Objective
To evaluate the cost-effectiveness of monthly and as-needed dosing protocols using ranibizumab or bevacizumab for the treatment of neovascular age-related macular degeneration (AMD), when the treatment costs of severe ocular and systemic adverse events are considered.
Methods
A Markov model was developed to assess the cost effectiveness of each of the following protocols: monthly ranibizumab, monthly bevacizumab, as-needed ranibizumab and as-needed bevacizumab. Direct costs and utilities were assessed from the perspective of a third-party payer or an insurance company. Cost effectiveness was evaluated in 2011 US dollars per quality-adjusted life year (QALY).
Results
Considering the treatment costs of severe medical and ocular adverse events, the cost effectiveness of each protocol is as follows: monthly ranibizumab $63,333/QALY, ranibizumab as needed $18,571/QALY, bevacizumab monthly $2,676/QALY and bevacizumab as needed $3,333/QALY Sensitivity analysis of the treatment costs of medical and ocular adverse events demonstrated minimal impact on relative cost-effectiveness.
Conclusion
At current prices, monthly bevacizumab is the most cost-effective anti-VEGF AMD treatment protocol. Ranibizumab is as cost effective as bevacizumab at a maximum price of $158 per dose.
There is a paucity of information on the experience of subcontracted work despite the widespread use of subcontracting in the building construction industry. This study examined the influence of subcontracting processes on wages and workloads in the building construction industry in Nigeria. Data collection for the study was based on a cross-sectional research design with a survey research strategy, including a structured questionnaire and some key informant interviews. A sample of 908 subcontracted workers was randomly selected from 388 building construction sites in Lagos State, Nigeria. Data obtained from the structured questionnaire were subjected to descriptive statistics and regression analysis, while an ethnographic technique was used to analyze the data from the interviews. The regression results (β = –0.046; p < 0.05) showed that to some extent subcontracting processes significantly influenced workers’ participation in wage determination; and that the regression results (β = –0.040; p < 0.05) revealed that to some extent subcontracting processes significantly influenced workers’ participation in the determination of workloads in the building construction industry in Nigeria. Wages and workloads are inappropriate when the degree of influence of the subcontracting process on workers' participation in the determination of wages and workloads in the building construction industry is considered. These findings imply that working in a subcontracting system could promote the alienation of subcontracted workers from the determination of wages and workloads, thereby showing the need for adequate protection for the affected workers. Therefore, the subcontracted workers in Lagos state should strengthen their associations to achieve justice and decent work in the building construction industry.
Keywords: Building Construction; Subcontracted Workers; Wages; Workload.
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