WorldWideScience

Sample records for budget impact analysis

  1. [Guidelines for budget impact analysis of health technologies in Brazil].

    Science.gov (United States)

    Ferreira-Da-Silva, Andre Luis; Ribeiro, Rodrigo Antonini; Santos, Vânia Cristina Canuto; Elias, Flávia Tavares Silva; d'Oliveira, Alexandre Lemgruber Portugal; Polanczyk, Carisi Anne

    2012-07-01

    Budget impact analysis (BIA) provides operational financial forecasts to implement new technologies in healthcare systems. There were no previous specific recommendations to conduct such analyses in Brazil. This paper reviews BIA methods for health technologies and proposes BIA guidelines for the public and private Brazilian healthcare system. The following recommendations were made: adopt the budget administrator's perspective; use a timeframe of 1 to 5 years; compare reference and alternative scenarios; consider the technology's rate of incorporation; estimate the target population by either an epidemiological approach or measured demand; consider restrictions on technologies' indication or factors that increase the demand for them; consider direct and averted costs; do not adjust for inflation or discounts; preferably, integrate information on a spreadsheet; calculate the incremental budget impact between scenarios; and summarize information in a budget impact report.

  2. Budget impact analysis of medicines: updated systematic review and implications.

    Science.gov (United States)

    Faleiros, Daniel Resende; Álvares, Juliana; Almeida, Alessandra Maciel; de Araújo, Vânia Eloisa; Andrade, Eli Iola Gurgel; Godman, Brian B; Acurcio, Francisco A; Guerra Júnior, Augusto A

    2016-01-01

    This evaluation determines whether published studies to date meet the key characteristics identified for budget impact analyses (BIA) for medicines, accomplished through a systematic review and assessment against identified key characteristics. Studies from 2001-2015 on 'budget impact analysis' with 'drug' interventions were assessed, selected based on their titles/abstracts and full texts, and their characteristics checked according to key criteria. Out of 1,984 studies, 92 were subsequently identified for review. Of these, 95% were published in Europe and the USA. 2012 saw the largest number of publications (16%) with a decline thereafter. 48% met up to 7 out of the 9 key characteristics. Only 22% stated no conflict of interest. The results indicate low adherence to the key characteristics that should be considered for BIAs and strong conflict of interest. This is an issue since BIAs can be of fundamental importance in managing the entry of new medicines including reimbursement decisions.

  3. A budget impact analysis of natalizumab use in Ireland.

    LENUS (Irish Health Repository)

    Dee, A

    2011-10-20

    BACKGROUND: Multiple sclerosis is the commonest cause of disability in young Irish adults. Natalizumab reduces disability progression in those patients with relapsing remitting multiple sclerosis who are suitable for it. First line disease modifying therapies are given in the community and are paid for by the hi-tech drug scheme. Natalizumab is given in hospital and is paid for from the hospital\\'s budget. Access to natalizumab has been problematic in some Irish hospitals. A budget impact analysis was performed to look at the overall cost to the Health Service Executive of giving natalizumab. METHODS: A budget impact analysis was performed from the perspective of the Health Service Executive comparing the use of natalizumab with first line disease modifying therapies for 2009-2011. RESULTS: The study showed that currently, the use of natalizumab is likely to be cost saving to the Health Service Executive overall, because some of the costs for natalizumab are borne by private insurers, whereas, all of the costs of disease modifying therapies are borne by the Health Service Executive. CONCLUSIONS: Although the use of natalizumab is cost saving, current funding arrangements in the Health Service Executive do not allow for the transfer of money saved from drugs paid for in the hi-tech scheme, to hospitals who are supplying alternative treatments.

  4. BUDGET IMPACT ANALYSIS OF BELIMUMAB IN TREATING SYSTEMIC LUPUS ERYTHEMATOSUS.

    Science.gov (United States)

    Pierotti, Francesca; Palla, Iaria; Pippo, Lara; Lorenzoni, Valentina; Turchetti, Giuseppe

    2016-01-01

    The study evaluates the costs of systemic lupus erythematosus (SLE) and the budget impact due to the introduction of belimumab in the Italian setting. Adaptation to the Italian setting of a budget impact model with a time horizon of 4 years (year 0 without belimumab, years 1-3 with belimumab) to compare treatment, administration, and clinical monitoring costs of standard therapy and of the alternative scenario in which belimumab is administered in addition to the standard therapy to the subgroup of patients selected according to the label approved by the European Medicines Agency. The model takes also into account the costs of flares. Over 3 years, belimumab is able to prevent cumulatively 1,111 severe flares and 3,631 nonsevere flares with a total saving for the Italian National Health System (NHS) of approximately €6.2 million. Budget impact ranges from €4.4 million in the first year to €20.3 million in the third year. The decrease in the number of flare partially counterbalances the costs of the new technology (impact attenuation of approximately 16 percent). These data elucidate the importance to control and monitor the disease progression and to prevent exacerbations, which are the major causes of the increase in costs paid by the NHS and by the society. The financial impact could be replicate on a regional basis, to inform local decision makers. Further developments are possible as the model does not consider the additional clinical and economic benefits of reduced damage accrual and slowed disease progression.

  5. Budget impact analysis of trastuzumab in early breast cancer: a hospital district perspective.

    Science.gov (United States)

    Purmonen, Timo T; Auvinen, Päivi K; Martikainen, Janne A

    2010-04-01

    Adjuvant trastuzumab is widely used in HER2-positive (HER2+) early breast cancer, and despite its cost-effectiveness, it causes substantial costs for health care. The purpose of the study was to develop a tool for estimating the budget impact of new cancer treatments. With this tool, we were able to estimate the budget impact of adjuvant trastuzumab, as well as the probability of staying within a given budget constraint. The created model-based evaluation tool was used to explore the budget impact of trastuzumab in early breast cancer in a single Finnish hospital district with 250,000 inhabitants. The used model took into account the number of patients, HER2+ prevalence, length and cost of treatment, and the effectiveness of the therapy. Probabilistic sensitivity analysis and alternative case scenarios were performed to ensure the robustness of the results. Introduction of adjuvant trastuzumab caused substantial costs for a relatively small hospital district. In base-case analysis the 4-year net budget impact was 1.3 million euro. The trastuzumab acquisition costs were partially offset by the reduction in costs associated with the treatment of cancer recurrence and metastatic disease. Budget impact analyses provide important information about the overall economic impact of new treatments, and thus offer complementary information to cost-effectiveness analyses. Inclusion of treatment outcomes and probabilistic sensitivity analysis provides more realistic estimates of the net budget impact. The length of trastuzumab treatment has a strong effect on the budget impact.

  6. Budget impact analysis of 8 hormonal contraceptive options.

    Science.gov (United States)

    Crespi, Simone; Kerrigan, Matthew; Sood, Vipan

    2013-07-01

    To develop a model comparing costs of 8 hormonal contraceptives and determine whether acquisition costs for implants and intrauterine devices (IUDs) were offset by decreased pregnancy-related costs over a 3-year time horizon from a managed care perspective. A model was developed to assess the budget impact of branded or generic oral contraceptives (OCs), quarterly intramuscular depot medroxyprogesterone, etonogestrel/ethinyl estradiol vaginal ring, etonogestrel implant, levonorgestrel IUD, norelgestromin/ethinyl estradiol transdermal contraceptive, and ethinyl estradiol/levonorgestrel extended-cycle OC. Major variables included drug costs, typical use failure rates, discontinuation rates, and pregnancy costs. The base case assessed costs for 1000 women initiating each of the hormonal contraceptives. The etonogestrel implant and levonorgestrel IUD resulted in the fewest pregnancies, 63 and 85, respectively, and the least cost, $1.75 million and $2.0 million, respectively. In comparison, generic OC users accounted for a total of 243 pregnancies and $3.4 million in costs. At the end of year 1, costs for the etonogestrel implant ($800,471) and levonorgestrel IUD ($949,721) were already lower than those for generic OCs ($1,146,890). Sensitivity analysis showed that the cost of pregnancies, not product acquisition cost, was the primary cost driver. Higher initial acquisition costs for the etonogestrel implant and levonorgestrel IUD were offset within 1 year by lower contraceptive failure rates and consequent pregnancy costs. Thus, after accounting for typical use failure rates of contraceptive products, the etonogestrel implant and levonorgestrel IUD emerged as the least expensive hormonal contraceptives.

