Death from drowning: defining a new challenge for child survival in Bangladesh

The study focuses on children less than 5 years old and explores the epidemiological profile and correlates of drowning as a challenge to child survival in Bangladesh. Two data sources from Bangladesh, a cohort of 8,070 children followed for 2 years in a rural area and a nation-wide survey conducted in 1996–97 have been used. In addition, a systematic review of the literature has been conducted spanning the past two decades for analysis of drowning in children. Seventy drowning deaths were reported in the cohort and 726 deaths were reported in the national survey. Verbal autopsy and semi-structured interviews were conducted on all deaths. Drowning accounted for 43% of deaths in the cohort and 20% of deaths in 1–4-year-old children in the national survey. Most drowning deaths were in 12–23 month old children from falling into ditches and ponds. Communities provided valuable insights on possible interventions to reduce deaths due to drowning. Drowning is a newly recognized challenge for Bangladesh. Considerable research and programmatic work is required to understand the nature of the problem and develop appropriate interventions. This paper calls on aid agencies to create opportunities for drowning research and action in their work plans for the country.     

Contract farmer and poultry farm efficiency in Bangladesh: a data envelopment analysis

The objective of this article is to determine the efficiency of the poultry farm in Bangladesh and to assess the influence of contract farming system, using a data envelopment analysis. Seventy-five commercial poultry farms (25 and 50 independent and contract farms, respectively) were randomly selected. The results reveal that efficiency scores vary across sample farms. To explain some of these variations, the efficiency scores were regressed on some human capital variables and farming system using a Tobit model. The study also estimates elasticities to provide the information on the magnitude of the influence of variables on Technical Efficiency (TE), Allocative Efficiency (AE) and Economic Efficiency (EE). The results show that the contracting system is positively and significantly related to the farm's TE, AE and EE. This is expected because under contractual agreement, in order to obtain sufficient supplies of the right quality of poultry meat at the right time, the company provides technical know how assistance through company's recruited supervisor, production inputs and services, and production credit along with intensive supervision, which in turn improves farm efficiency. Thus, by receiving technical know how contract farmers have gained more knowledge on their resource and practices, which enables them to use resources more efficiently. Empirical results can provide crucial information to policy makers that improve poultry farm efficiency.     

Cohort versus patient level simulation for the economic evaluation of single versus combination immuno-oncology therapies in metastatic melanoma

Abstract

Background: Model structure, despite being a key source of uncertainty in economic evaluations, is often not treated as a priority for model development. In oncology, partitioned survival models (PSMs) and Markov models, both types of cohort model, are commonly used, but patient responses to newer immuno-oncology (I-O) agents suggest that more innovative model frameworks should be explored.

Objective: A discussion of the theoretical pros and cons of cohort level vs patient level simulation (PLS) models provides the background for an illustrative comparison of I-O therapies, namely nivolumab/ipilimumab combination and ipilimumab alone using patient level data from the CheckMate 067 trial in metastatic melanoma. PSM, Markov, and PLS models were compared on the basis of coherence with short-term clinical trial endpoints and long-term cost per QALY outcomes reported.

Methods: The PSM was based on Kaplan-Meier curves from CheckMate 067 with 3-year data on progression free survival (PFS) and overall survival (OS). The Markov model used time independent transition probabilities based on the average trajectory of PFS and OS over the trial period. The PLS model was developed based on baseline characteristics hypothesized to be associated with disease as well as significant mortality and disease progression risk factors identified through a proportional hazards model.

Results: The short-term Markov model outputs matched the 1–3?year clinical trial results approximately as well as the PSMs for OS but not PFS. The fixed (average) cohort PLS results corresponded as well as the PSMs for OS in the combination therapy arm and PFS in the monotherapy arm. Over the lifetime horizon, the PLS produced an additional 5.95 quality adjusted life years (QALYs) associated with combination therapy relative to ipilimumab alone, resulting in an incremental cost-effectiveness ratio (ICER) of £6,474 per QALY, compared with £14,194 for the PSMs which gave an incremental benefit of between 2.2 and 2.4 QALYs. The Markov model was an outlier (～ £49,000 per QALY in the base case).

Conclusions: The 4- and 5-state versions of the PSM cohort model estimated in this study deviate from the standard 3-state approach to better capture I-O response patterns. Markov and PLS approaches, by modeling state transitions explicitly, could be more informative in understanding I-O immune response, the PLS particularly so by reflecting heterogeneity in treatment response. However, both require a number of assumptions to capture the immune response effectively. Better I-O representation with surrogate endpoints in future clinical trials could yield greater model validity across all models.     

Economic growth and child poverty reduction in Bangladesh and China

This paper analyzes child poverty in Bangladesh and China during periods of rapid economic growth. It compares the extent as well as profile of child poverty in both countries. Comparisons on the extent of child poverty over time and across countries are made using a decomposition framework attributing child poverty differences to differences in three components: mean child income, demographic circumstances and the distribution of child income. Child poverty is found to be more extensive in Bangladesh than in China, and is very much a problem for rural children in both countries. The results show that economic growth can reduce child poverty but does not always do so. For understanding changes over time and across countries in the extent of child poverty, it can be necessary to also consider changes/differences in the distribution of child income as well as in the demographic composition.