistic screening respectively). The targeted screening strategy was predicted to provide an additional 3.40 and 2.05 QALYs per 1,000 patients screened versus systematic and opportunistic strategies. The targeted screening strategy remained cost-effective in all scenarios evaluated.

Limitations: The analysis relied on assumptions that include the extended period of patient life span and the lack of consideration for treatment discontinuations/switching, as well as the assumption that the ML risk-prediction algorithm will identify asymptomatic AF.

Conclusions: Targeted screening using a ML risk prediction algorithm has the potential to enhance the clinical and cost-effectiveness of AF screening, improving health outcomes through efficient use of limited healthcare resources.     

Planning under market socialism when iteration is incomplete

If an iterative planning procedure is cut short due to time shortage, the plan must be set subject to information gaps. But the nature of these gaps depends on which iterative procedure was used. For the case of Lange's model, Weitzman's “prices versus quantities” framework is redeveloped for the particular information gaps then found. With one good, the optimal quantity signal comes from the expected supply-demand intersection, but an optimal price signal lies between this intersection and the price from the last stage of iteration. When there are many goods, however, we cannot be so specific.     

Individual‐Level Ambidexterity and Entrepreneurial Entry

This study examines the organizational drivers of entrepreneurial entry through the lens of individual‐level ambidexterity. We theorize that employees that both explore and exploit new activities within organizations are more likely to become entrepreneurs outside the organization. Multilevel analysis results from a large sample of Global Entrepreneurship Monitor survey data support this hypothesis. This study contributes to the entrepreneurship literature by highlighting the role of individuals' prior ambidexterity experiences in organizations as foundational building blocks of entrepreneurial entry. The study links entrepreneurship and ambidexterity theories with evidence that an individual's ambidexterity and entrepreneurial activities are related.     

‘Conscience Capitalism’ and the Neoliberalisation of the Non-Profit Sector

This article analyses a range of initiatives, labelled as ‘conscience capitalist’, that have become prominent since the 2008 financial crash. Conscience capitalism encompasses projects emerging in both the for- and non-profit sectors that seek to connect neoliberal capitalism with concepts of morality and conscience. The article begins by unpacking conscience capitalism, showing how its for-profit advocates seek to transform capitalism by orienting it towards accounting for social and environmental externalities, and how its non-profit supporters seek to incorporate components of neoliberalism to serve their environmentally and/or socially focused agendas. Conscience capitalism appears to be a re-evaluation and call for reform of the prominent forms of neoliberalism. However, this article argues that, rather than comprising a hindrance, conscience capitalism offers a means of advancing the project. This is evident in its attempts to reconstitute social and environmental externalities in terms relatable to the market, and represent social and environmental problems in quantitative terms in which the success of market-based solutions can be read. Acknowledging some of the successes of conscience capitalist campaigns, the article concludes by arguing that this continued neoliberalisation of the non-profit sector favours campaigns consistent with neoliberalism and has the potential to undermine the democratic governance of non-profits.     

The Benefits of Farm Animal Welfare Legislation: The Case of the EU Broiler Directive and Truthful Reporting

The EU Broiler Directive came into force in the UK in June 2010 with the aim of setting new minimum standards, monitoring broiler welfare and addressing any welfare problems. A survey questionnaire was used to elicit information from a stratified sample of citizens in England and Wales regarding their willingness to pay for the provisions of the Directive, as an estimate of the consumer surplus associated with the legislation. We also explore the usefulness of Prelec's ( 2004 ) Bayesian Truth Serum (BTS) in promoting respondents’ truthful reporting. A median willingness to pay of £21.50 per household per year (corrected for sample bias and possible ‘yea saying’) was estimated from 665 responses. This provides an estimated benefit of the legislation to citizens of over £503 million per year, equivalent to 5.3% of current consumer expenditure on chicken. This compares to an estimated £22 million per year cost of producers’ compliance and government enforcement associated with the legislation. No statistically significant differences in responses between respondents that did and did not have a BTS incentive to answer questions truthfully were found, which might reflect apparently truthful answers in this case, an insufficiently strong financial incentive or a weakened effect due to an element of disbelief in the BTS amongst the sample. The analysis suggests that the benefits of the Broiler Directive to citizens greatly outweigh the additional costs to producers, making a case for the legislation to be retained.     

Is coworker feedback more important than supervisor feedback for increasing innovative behavior?

A growing body of research explores human resource management practices that encourage employees to innovate. In this study, we examine the links between different sources of feedback (supervisor and coworker) and employees’ innovative behavior. Drawing on social exchange theory and the job demands‐resources theory, we first propose that work engagement and psychological contract breach mediate the relationship between supervisor feedback and employees’ innovative behavior. Second, we propose a moderated mediation model in which coworker feedback attenuates the relationships between supervisor feedback and employees’ innovative behavior through the mediating mechanisms of both work engagement and psychological contract breach. Using three waves of multisource data from 300 Chinese employees and their 64 supervisors, we found a dual‐mediation pathway by which employees’ work engagement and perceptions of psychological contract breach mediate the influence of supervisor feedback on innovative behavior. Our results also show that coworker feedback can be used to supplement the lack of supervisor feedback when required. Organizations are advised to ensure that employees obtain regular feedback from multiple sources because such feedback can promote employees’ work engagement and perceptions that the organization is upholding its side of the psychological contract, which fosters employees’ innovative behavior.     

Strengths and Weaknesses of Crosscompliance in the CAP

Cross-compliance has increasingly been used to integrate environmental considerations into the CAP. From 2005 it became compulsory for all Member States to ensure that recipients of Single Farm Payments adhered to Statutory Management Requirements (SMRs), stemming from 19 EU regulations and directives, and kept their whole agricultural holding in 'Good Agricultural and Environmental Condition' (GAEC), to be defined by Member States or regional authorities. The potential for cross-compliance to enhance implementation of EU environmental legislation and reach a large area of farmland seems good, although there are some questions remaining over whether it will reach the agricultural land at most risk of environmental damage or with the highest nature value. In addition, farmers could react in several ways to exempt themselves or some area of their holding from cross-compliance conditions. Member States or regional authorities have taken a variety of approaches to setting cross-compliance standards, some of which seem minimal and vague. There is scope for the SMRs and GAEC to cover more environmental issues. Better guidance at EU level and increased communication could enhance implementation of cross-compliance. Self-audits, co-operation with private assurance schemes or other methods of monitoring should be explored to maximise the efficiency and effectiveness of administrative efforts.