  7. Budget impact analysis of adjunctive therapy with lacosamide for partial-onset epileptic seizures in Belgium.

    Science.gov (United States)

    Simoens, Steven

    2011-01-01

    This study aims to compute the budget impact of lacosamide, a new adjunctive therapy for partial-onset seizures in epilepsy patients from 16 years of age who are uncontrolled and having previously used at least three anti-epileptic drugs from a Belgian healthcare payer perspective. The budget impact analysis compared the 'world with lacosamide' to the 'world without lacosamide' and calculated how a change in the mix of anti-epileptic drugs used to treat uncontrolled epilepsy would impact drug spending from 2008 to 2013. Data on the number of patients and on the market shares of anti-epileptic drugs were taken from Belgian sources and from the literature. Unit costs of anti-epileptic drugs originated from Belgian sources. The budget impact was calculated from two scenarios about the market uptake of lacosamide. The Belgian target population is expected to increase from 5333 patients in 2008 to 5522 patients in 2013. Assuming that the market share of lacosamide increases linearly over time and is taken evenly from all other anti-epileptic drugs (AEDs), the budget impact of adopting adjunctive therapy with lacosamide increases from €5249 (0.1% of reference drug budget) in 2008 to €242,700 (4.7% of reference drug budget) in 2013. Assuming that 10% of patients use standard AED therapy plus lacosamide, the budget impact of adopting adjunctive therapy with lacosamide is around €800,000-900,000 per year (or 16.7% of the reference drug budget). Adjunctive therapy with lacosamide would raise drug spending for this patient population by as much as 16.7% per year. However, this budget impact analysis did not consider the fact that lacosamide reduces costs of seizure management and withdrawal. The literature suggests that, if savings in other healthcare costs are taken into account, adjunctive therapy with lacosamide may be cost saving.

  8. [HAS budget impact analysis guidelines: A new decision-making tool].

    Science.gov (United States)

    Ghabri, Salah; Poullié, Anne-Isabelle; Autin, Erwan; Josselin, Jean-Michel

    2017-10-02

    Budget impact analysis (BIA) provides short and medium-term estimates on changes in budgets and resources resulting from the adoption of new health interventions. The objective of this article is to present the main messages of the newly developed French National Authority for Health (HAS) guidelines on budget impact analysis : issues, recommendations and perspectives. The HAS guidelines development process was based on data derived from a literature review on BIA (search dates : January 2000 to June 2016), an HAS retrospective investigation, a public consultation, international expert advice, and approval from the HAS Board and the Economic and Public Health Evaluation Committee. Based on its research findings, HAS developed its first BIA guidelines, which include recommendations on the following topics : BIA definition, perspective, populations, time horizon, compared scenarios, budget impact models, costing, discounting, choice of clinical data, reporting of results and uncertainty analysis. The HAS BIA guidelines are expected to enhance the usefulness of BIA as an essential part of a comprehensive economic assessment of healthcare interventions, which itself includes cost-effectiveness analysis and equity of access to healthcare.

  9. Review of economic studies and budget impact analysis of ocriplasmin as a treatment of vitreomacular traction.

    Science.gov (United States)

    García-Pérez, L; Abreu-González, R; Pérez-Ramos, J; García-Pérez, S; Serrano-Aguilar, P

    2016-06-01

    To review the evidence on the cost-effectiveness of ocriplasmin as a treatment for vitreomacular traction (VMT), and to estimate the impact on the Spanish National Health System (NHS). 1) Systematic review. The following databases were searched in January 2015: MEDLINE, PREMEDLINE, EMBASE, CRD, the Cochrane Library, and key websites. Selection criteria were: full economic evaluations that compared ocriplasmin with usual care ('watch and wait' and/or vitrectomy) in patients with VMT. The outcomes to extract were costs of the alternatives and the incremental cost-effectiveness ratio. Studies of budget impact analysis were also included. The methodological quality was assessed, and a narrative synthesis of the included studies was carried out. 2) Estimation of budget impact. The impact on the budget as a result of the introduction of ocriplasmin in the NHS was estimated, including data from different sources. Six studies were identified, none of them performed in Spain. The two best studies concluded that ocriplasmin is cost-effective in their respective countries (Canada and United Kingdom), but only in patients with certain conditions (without epiretinal membrane, for example). The results of the budget impact analysis are different between countries. The analysis for Spain showed that the introduction of ocriplasmin would mean a saving over 1 million Euros for the NHS in 5 years. The cost-effectiveness of ocriplasmin has not been demonstrated in Spain. However, good studies performed in other countries found that ocriplasmin is cost-effective in selected patients. Given the current prices in Spain, ocriplasmin could involve a saving for the Spanish NHS. Copyright © 2016 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

  10. Budget impact analysis of drugs for ultra-orphan non-oncological diseases in Europe.

    Science.gov (United States)

    Schlander, Michael; Adarkwah, Charles Christian; Gandjour, Afschin

    2015-02-01

    Ultra-orphan diseases (UODs) have been defined by a prevalence of less than 1 per 50,000 persons. However, little is known about budget impact of ultra-orphan drugs. For analysis, the budget impact analysis (BIA) had a time horizon of 10 years (2012-2021) and a pan-European payer's perspective, based on prevalence data for UODs for which patented drugs are available and/or for which drugs are in clinical development. A total of 18 drugs under patent protection or orphan drug designation for non-oncological UODs were identified. Furthermore, 29 ultra-orphan drugs for non-oncological diseases under development that have the potential of reaching the market by 2021 were found. Total budget impact over 10 years was estimated to be €15,660 and €4965 million for approved and pipeline ultra-orphan drugs, respectively (total: €20,625 million). The analysis does not support concerns regarding an uncontrolled growth in expenditures for drugs for UODs.

  11. Budget impact analysis of two immunotherapy products for treatment of grass pollen-induced allergic rhinoconjunctivitis

    Directory of Open Access Journals (Sweden)

    Rønborg SM

    2012-09-01

    Full Text Available Steen M Rønborg,1 Ulrik G Svendsen,2 Jesper S Micheelsen,3 Lars Ytte,4 Jakob N Andreasen,5 Lars Ehlers61The Pulmonology and Allergy Clinic of Copenhagen, Copenhagen, 2Bispebjerg Hospital, Copenhagen, 3Private ENT practice, Aalborg, 4General Practice Aalborg, 5ALK, Hørsholm, 6Aalborg University, Aalborg, DenmarkBackground: Grass pollen-induced allergic rhinoconjunctivitis constitutes a large burden for society. Up to 20% of European and United States (US populations suffer from respiratory allergies, including grass pollen-induced allergic rhinoconjunctivitis. The majority of patients are treated with symptomatic medications; however, a large proportion remains uncontrolled despite use of such treatments. Specific immunotherapy is the only treatment documented to target the underlying cause of the disease, leading to a sustained effect after completion of treatment. The aim of this study was to compare the economic consequences of treating patients suffering from allergic rhinoconjunctivitis with either a grass allergy immunotherapy tablet (AIT or subcutaneous immunotherapy (SCIT.Methods: A budget impact analysis was applied comparing SQ-standardized grass AIT (Grazax®; Phleum pratense, 75,000 SQ-T/2,800 BAU; ALK, Denmark with SCIT (Alutard®; P. pratense, 100,000 SQ-U/mL; ALK, Denmark. Budget impact analysis included health care utilization measured in physical units based on systematic literature reviews, guidelines, and expert opinions, as well as valuation in unit costs based on drug tariffs, physician fees, and wage statistics. Budget impact analysis was conducted from a Danish health care perspective.Results: Treating patients suffering from allergic rhinoconjunctivitis with grass AIT instead of grass SCIT resulted in a total reduction in treatment costs of €1291 per patient during a treatment course. This cost saving implies that approximately 40% more patients could be treated with grass AIT per year without influencing the cost of

