(Georgia Institute of Technology, 2014-11-10)
Uzochukwu, Kelechi Nmaobi
In municipalities across the globe, traditional forms of governance are being supplemented by collaborative arrangements between governments and their constituencies toward jointly produced public services. Since the late 1970s, this phenomenon known as coproduction has been utilized in efforts to survive severe budget cuts, improve performance, increase accountability, and welcome traditionally silenced voices. However, no study to date has undergone a citywide assessment of coproduction to determine its breadth and depth in a city. Additionally, there is practically no empirical study that examines what citizen characteristics and perceptions are associated with participation in coproduction. The present study represents a first attempt to begin to fill these gaps in the literature. Specifically, this dissertation analyses: (1) How prevalent is coproduction? (2) Who engages in coproduction? and (3)What motivates coproducers? I employ a mixed-method case study of Atlanta, Georgia via its Neighborhood Planning Unit system, using focus groups, citizen questionnaires, census and GIS data, and direct observations. Overall, the coproduction classifications developed in this dissertation enable more systematic research on coproduction. The dissertation findings also contribute to our understanding of (1) how much this service delivery strategy is being utilized in an urban municipality, (2) which forms are most utilized, (3) what triggers participation in each form, and (4) who utilizes coproduction the most – even challenging the longstanding perception that African Americans and low-income groups do not participate in such activities. Lastly, study findings suggest a need to reconceptualize the current theory of coproduction as a public service delivery strategy.
(Georgia Institute of Technology, 2014-04-07)
Ferroussier-Davis, Odile
Preventative interventions often demand that resources be consumed in the present in exchange for future benefits. Understanding these trade-offs, in a context of resource constraints, is essential for policy makers. Cost-effectiveness analysis is one tool to inform decision-making.
Targeted testing and treatment (TTT) for latent tuberculosis infection (LTBI) consists in identifying people at high risk for LTBI for preventive treatment to decrease the risk that they will develop active tuberculosis disease (ATBD). The state of Tennessee began conducting TTT statewide in 2001. This study uses a decision tree to evaluate the cost and outcomes of TTT for LTBI in Tennessee, compared to passive ATBD case finding (PACF).
Key event probabilities were obtained from the Tennessee TTT program and from the literature. Outcomes are measured in terms of Quality Adjusted Life Years (QALY). The cost-effectiveness threshold was set at $100,000/QALY saved. One-way sensitivity analyses around factors related to study design (exclusion of patient costs, secondary transmission, discount rate and analytical horizon), the program’s environment (prevalence of LTBI and drug resistance, ATBD treatment costs) and program performance (program maturity, treatment initiation and completion rate, testing in low-risk group, test characteristics, screening costs) were conducted, as was probabilistic sensitivity analysis (PSA) which takes into account the uncertainty in multiple parameters simultaneously.
The base case, with a 25-year time horizon and 3% discount rate, shows that TTT prevents 47 ATBD cases, and saves 31 QALYs per 100,000 patients screened for LTBI at a societal cost of $12,579 (2011 US$) per QALY saved. Sensitivity analyses identified value thresholds that would trigger a change in preferred policy. PSA shows that the likelihood that TTT would be cost-effective is low.
Decision makers interested in implementing TTT should carefully assess the characteristics of the local TB epidemic and expected program performance to determine whether TTT is preferable over PACF from a cost-effectiveness viewpoint.