A technology assessment (TA) program was launched in Switzerland in 1991. One project in the series of pilot projects was meant to assess the impact of so-called LESIT technologies on energy consumption. (LESIT was a priority research program and a German acronym for power electronics, systems and information technology.) In this paper the institutional environment, applied methods and main results of the TA study are summarised. One of the questions that arose was whether it is reasonable to expect a high-tech engineering research program to serve any societal goals other than the more immediate technical and economic goals the research partners in university and industry are accustomed to follow. It was found that without special efforts this expectation was not realistic. Politically desirable goals are best served when enough emphasis, time, and money are given to the process of bringing together research partners from academia and industry who all have a (self-serving) interest in furthering the politically desirable goal and then support their collaboration. 相似文献
Objective: To evaluate cost-effectiveness of brentuximab vedotin in patients with relapsed/refractory Hodgkin lymphoma who have received autologous stem cell transplantation, from a Scottish healthcare payer perspective.
Methods: A Microsoft Excel-based partitioned survival model comprising three health states (progression-free survival [PFS], post-progression survival, and death) was developed. Relevant comparators were chemotherapy with or without radiotherapy (C/R) and C/R with intent to allogeneic hematopoietic stem cell transplantation (alloSCT). Data were obtained from the pivotal phase II single-arm trial in 102 patients (SG035-0003; NCT00848926), a systematic literature review and clinical expert opinions (where empirical evidence was unavailable). PFS and overall survival for brentuximab vedotin were estimated using 5-year follow-up data from SG035-0003, and extrapolated using event rates observed for comparator treatments from published survival data. Resource use included drug acquisition and administration; alloSCT; treatment of adverse events; and long-term follow-up. Deterministic and probabilistic sensitivity analyses were conducted to evaluate the impact of uncertainty.
Results: In the base case, the incremental cost-effectiveness ratio (ICER) for brentuximab vedotin was £38,769 per quality-adjusted life year (QALY) vs C/R, whereas C/R with intent to alloSCT was dominated by brentuximab vedotin. ICERs for brentuximab vedotin generated by the deterministic sensitivity analysis ranged between £32,000–£54,000 per QALY. Including productivity benefits reduced the ICER to £28,881 per QALY.
Limitations: Limitations include lack of comparative data from this single arm study and the heterogeneous population. Inconsistent baseline characteristic reporting across studies prevented complete assessment of heterogeneity and the extent of potential bias in clinical and cost-effectiveness estimates.
Conclusions: Although the base case ICER is above the threshold usually applied in Scotland, it is relatively low compared with other orphan drugs, and lower than the ICER generated using a previous data cut of SG035-0003 that informed a positive recommendation from the Scottish Medicines Consortium, under its decision-making framework for assessment of ultra-orphan medicines. 相似文献
This paper tries to develop a neat and comprehensive probability theory for sample spaces where the events are fuzzy subsets of The investigations are focussed on the discussion how to equip those sample spaces with suitable -algebras and metrics. In the end we can point out a unified concept of random elements in the sample spaces under consideration which is linked with compatible metrics to express random errors. The result is supported by presenting a strong law of large numbers, a central limit theorem and a Glivenko-Cantelli theorem for these kinds of random elements, formulated simultaneously w.r.t. the selected metrics. As a by-product the line of reasoning, which is followed within the paper, enables us to generalize as well as to bring together already known results and concepts from literature.Acknowledgement. The author would like to thank the participants of the 23rd Linz Seminar on Fuzzy Set Theory for the intensive discussion of the paper. Especially he is indebted to Professors Diamond and Höhle whose remarks have helped to get deeper insights into the subject. Additionally, the author is grateful to one anonymous referee for careful reading and valuable proposals which have led to an improvement of the first draft.This paper was presented at the 23rd Linz Seminar on Fuzzy Set Theory, Linz, Austria, February 5–9, 2002. 相似文献