  12. Budget impact analysis of pemetrexed introduction: case study from a teaching hospital perspective, Thailand.

    Science.gov (United States)

    Chanjaruporn, Farsai; Roughead, Elizabeth E; Sooksriwong, Cha-oncin; Kaojarern, Sming

    2011-09-01

    Thailand does not currently require Budget Impact Analysis (BIA) assessment. The present study aimed to estimate the annual drug cost and the incremental impact on the hospital pharmaceutical budget of the introduction of pemetrexed to a Thai teaching hospital. The budget impact model was conducted in accordance with the Guidelines for preparing submissions to the Pharmaceutical Benefits Advisory Committee (PBAC). The model variables consisted of number of patients, growth rate of lung cancer, uptake rate of pemetrexed over time, unit prices of drugs, and the length and cost of treatment. Sensitivity analysis was performed to determine changes in budgetary impact due to variation of parameters or assumptions in the model. The introduction of pemetrexed was estimated to cause considerable costs for the teaching hospital. In the base-case analysis, the incremental costs were estimated at 8,553,984 Baht in the first year increasing to 12, 118, 144 Baht, 17,820,800 Baht and 17,820,800 Baht in the following years. The 4-year net budgetary impact was 20,154,480 Baht or approximately 127,560 Baht per patient. Sensitivity analyses found that number of treatment cycles andproportion of patients assumed to be treated with pemetrexed were the two most important influencing factors in the model. New costly innovative interventions should be evaluated using the BIA model to determine whether they are affordable. The Thai government should consider requiring the BIA study as one of the requirements for drug submission to assist in the determination of listing and subsidizing decision for medicines.

  13. The effect of new biosimilars in rheumatology and gastroenterology specialities on UK healthcare budgets: Results of a budget impact analysis.

    Science.gov (United States)

    Aladul, Mohammed I; Fitzpatrick, Raymond W; Chapman, Stephen R

    2018-05-15

    The approval of new biosimilars of infliximab, etanercept and adalimumab by the European Medicines Agency is expected to produce further cost savings to the healthcare system budget. This study aimed to estimate the budget impact of the introduction of new biosimilars Flixabi ® , Erelzi ® , Solymbic ® , Amgevita ® and Imraldi ® in rheumatology and gastroenterology specialities in the UK. A published budget impact model was adapted to estimate the expected cost savings following the entry of new biosimilars Flixabi ® , Erelzi ® , Solymbic ® , Amgevita ® and Imraldi ® in the UK over three-year time horizon. This model was based on retrospective market shares of biologics used in rheumatology and gastroenterology which were derived from DEFINE Software and healthcare professional perspectives. The model predicted that infliximab and etanercept biosimilars would replace their corresponding reference agents by 2020. Adalimumab biosimilars were predicted to achieve 19% of the rheumatology and gastroenterology market by 2020. Without the introduction of further biosimilars, the model predicted a reduction in expenditure of £44 million on biologics over the next three years. With the entry of Flixabi ® , Erelzi ® , Solymbic ® , Amgevita ® and Imraldi ® the model estimates cumulative savings of £285 million by 2020. The introduction of new infliximab, etanercept and adalimumab biosimilars will be associated with considerable cost savings and have a substantial favourable impact on the UK NHS budget. The number of biosimilars and time of entry of is critical to create competition which will result in maximum cost savings. Copyright © 2018 Elsevier Inc. All rights reserved.

  14. Budget impact analysis of chronic kidney disease mass screening test in Japan.

    Science.gov (United States)

    Kondo, Masahide; Yamagata, Kunihiro; Hoshi, Shu-Ling; Saito, Chie; Asahi, Koichi; Moriyama, Toshiki; Tsuruya, Kazuhiko; Konta, Tsuneo; Fujimoto, Shouichi; Narita, Ichiei; Kimura, Kenjiro; Iseki, Kunitoshi; Watanabe, Tsuyoshi

    2014-12-01

    Our recently published cost-effectiveness study on chronic kidney disease mass screening test in Japan evaluated the use of dipstick test, serum creatinine (Cr) assay or both in specific health checkup (SHC). Mandating the use of serum Cr assay additionally, or the continuation of current policy mandating dipstick test only was found cost-effective. This study aims to examine the affordability of previously suggested reforms. Budget impact analysis was conducted assuming the economic model would be good for 15 years and applying a population projection. Costs expended by social insurers without discounting were counted as budgets. Annual budget impacts of mass screening compared with do-nothing scenario were calculated as ¥79-¥-1,067 million for dipstick test only, ¥2,505-¥9,235 million for serum Cr assay only and ¥2,517-¥9,251 million for the use of both during a 15-year period. Annual budget impacts associated with the reforms were calculated as ¥975-¥4,129 million for mandating serum Cr assay in addition to the currently used mandatory dipstick test, and ¥963-¥4,113 million for mandating serum Cr assay only and abandoning dipstick test. Estimated values associated with the reform from ¥963-¥4,129 million per year over 15 years are considerable amounts of money under limited resources. The most impressive finding of this study is the decreasing additional expenditures in dipstick test only scenario. This suggests that current policy which mandates dipstick test only would contain medical care expenditure.

  15. Budget impact and cost-utility analysis of universal infant rotavirus vaccination in Spain.

    Science.gov (United States)

    Imaz, Iñaki; Rubio, Beltrán; Cornejo, Ana M; González-Enríquez, Jesús

    2014-04-01

    Rotavirus is not included in the Spanish mass infant vaccination schedule but has also not been economically evaluated for its inclusion. We analysed cost-utility of the universal infant rotavirus vaccination using RotaTeq® versus no vaccination in Spain. We also carried out a budget impact analysis and determined the effect on results of different variables introduced in the model. A deterministic Markov model was built considering loss of quality of life for children and their parents, and introducing direct and indirect costs updated to 2011. The introduction of the vaccination using RotaTeq® as a universal infant vaccination would increase the annual health care budget in 10.43 million euro and would result in a gain of an additional Quality Adjusted Life Year at a cost of 280,338€ from the healthcare system perspective and 210,167€ from the societal perspective. The model was stable to variable modifications. To sum up, according to our model and estimates, the introduction of a universal infant rotavirus vaccination with RotaTeq® in Spain would cause a large impact on the health care budget and would not be efficient unless significant variations in vaccine price, vaccine efficacy and/or utilities took place. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Next-generation sequencing in NSCLC and melanoma patients: a cost and budget impact analysis

    Science.gov (United States)

    van Amerongen, Rosa A; Retèl, Valesca P; Coupé, Veerle MH; Nederlof, Petra M; Vogel, Maartje J; van Harten, Wim H

