Balázs Nagy

Climate and tectonically controlled river style changes on the Sajó-Hernád alluvial fan (Hungary)

Abstract Based on geomorphological field investigations, sediment analysis, radiocarbon and palynological data, changes in fluvial style have been recognized on one of the most important low-angle fluvial-dominant alluvial fans on the margin of the Great Hungarian Plain (Hungary). Late Pleistocene and Holocene climatic and tectonic controls are reflected partly by meandering and anastomosed channel pattern changes, and partly by erosional step features on the cone that mark erosional and accumulational phases. This work has led to the surface mapping of a ‘horizontal stratigraphy’ as part of a larger research project in the Tisza region.

High-resolution, well-preserved tritium record in the ice of Bortig Ice Cave, Bihor Mountains, Romania

Two 2 m long ice cores (BA and BB) were extracted from the floor ice of Borştig Ice Cave in December 2005. Below a co-existing dust horizon (~13 cm underneath the 10 December 2005 ice surface) neither core presented any sign of hiatus, so the ice deposition is considered to be continuous. Tritium concentration of 94 samples from a 1.85 m long ice section were analysed by liquid scintillation counting technique. Samples from the lower 0.33 m of the sequence did not contain tritium above the critical level (7.2 TU). The highest value of tritium content (166.4±4.0 TU) was found at ~96 cm below the surface. This salient value is considered to be synchronous with the climax of tritium concentration in the Northern Hemispheres atmospheric precipitation (1963). Beside this characteristic global radiochemical marker event, minor events were also detected, and dated (ie, 1954, 1958 and 1975) by corresponding peaks in the tritium concentration record of BB ice core to peaks of an estimation of tritium activity of past precipitation at Borştig Ice Cave location. The estimation was based on a data set from four nearby stations of the Global Network of Isotopes in Precipitation. The highest annual accumulation rate (6.74 cm/yr) was between 1958 and 1963 and gradually decreased to 0.54 cm/yr for the recent decades. The mean ice accumulation rate was 4.34 cm/yr over the 1954—1986 period. The estimated age at the bottom of the 21 m thick ice block assuming constant accumulation is roughly 500 years.

The cost-effectiveness of ulipristal acetate tablets in treating patients with moderate to severe symptoms of uterine fibroids

OBJECTIVES Ulipristal acetate is a selective progesterone receptor modulator that has been demonstrated to be an effective 3-month pre-operative treatment for moderate to severe symptoms of uterine fibroids in adult women of reproductive age. The aim of this analysis was to assess the cost-effectiveness of 5mg ulipristal as an add-on therapy to standard pre-surgical observation and treatment in Hungary. STUDY DESIGN A Markov model was developed using a 10-year time horizon. Ulipristal was compared with pre-surgical observation and immediate hysterectomy. The model comprised the following mutually exclusive health states: mild, moderate, severe, or persistent severe excessive bleeding disorder; myomectomy; post-myomectomy with mildly to moderately excessive bleeding disorder; post-myomectomy with severely excessive bleeding disorder; hysterectomy; post-hysterectomy; post-menopause; and death. Transition probabilities and utility values were obtained from clinical trials and the scientific literature. Resource utilisation and unit costs were derived from a consensus panel of clinical experts, National Health Insurance Fund tariffs, and publications. RESULTS Adding a 3-month course of ulipristal to pre-operative observation was predicted to achieve an additional 0.021 quality-adjusted life years (QALYs) at an estimated incremental cost of €397, which would result in an incremental cost of €19,200/QALY. When 3 months of ulipristal therapy was compared with immediate hysterectomy, the incremental cost-effectiveness ratio was reduced to €3575/QALY. The results were most sensitive to the utility value of the post-hysterectomy health state but responsive to changes in other model parameters. CONCLUSIONS The results of this analysis suggest that adding ulipristal treatment to standard pre-surgical therapy represents a good value for money in Hungary. The inclusion of societal benefits may considerably reduce the cost-effectiveness ratio.