    2016-01-01

    Next-generation sequencing (NGS) has reached the molecular diagnostic laboratories. Although the NGS technology aims to improve the effectiveness of therapies by selecting the most promising therapy, concerns are that NGS testing is expensive and that the ‘benefits’ are not yet in relation to these costs. In this study, we give an estimation of the costs and an institutional and national budget impact of various types of NGS tests in non-small-cell lung cancer (NSCLC) and melanoma patients within The Netherlands. First, an activity-based costing (ABC) analysis has been conducted on the costs of two examples of NGS panels (small- and medium-targeted gene panel (TGP)) based on data of The Netherlands Cancer Institute (NKI). Second, we performed a budget impact analysis (BIA) to estimate the current (2015) and future (2020) budget impact of NGS on molecular diagnostics for NSCLC and melanoma patients in The Netherlands. Literature, expert opinions, and a data set of patients within the NKI (n = 172) have been included in the BIA. Based on our analysis, we expect that the NGS test cost concerns will be limited. In the current situation, NGS can indeed result in higher diagnostic test costs, which is mainly related to required additional tests besides the small TGP. However, in the future, we expect that the use of whole-genome sequencing (WGS) will increase, for which it is expected that additional tests can be (partly) avoided. Although the current clinical benefits are expected to be limited, the research potentials of NGS are already an important advantage. PMID:27899957

  17. Budget impact analysis-principles of good practice: report of the ISPOR 2012 Budget Impact Analysis Good Practice II Task Force.

    Science.gov (United States)

    Sullivan, Sean D; Mauskopf, Josephine A; Augustovski, Federico; Jaime Caro, J; Lee, Karen M; Minchin, Mark; Orlewska, Ewa; Penna, Pete; Rodriguez Barrios, Jose-Manuel; Shau, Wen-Yi

    2014-01-01

    , disease severity mix, or treatment patterns cannot be credibly captured by using the cost calculator approach, a cohort or patient-level condition-specific model may be used to estimate the budget impact of the new intervention, accounting appropriately for those entering and leaving the eligible population over time. In either case, the BIA should use data that reflect values specific to a particular decision maker's population. Sensitivity analysis should be of alternative scenarios chosen from the perspective of the decision maker. The validation of the model should include at least face validity with decision makers and verification of the calculations. Data sources for the BIA should include published clinical trial estimates and comparator studies for the efficacy and safety of the current and new interventions as well as the decision maker's own population for the other parameter estimates, where possible. Other data sources include the use of published data, well-recognized local or national statistical information, and, in special circumstances, expert opinion. Reporting of the BIA should provide detailed information about the input parameter values and calculations at a level of detail that would allow another modeler to replicate the analysis. The outcomes of the BIA should be presented in the format of interest to health care decision makers. In a computer program, options should be provided for different categories of costs to be included or excluded from the analysis. We recommend a framework for the BIA, provide guidance on the acquisition and use of data, and offer a common reporting format that will promote standardization and transparency. Adherence to these good research practice principles would not necessarily supersede jurisdiction-specific BIA guidelines but may support and enhance local recommendations or serve as a starting point for payers wishing to promulgate methodology guidelines. © 2013 International Society for Pharmacoeconomics and

  18. Budget impact of vildagliptin

    Directory of Open Access Journals (Sweden)

    Orietta Zaniolo

    2008-09-01

    Full Text Available Introduction: to evaluate the impact on the Italian National Health Service (NHS budget of the recent introduction of the DPP-4 inhibitor vildagliptin in combination treatment for NIDDM patients. Methods: NIDDM patients eligible to vildagliptin treatment were identified and quantified based on approved indications and prevalence data review; adequate alternative strategies were identified; direct medical costs associated with competing strategies were calculated according to national practice and prices (drug acquisition, therapeutic monitoring, cost for managing severe adverse events – severe hypoglycemia events, fractures, new heart failure cases and the NHS budgetary impact was estimated according to market penetration assumptions (base-case: 5% and 10% for the first and second year, respectively. Results: patients estimated eligible for vildagliptin in Italy are about 237,500: pts inadequately controlled with metformin monotherapy (166,500, pts inadequately controlled with sulfonylurea monotherapy and intolerant/contraindicated to metformin (70,200, and those inadequately controlled with thiazolidinedione monotherapy (800. Costing and comparing of the vildagliptin-based and competing strategies revealed differences in both directions, depending on patient subgroup. Assuming uniform penetration among identified patient subgroups, vildagliptin introduction is expected to raise NHS costs by 2,750,000 Euro in the first and by 5,500,000 Euro in the second year, respectively representing 1,6% and 3,2% of the estimated total management cost of this patient population. Conclusions: the introduction of vildagliptin in the treatment of Italian NIDDM patients offers a new therapeutic option for three inadequately controlled NIDDM subpopulations; the financial impact on Italian NHS expenditures depends on patient selection and can be expected not to exceed 2-3% of the currently dedicated budget in the first two years.

  19. Economic Evaluation and Budget Impact Analysis of Vaccination against Haemophilus influenzae Type b Infection in Thailand

    Directory of Open Access Journals (Sweden)

    Surachai Kotirum

    2017-11-01

    Full Text Available Current study aimed to estimate clinical and economic outcomes of providing the Haemophilus influenzae type b (Hib vaccination as a national vaccine immunization program in Thailand. A decision tree combined with Markov model was developed to simulate relevant costs and health outcomes covering lifetime horizon in societal and health care payer perspectives. This analysis considered children aged under 5 years old whom preventive vaccine of Hib infection are indicated. Two combined Hib vaccination schedules were considered: three-dose series (3 + 0 and three-dose series plus a booster does (3 + 1 compared with no vaccination. Budget impact analysis was also performed under Thai government perspective. The outcomes were reported as Hib-infected cases averted and incremental cost-effectiveness ratios (ICERs in 2014 Thai baht (THB ($ per quality-adjusted life year (QALY gained. In base-case scenario, the model estimates that 3,960 infected cases, 59 disability cases, and 97 deaths can be prevented by national Hib vaccination program. The ICER for 3 + 0 schedule was THB 1,099 ($34 per QALY gained under societal perspective. The model was sensitive to pneumonia incidence among aged under 5 years old and direct non-medical care cost per episode of Hib pneumonia. Hib vaccination is very cost-effective in the Thai context. The budget impact analysis showed that Thai government needed to invest an additional budget of 110 ($3.4 million to implement Hib vaccination program. Policy makers should consider our findings for adopting this vaccine into national immunization program.

  20. Prophylaxis against febrile neutropenia with pegfilgrastim in Italy: a budget impact analysis

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    Giovanni Rosti

    2011-09-01

    Full Text Available Introduction: prophylaxis with granulocyte colony-stimulating factors (G-CSF is indicated for reduction in the duration of neutropenia and the incidence of febrile neutropenia in patients treated with cytotoxic chemotherapy for malignancy.
Objective: to evaluate the budgetary impact for the Italian NHS.
Design: a decision-analytic model has been developed to analyze the budget impact from the national health care system perspective. Costs include direct healthcare costs to the public payer of G-CSFs as well as their administration costs and costs of FN-related events. The comparison has been done using prophylaxis with G‑CSF (filgrastim for 11 days, pegfilgrastim, lenograstim for 11 days and antibiotics.
Patients and participants: The population of interest for the analysis were patients with breast cancer in stage II and III and patients with non-Hodgkin’s lymphoma (NHL.
Main outcome measures and results: for all the three patients group (NHL, Breast II and III, and for all the chemotherapy regimens (CHOP 21 and R-CHOP 21 for NHL, AC-T, TAC and TC for Breast stage II and III the budget impact analyses shows a cost reduction for the Italian NHS, as a result of an increase of the use of pegfilgrastim.
Conclusions: in Italy, a treatment strategy including pegfilgrastim as either primary or secondary prophylaxis provides value for money.


  1. Budget impact analysis of the fentanyl buccal tablet for treatment of breakthrough cancer pain

    Directory of Open Access Journals (Sweden)

    Darbà J

    2013-12-01

    the total costs of BTcP over the next 4 years. Results of the sensitivity analysis showed that the model was most sensitive to drug cost per day for the fentanyl buccal tablet. A 50% decrease in the daily cost of the fentanyl buccal tablet resulted in the largest overall decrease in budget impact of €5.4 million.Conclusion: The increase in use of the fentanyl buccal tablet leads to overall savings in the budget impact for the Spanish National Health System. Although the economic impact of treatment for BTcP was shown to increase over 4 years due to population growth, the average annual cost per patient was reduced by €29 with increased use of the fentanyl buccal tablet.Keywords: cancer, breakthrough pain, economic analysis, costs, rapid onset opioids

  2. Budget impact analysis in Spanish patients with Dupuytren's contracture: fasciectomy vs. collagenase Clostridium histolyticum.

    Science.gov (United States)

    De Salas-Cansado, M; Cuadros, M; Del Cerro, M; Arandes, J M

    2013-04-01

    The aim of this study was to estimate the budget impact of collagenase Clostridium histolyticum (CCH) vs. fasciectomy (FSC) surgery for the treatment of Dupuytren's disease (DD) in Spain. A cost minimization analysis was adopted (effectiveness was assumed to be equivalent for both techniques). DD related costs were considered. CCH costs (including drug, administration and visits) were obtained from clinical trials and a real-life study. FSC costs (including type of admission, visits, operating room, re-admissions, tests, drugs and rehabilitation costs) were collected through a retrospective, observational, local study. Unit costs were obtained from local database systems (e-SALUD and BOT). Results were presented from the NHS perspective for the next 3 years. We assumed that there were 5100 fasciectomies per year (with a 5% annual increase) and that 20%, 30% and 40% of them will annually utilize CCH. In addition, a 10%, 15% and 20% of untreated diagnosed patients were expected to receive CCH. All the data were validated through an expert panel. A sensitivity analysis was performed with the main variables. The average FSC cost was €2250 (72% inpatients), €1703 for outpatients and €2467 for inpatients. The average CCH cost was €1220 (1.5 vial/injection and four visits) and could drop to €898 (1.1 vial/injections and three visits). The accumulated 3years budget impact analysis (BIA) was 45,971€ (K€-2993(1); 3870). According to this study, the inclusion of the CCH should produce a 3-year cumulative budgetary impact of €45,971 (K€-2993; 3870) for the NHS. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  3. Budget impact analysis of conversion from cyclosporine to sirolimus as immunosuppressive medication in renal transplantation therapy

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    Foroutan N

    2013-10-01

    Full Text Available Naghmeh Foroutan,1 Hamid R Rasekh,1 Jamshid Salamzadeh,1 Hamid R Jamshidi,1 Mohsen Nafar2 1Department of Pharmacoeconomics and Pharmaceutical Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, 2Department of Kidney Transplantation, Urinary Nephrology Research Center (UNRC, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Objectives: The aim of this study was to determine budget impact of conversion from cyclosporine (CsA to sirolimus (SRL in renal transplant therapy (RTT from the perspective of insurance organizations in Iran. Methods: An Excel-based model was developed to determine cost of RTT, comparing current CsA based therapy to an mTOR inhibitor-based therapy regimen. Total cost included both cost of immunosuppressive agents and relative adverse events. The inputs were derived from database of Ministry of Health and insurance organizations, hospital and pharmacy based registries, and available literature that were varied through a one-way sensitivity analysis. According to the model, there were almost 17,000 patients receiving RTT in Iran, out of which about 2,200 patients underwent the operation within the study year. The model was constructed based on the results of a local RCT, in which test and control groups received CsA, SRL, and steroids over the first 3 months posttransplantation and, from the fourth month on, CsA, mycophenolate mofetil (MMF, and steroids were used in the CsA group and SRL, MMF, and steroids were administered in the SRL group, respectively. Results: The estimated cost of RTT with CsA was US$4,850,000 versus US$4,300,000 receiving SRL. These costs corresponded to the cost saving of almost US$550,000 for the payers. Conclusion: To evaluate the financial consequence of adding mTOR inhibitors to the insurers’ formulary, in the present study, a budget impact analysis was conducted on sirolimus. Fewer cases of costly adverse events along with

  4. Bariatric Surgery Coverage: a Comprehensive Budget Impact Analysis from a Payer Perspective.

    Science.gov (United States)

    Palli, Swetha R; Rizzo, John A; Heidrich, Natalie

    2018-06-01

    The objective of this study was to estimate a payer's budget impact of bariatric surgery coverage under (1) unrestricted, (2) budget-restricted ($500,000/year), and (3) quantity-restricted (100/year) medical benefit plan scenarios versus non-coverage in general and type 2 diabetes mellitus (T2DM) populations over a 10-year period. Using recently published literature and health technology assessment reports, the model evaluated a hypothetical payer population of 100,000 members under current real-world trends: BMI-defined obesity groups (31.3% normal/underweight, 33% overweight, 20.4% obese, 9% severely obese and 6.3% morbidly obese), T2DM prevalence (6.7-27.5%; 100% for the T2DM model), surgery type (LAGB, BPD/DS, VSG, and RYGB), and differential outcomes (T2DM resolution, costs, and reoperation and complications rates). Assuming a surgery election rate of 1.42% among eligible candidates with a 3% discount rate and 10% annual surgery turnover rate, the model calculated the incremental cost per-member-per-month (PMPM) by estimating the difference in total non-T2DM and T2DM-related expected costs and savings. One-way (± 25%) sensitivity analysis was performed. The impact of covering bariatric surgery under multiple scenarios for a general (or T2DM) population ranged from an additional $0.3 to $3.6 (T2DM: $0.3 to $10.5) PMPM in year 1. Incremental costs diminished over time, breaking even between years 5 and 9 (T2DM: 5-6), and by year 10, cost savings were estimated to be between $1.5 and $4.8 (T2DM: $1.2 and $31.8). Providing bariatric surgery coverage may have a modest short-term budget impact increase but would lead to long-term net cost savings in a general population model. The cost savings were much more pronounced in the T2DM model.

  5. Assessing the Value of Biosimilars: A Review of the Role of Budget Impact Analysis.

    Science.gov (United States)

    Simoens, Steven; Jacobs, Ira; Popovian, Robert; Isakov, Leah; Shane, Lesley G

    2017-10-01

    Biosimilar drugs are highly similar to an originator (reference) biologic, with no clinically meaningful differences in terms of safety or efficacy. As biosimilars offer the potential for lower acquisition costs versus the originator biologic, evaluating the economic implications of the introduction of biosimilars is of interest. Budget impact analysis (BIA) is a commonly used methodology. This review of published BIAs of biosimilar fusion proteins and/or monoclonal antibodies identified 12 unique publications (three full papers and nine congress posters). When evaluated alongside professional guidance on conducting BIA, the majority of BIAs identified were generally in line with international recommendations. However, a lack of peer-reviewed journal articles and considerable shortcomings in the publications were identified. Deficiencies included a limited range of cost parameters, a reliance on assumptions for parameters such as uptake and drug pricing, a lack of expert validation, and a limited range of sensitivity analyses that were based on arbitrary ranges. The rationale for the methods employed, limitations of the BIA approach, and instructions for local adaptation often were inadequately discussed. To understand fully the potential economic impact and value of biosimilars, the impact of biosimilar supply, manufacturer-provided supporting services, and price competition should be included in BIAs. Alternative approaches, such as cost minimization, which requires evidence demonstrating similarity to the originator biologic, and those that integrate a range of economic assessment methods, are needed to assess the value of biosimilars.