The Cost Effectiveness of Lisdexamfetamine Dimesylate for the Treatment of Binge Eating Disorder in the USA

BackgroundLisdexamfetamine dimesylate (LDX) demonstrated efficacy in terms of reduced binge eating days per week in adults with binge eating disorder (BED) in two randomized clinical trials (RCTs).ObjectiveThe objective of this study was to evaluate the cost effectiveness of LDX versus no pharmacotherapy (NPT) in adults with BED from a USA healthcare payer’s perspective.Study Design and MethodsA decision-analytic Markov cohort model was developed using 1-week cycles and a 52-week time horizon. Markov health states were defined based upon the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition criteria of BED. Model parameter estimates were obtained from RCTs, a survey, and literature. The primary outcome was incremental cost-effectiveness ratio (ICER). The analysis assumed a 12-week course of treatment, based upon RCTs’ treatment duration. One-way deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the results.ResultsPatients on LDX therapy gained 0.006 quality-adjusted life years (QALY) compared to patients on the NPT arm, while the average total cost was US

A systematic review of health economic models and utility estimation methods in schizophrenia

175 higher for LDX therapy. The estimated ICER for LDX compared with NPT was US

Budget Impact Analysis of Introducing Lisdexamfetamine Dimesylate for the Treatment of Binge Eating Disorder in the United States

27,618 per QALY, which was shown to be cost effective given a willingness-to-pay threshold of US

Examples from the Boundaries of Geographic Survey: Architecture and Flood Modeling

50,000.ConclusionsTreatment of BED with LDX showed increase in QALYs at an acceptable cost and is considered to be cost effective at the commonly used willingness-to-pay threshold in the USA. Based on the available evidence, the current model focused on short-term benefits only. There is a need to generate additional scientific evidence supporting long-term benefits of LDX therapy for BED.

The value of a child born in the European Union

ABSTRACT Introduction: There is a growing need for economic evaluations describing the disease course, as well as the costs and clinical outcomes related to the treatment of schizophrenia. Areas covered: A systematic review on studies describing health economic models in schizophrenia and a targeted literature review on utility mapping algorithms in schizophrenia were carried out. Models found in the review were collated and assessed in detail according to their type and various other attributes. Fifty-nine studies were included in the review. Modeling techniques varied from simple decision trees to complex simulation models. The models used various clinical endpoints as value drivers, 47% of the models used quality-adjusted life years, and eight percent used disability-adjusted life years to measure benefits, while others applied various clinical outcomes. Most models considered patients switching between therapies, and therapeutic adherence, compliance or persistence. The targeted literature review identified four main approaches to map PANSS scores to utility values. Expert commentary: Health economic models developed for schizophrenia showed great variability, with simulation models becoming more frequently used in the last decade. Using PANSS scores as the basis of utility estimations is justifiable.

Az alacsony dózisú CT-vel végzett tüdőrákszűrés magyarországi egészség-gazdaságtani elemzésének koncepcionális terve

Vereinigung) in Nordbaden/Germany was available for analysis, covering the total regional population enrolled in Statutory Health Insurance (> 2.2 million lives for years 2003 to 2009). Linear trend analyses were performed using regression analysis with the growth index of the prevalence rates of MHDs as dependent variable, and a coefficient of determination R2> 0.57 at a significance level p< 0.05 indicating a meaningful trend observation. Results: Overall, MHD diagnoses remained stable at rates between 31% and 34% during the observation period. MHDs were diagnosed more frequently in females (rates 37%-43%) than in males, whereas a significant increase was observed in males only (from 23.5% in 2003 to 28% in 2009). Most frequently diagnosed mental health problems in 2009 were depressive episodes, with an overall administrative 12-months prevalence rate of 8.3%; unspecified somatoform disorders, 4.8%; harmful use of tobacco, 3.4%; neurasthenia, 2.3%; and adjustment disorders, 2.2%. Age and gender specific trends will be reported in detail. For example, from 2003 to 2009, the administrative prevalence of attention-deficit/hyperactivity disorder (ADHD) increased by 79% (from 0.53% in 2003 to 0.95% overall; 6-12 years, 8.0%; 13-17 years, 4.2%; adults from 0.04% in 2003 to 0.17% in 2009). Substantial prevalence increases were also found for dementia (significant for males only) and for disorders due to substance abuse (both males and females). ConClusions: The overall prevalence of MHDs did not increase during the observation period. Growing numbers for some disorders were compensated for by decreases of others.

Cost-Utility Analysis of Heberprot-P as an Add-on Therapy to Good Wound Care for Patients in Slovakia with Advanced Diabetic Foot Ulcer

This chapter will be more practical in nature. It will discuss two fields in which UAV-based photogrammetry proves a particularly efficient tool in geographic and architectural surveys. We will also reflect on the expectable accuracy of these relatively low-cost instruments.