  6. Budget Impact Analysis of Biosimilar Trastuzumab for the Treatment of Breast Cancer in Croatia.

    Science.gov (United States)

    Cesarec, August; Likić, Robert

    2017-04-01

    Breast cancer is the most common cancer in women and has considerable impact on healthcare budgets and patients' quality of life. Trastuzumab (Herceptin ® ) is a monoclonal antibody directed against the human epidermal growth factor receptor (HER2) for the treatment of breast cancer. Several trastuzumab biosimilars are currently in development. In 2015, trastuzumab was the drug with the highest financial consumption among all drugs in Croatia. This model estimates the 1-year budget impact of the introduction of biosimilar trastuzumab in Croatia. A budget impact model, based on approvals for trastuzumab treatment in 2015, was developed for the introduction of biosimilars. Two biosimilar scenarios were developed: biosimilar scenario 1, based on all approvals in 2015, and biosimilar scenario 2, based on approvals after February 2015 and the reimbursement of the subcutaneous formulation of trastuzumab in Croatia. Only trastuzumab-naïve patients and drug-acquisition costs were used in the model. Uptake of biosimilar was assumed at 50 %. Scenarios were calculated with price discounts of 15, 25 and 35 %. The robustness of the model was tested by extensive sensitivity analyses. The projected drug cost savings from the introduction of biosimilar trastuzumab range from €0.26 million (scenario 2, 15 % price discount) to €0.69 million (scenario 1, 35 % price discount). If budget savings were reinvested to treat additional patients with trastuzumab, 14 (scenario 2, 15 % price discount) to 47 (scenario 1, 35 % price discount) additional patients could be treated. Sensitivity analyses showed that the incidence of breast cancer had the highest impact on the model, with a 10 % decrease in incidence leading to an 11.3 % decrease in projected savings. The introduction of biosimilar trastuzumab could lead to significant drug cost savings in Croatia.

  7. Economic evaluation of the breast cancer screening programme in the Basque Country: retrospective cost-effectiveness and budget impact analysis.

    Science.gov (United States)

    Arrospide, Arantzazu; Rue, Montserrat; van Ravesteyn, Nicolien T; Comas, Merce; Soto-Gordoa, Myriam; Sarriugarte, Garbiñe; Mar, Javier

    2016-06-01

    Breast cancer screening in the Basque Country has shown 20 % reduction of the number of BC deaths and an acceptable overdiagnosis level (4 % of screen detected BC). The aim of this study was to evaluate the breast cancer early detection programme in the Basque Country in terms of retrospective cost-effectiveness and budget impact from 1996 to 2011. A discrete event simulation model was built to reproduce the natural history of breast cancer (BC). We estimated for lifetime follow-up the total cost of BC (screening, diagnosis and treatment), as well as quality-adjusted life years (QALY), for women invited to participate in the evaluated programme during the 15-year period in the actual screening scenario and in a hypothetical unscreened scenario. An incremental cost-effectiveness ratio was calculated with the use of aggregated costs. Besides, annual costs were considered for budget impact analysis. Both population level and single-cohort analysis were performed. A probabilistic sensitivity analysis was applied to assess the impact of parameters uncertainty. The actual screening programme involved a cost of 1,127 million euros and provided 6.7 million QALYs over the lifetime of the target population, resulting in a gain of 8,666 QALYs for an additional cost of 36.4 million euros, compared with the unscreened scenario. Thus, the incremental cost-effectiveness ratio was 4,214€/QALY. All the model runs in the probabilistic sensitivity analysis resulted in an incremental cost-effectiveness ratio lower than 10,000€/QALY. The screening programme involved an increase of the annual budget of the Basque Health Service by 5.2 million euros from year 2000 onwards. The BC screening programme in the Basque Country proved to be cost-effective during the evaluated period and determined an affordable budget impact. These results confirm the epidemiological benefits related to the centralised screening system and support the continuation of the programme.

  8. Budget impact analysis of botulinum toxin A therapy for upper limb spasticity in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Abogunrin S

    2015-04-01

    Full Text Available Seye Abogunrin,1 Linda Hortobagyi,2 Edit Remak,3 Jerome Dinet,4 Sylvie Gabriel,5 Abdel Magid O Bakheit6 1Meta Research, 2Health Economics, Evidera, London, UK; 3Health Economics, Evidera, Budapest, Hungary; 4Health Economics and Outcomes Research (Global, 5Global Market Access and Pricing, Ipsen Pharma, Boulogne-Billancourt, France; 6Neurological Rehabilitation, Moseley Hall Hospital, Birmingham, UK Background: Botulinum toxin A (BoNT-A is an effective treatment for patients with upper limb spasticity (ULS, which is a debilitating feature of upper motor neuron lesions. BoNT-A preparations available in the UK are associated with different costs. Methods: We developed a budget impact model to assess the effect of changing market shares of different BoNT-A formulations – abobotulinumtoxinA, onabotulinumtoxinA, and incobotulinumtoxinA – and best supportive care, from the UK payer perspective, over a 5-year time horizon. Epidemiological and resource use data were derived from published literature and clinical expert opinion. One-way sensitivity analyses were performed to determine parameters most influential on budget impact. Results: Base-case assumptions showed that an increased uptake of abobotulinumtoxinA resulted in a 5-year savings of £6,283,829. Treatment with BoNT-A costs less than best supportive care per patient per year, although treating a patient with onabotulinumtoxinA (£20,861 and incobotulinumtoxinA (£20,717 cost more per patient annually than with abobotulinumtoxinA (£19,800. Sensitivity analyses showed that the most influential parameters on budget were percentage of cerebral palsy and stroke patients developing ULS, and the prevalence of stroke. Conclusion: Study findings suggest that increased use of abobotulinumtoxinA for ULS in the UK could potentially reduce total ULS cost for the health system and society. Keywords: stroke, cerebral palsy, multiple sclerosis, traumatic brain injury 

  9. Budget impact analysis of use of aliskiren in hypertension on the Italian Health Care System

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    Orietta Zaniolo

    2009-01-01

    Full Text Available Cardiovascular (CV disease management and prevention has been the leading cost driver in health care expenditures of industrialized Countries for many years, and this trend is not expected to change in the next future. Although drugs used for the treatment of arterial hypertension and heart failure account for three fourths of the total Italian pharmaceutical expenditures in this disease area, population studies indicate that only about half of all hypertensive patients are treated for this condition, and that, among treated individuals, only a minority achieves a satisfactory and stable blood pressure control. A complementary observation is that drug expenditures, as high as they seem to be, actually account for only about a fourth of the total direct cost of CV illness, as they are exceeded by costs of hospitalizations required for the acute management of the clinical events that should be, at least partially, prevented by the same cardiovascular drugs. An often pointed out corollary to these findings is that an increase in the rate of controlled hypertension in the population, although surely linked to a further increase in pharmaceutical expenditures, carries the potential to reduce overall health care costs for the management of CV patients. As far as drug treatment is concerned, there seem to be three applicable strategies capable of increasing blood pressure control rates, i.e. interventions directed toward the increase of the treated population, interventions aimed at improving compliance, and the introduction of innovative drugs to cover unmet needs. Aliskiren is the first agent of the new direct renin inhibitors drug class, and has been recently approved in Italy under strict reimbursement restrictions. In this paper, the Authors present a budget impact analysis in the perspective of the National Health Service, conducted by estimating eligible populations according to reimbursement limitations, calculating differential costs by

  10. A Budget Impact Analysis of Newly Available Hepatitis C Therapeutics and the Financial Burden on a State Correctional System.

    Science.gov (United States)

    Nguyen, John T; Rich, Josiah D; Brockmann, Bradley W; Vohr, Fred; Spaulding, Anne; Montague, Brian T

    2015-08-01

    Hepatitis C virus (HCV) infection continues to disproportionately affect incarcerated populations. New HCV drugs present opportunities and challenges to address HCV in corrections. The goal of this study was to evaluate the impact of the treatment costs for HCV infection in a state correctional population through a budget impact analysis comparing differing treatment strategies. Electronic and paper medical records were reviewed to estimate the prevalence of hepatitis C within the Rhode Island Department of Corrections. Three treatment strategies were evaluated as follows: (1) treating all chronically infected persons, (2) treating only patients with demonstrated fibrosis, and (3) treating only patients with advanced fibrosis. Budget impact was computed as the percentage of pharmacy and overall healthcare expenditures accrued by total drug costs assuming entirely interferon-free therapy. Sensitivity analyses assessed potential variance in costs related to variability in HCV prevalence, genotype, estimated variation in market pricing, length of stay for the sentenced population, and uptake of newly available regimens. Chronic HCV prevalence was estimated at 17% of the total population. Treating all sentenced inmates with at least 6 months remaining of their sentence would cost about $34 million-13 times the pharmacy budget and almost twice the overall healthcare budget. Treating inmates with advanced fibrosis would cost about $15 million. A hypothetical 50% reduction in total drug costs for future therapies could cost $17 million to treat all eligible inmates. With immense costs projected with new treatment, it is unlikely that correctional facilities will have the capacity to treat all those afflicted with HCV. Alternative payment strategies in collaboration with outside programs may be necessary to curb this epidemic. In order to improve care and treatment delivery, drug costs also need to be seriously reevaluated to be more accessible and equitable now that HCV

  11. Seasonal influenza vaccination in China: Landscape of diverse regional reimbursement policy, and budget impact analysis.

    Science.gov (United States)

    Yang, Juan; Atkins, Katherine E; Feng, Luzhao; Pang, Mingfan; Zheng, Yaming; Liu, Xinxin; Cowling, Benjamin J; Yu, Hongjie

    2016-11-11

    To explore the current landscape of seasonal influenza vaccination across China, and estimate the budget of implementing a national "free-at-the-point-of-care" vaccination program for priority populations recommended by the World Health Organization. In 2014 and 2016, we conducted a survey across provincial Centers for Disease Control and Prevention to collect information on regional reimbursement policies for influenza vaccination, estimated the national uptake using distributed doses of influenza vaccines, and evaluated the budget using population size and vaccine cost obtained from official websites and literatures. Regular reimbursement policies for influenza vaccination are available in 61 mutually exclusive regions, comprising 8 provinces, 45 prefectures, and 8 counties, which were reimbursed by the local Government Financial Department or Basic Social Medical Insurance (BSMI). Finance-reimbursed vaccination was offered mainly for the elderly, and school children for free in Beijing, Dongli district in Tianjin, Karamay, Shenzhen and Xinxiang cities. BSMI-reimbursement policies were limited to specific medical insurance beneficiaries with distinct differences in the reimbursement fractions. The average national vaccination coverage was just 1.5-2.2% between 2004 and 2014. A free national vaccination program for priority populations (n=416million), would cost government US$ 757million (95% CI 726-789) annually (uptake rate=20%). An increasing number of regional governments have begun to pay, partially or fully, for influenza vaccination for selected groups. However, this small-scale policy approach has failed to increase national uptake. A free, nationwide vaccination program would require a substantial annual investment. A cost-effectiveness analysis is needed to identify the most efficient methods to improve coverage. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  12. Impacts of heterogeneous reactions to atmospheric peroxides: Observations and budget analysis study

    Science.gov (United States)

    Qin, Mengru; Chen, Zhongming; Shen, Hengqing; Li, Huan; Wu, Huihui; Wang, Yin

    2018-06-01

    Atmospheric peroxides play important roles in atmospheric chemistry, acting as reactive oxidants and reservoirs of HOX and ROX radicals. Field measurements of atmospheric peroxides were conducted over urban Beijing from 2015 to 2016, including dust storm days, haze days and different seasons. We employed a box model based on RACM2 mechanism to conduct concentration simulation and budget analysis of hydrogen peroxide (H2O2) and peroxyacetic acid (PAA). In this study, heterogeneous reaction is found to be a significant sink for atmospheric H2O2 and PAA in urban Beijing. Here, we recommend a suitable uptake coefficient formula considering the water effect for model research of peroxides. It is found that H2O2 and PAA unexpectedly maintained considerable concentrations on haze days, even higher than that on non-haze days. This phenomenon is mainly ascribed to relatively high levels of volatile organic compounds and ozone on haze days. In addition, high levels of water vapor in pollution episode can promote not only the heterogeneous uptake to aerosol phase but also the production of H2O2. Atmospheric PAA formation is suggested to be sensitive to alkenes and NOX in urban Beijing. In particular, with the help of peroxides, sulfate formation rate from heterogeneous uptake could increase by ∼4 times on haze days, indicating the potential effect of peroxides on enhancement of aerosol oxidative property and secondary sulfate formation.

  13. AbobotulinumtoxinA in the management of cervical dystonia in the United Kingdom: a budget impact analysis

    Directory of Open Access Journals (Sweden)

    Abogunrin S

    2015-09-01

    Full Text Available Seye Abogunrin,1 Sarah Brand,2 Kamal Desai,3 Jerome Dinet,4 Sylvie Gabriel,5 Timothy Harrower61Meta Research, Evidera, London, UK; 2Health Economics, Evidera, Bethesda, MD, USA; 3Health Economics, Evidera, London, UK; 4Health Economics and Outcomes Research (Global, 5Global Market Access and Pricing, Ipsen Pharma, Boulogne-Billancourt, France; 6Royal Devon and Exeter NHS Foundation Trust, Exeter, UKBackground: Cervical dystonia (CD can be effectively managed by a combination of botulinum neurotoxin A (BoNT-A and conventional therapy (skeletal muscle relaxants and rehabilitative therapy, but the costs of different interventions in the UK vary.Methods: A budget impact model was developed from the UK payer perspective with a 5-year time horizon to evaluate the effects of changing market shares of abobotulinumtoxinA, nabotulinumtoxinA, and incobotulinumtoxinA, and best supportive care from the UK payer perspective. Epidemiological and resource use data were retrieved from the published literature and clinical expert opinion. Deterministic sensitivity analyses were performed to determine the parameters most influential on the budgetary findings under base case assumptions.Results: Under base case assumptions, an increased uptake of abobotulinumtoxinA showed an accumulated savings of £2,250,992 by year 5. Treatment per patient per year with onabotulinumtoxinA and incobotulinumtoxinA costs more when compared to treatment with abobotulinumtoxinA. One-way sensitivity analyses showed that the prevalence of CD, dose per injection of each of the BoNT-As, and time to reinjection of incobotulinumtoxinA and abobotulinumtoxinA influenced the base case findings most.Conclusion: There is potential for cost savings associated with the greater use of abobotulinumtoxinA rather than other BoNT-A treatments, permitting more patients to benefit more from effective BoNT-A treatment with a fixed budget. Keywords: cervical dystonia, torticollis, botulinum toxin A, budget

  14. Budget Impact Analysis to Estimate the Cost Dynamics of Treating Refractory Gastroesophageal Reflux Disease With Radiofrequency Energy: a Payer Perspective.

    Science.gov (United States)

    Gregory, David; Scotti, Dennis J; Buck, Daniel; Triadafilopoulos, George

    2016-05-01

    A minimally invasive endoscopic treatment that utilizes radio-frequency energy (RFE) has received increased attention as an appropriate middle-ground approach in the treatment of refractory gastroesophageal reflux disease (GERD) and as an alternative to complicated and invasive surgical procedures. The objective of this study was to develop a longitudinal budget impact analysis from the payer perspective to estimate the direct medical costs of treatment for the refractory GERD patient population and to estimate the budgetary impact of further extending the RFE treatment option to other target populations. A retrospective analysis of claims designed to assess the longitudinal costs and budget impact on payer expenditures associated with managing and treating GERD surgically (Nissen fundoplication [NF]), endoscopically (RFE), or medically was performed. Both Medicare and commercially insured claims databases were interrogated for such population-level analyses. At current adoption rates (less than 1% of procedures), RFE demonstrated overall cost savings ranging from 7.3% to 50.5% in the 12-month time period following the index procedure (inclusive of procedure costs) when compared to medical management and fundoplication across the commercial and Medicare patient populations. Increasing the total number of RFE procedures to 2% of total cases performed generated per-member, per-month (PMPM) savings of $0.28 in the Medicare population and $0.37 in the commercially insured population. Further increases yielded higher PMPM savings. Adding to the clinical importance of RFE in filling the gap between medical and surgical management, this economic analysis demonstrates to payers that the adoption of RFE can create notable savings to their plans when compared to surgery or medical management.

  15. Budget impact analysis of heparin-bonded polytetrafluoroethylene grafts (Propaten) against standard polytetrafluoroethylene grafts for below-the-knee bypass in patients with critical limb ischaemia in France

    Science.gov (United States)

    Vergnaud, Simon; Riche, Valéry-Pierre; Tessier, Philippe; Mauduit, Nicolas; Kaladji, Adrien; Gouëffic, Yann

    2018-01-01

    Objectives To evaluate the budget impact of progressive replacement of standard polytetrafluoroethylene (PTFE) grafts by heparin-bound PTFE (Propaten) for below-the-knee (BTK) bypass in patients with critical limb ischaemia (CLI). Design From a review of the scientific literature, we calculated a theoretical BTK primary patency for Propaten grafts. Using the French hospital expenditure database (PMSI), we retrospectively estimated a rehospitalisation rate for standard PTFE grafts. From these data, a model was created to assess the budget impact of a progressive replacement from standard PTFE grafts to Propaten grafts over a 5-year horizon. We performed an univariate sensitivity analysis to assess the robustness of our results. Setting French National Health Insurance (FNHI) perspective. Participant Patients with CLI. Main outcome measures Budget impact analysis. Results Data extraction from the PMSI revealed that 656 patients were treated with PTFE grafts in 2011 in French public hospitals for a BTK bypass. Assuming a 2-year survival rate of 76.8%, observed reinterventions rate for standard PTFE grafts at 24 months from the PMSI was 35.1%. The mean rehospitalisation cost was €10 689. The budget impact analysis based on these data found a net cumulative 5-year payer budget reduction of €112 420 in favour of Propaten, under the assumption of a 75.6% primary patency for Propaten grafts for a projected population of 3215 patients of which 801 received a Propaten graft. Conclusions Our budget impact analysis showed a positive impact on the national health insurance budget of the replacement of standard PTFE grafts by Propaten grafts for BTK bypass in patients with CLI in France. This supports the enactment of a reimbursement policy by the FNHI. PMID:29490953

  16. Budget impact analysis of gene expression tests to aid therapy decisions for breast cancer patients in Germany.

    Science.gov (United States)

    Lux, M P; Nabieva, N; Hildebrandt, T; Rebscher, H; Kümmel, S; Blohmer, J-U; Schrauder, M G

    2018-02-01

    Many women with early-stage, hormone receptor-positive breast cancer may not benefit from adjuvant chemotherapy. Gene expression tests can reduce chemotherapy over- and undertreatment by providing prognostic information on the likelihood of recurrence and, with Oncotype DX, predictive information on chemotherapy benefit. These tests are currently not reimbursed by German healthcare payers. An analysis was conducted to evaluate the budget impact of gene expression tests in Germany. Costs of gene expression tests and medical and non-medical costs associated with treatment were assessed from healthcare payer and societal perspectives. Costs were estimated from data collected at a university hospital and were combined with decision impact data for Oncotype DX, MammaPrint, Prosigna and EndoPredict (EPclin). Changes in chemotherapy use and budget impact were evaluated over 1 year for 20,000 women. Chemotherapy was associated with substantial annual costs of EUR 19,003 and EUR 84,412 per therapy from the healthcare payer and societal perspective, respectively. Compared with standard care, only Oncotype DX was associated with cost savings to healthcare payers and society (EUR 5.9 million and EUR 253 million, respectively). Scenario analysis showed that both women at high clinical but low genomic risk and low clinical but high genomic risk were important contributors to costs. Oncotype DX was the only gene expression test that was estimated to reduce costs versus standard care in Germany. The reimbursement of Oncotype DX testing in standard clinical practice in Germany should be considered. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Does National Culture Impact Capital Budgeting Systems?

    Directory of Open Access Journals (Sweden)

    Peter J. Graham

    2017-06-01

    Full Text Available We examine how national culture impacts organisational selection of capital budgeting systems to develop our understanding of what influence a holistic formulation of national culture has on capital budgeting systems. Such an understanding is important as it would not only provide a clearer link between national culture and capital budgeting systems and advance extant literature but would also help multinational firms that have business relationships with Indonesian firms in suitably designing strategies. We conducted semi-structured interviews of selected finance managers of listed firms in Indonesia and Australia. Consistent with the contingency theory, we found that economic, political, legal and social uncertainty impact on the use of capital budgeting systems. The levels of uncertainty were higher in Indonesia than Australia and need to be reckoned in the selection of capital budgeting systems used by firms. We also found that firms are influenced by project size and complexity, when selecting capital budgeting systems.

  18. Cost-effectiveness and budget impact analysis of a population-based screening program for colorectal cancer.

    Science.gov (United States)

    Pil, L; Fobelets, M; Putman, K; Trybou, J; Annemans, L

    2016-07-01

    Colorectal cancer (CRC) is one of the leading causes of cancer mortality in Belgium. In Flanders (Belgium), a population-based screening program with a biennial immunochemical faecal occult blood test (iFOBT) in women and men aged 56-74 has been organised since 2013. This study assessed the cost-effectiveness and budget impact of the colorectal population-based screening program in Flanders (Belgium). A health economic model was conducted, consisting of a decision tree simulating the screening process and a Markov model, with a time horizon of 20years, simulating natural progression. Predicted mortality and incidence, total costs, and quality-adjusted life-years (QALYs) with and without the screening program were calculated in order to determine the incremental cost-effectiveness ratio of CRC screening. Deterministic and probabilistic sensitivity analyses were conducted, taking into account uncertainty of the model parameters. Mortality and incidence were predicted to decrease over 20years. The colorectal screening program in Flanders is found to be cost-effective with an ICER of 1681/QALY (95% CI -1317 to 6601) in males and €4,484/QALY (95% CI -3254 to 18,163). The probability of being cost-effective given a threshold of €35,000/QALY was 100% and 97.3%, respectively. The budget impact analysis showed the extra cost for the health care payer to be limited. This health economic analysis has shown that despite the possible adverse effects of screening and the extra costs for the health care payer and the patient, the population-based screening program for CRC in Flanders is cost-effective and should therefore be maintained. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  19. A cost-utility and budget impact analysis of allogeneic hematopoietic stem cell transplantation for severe thalassemic patients in Thailand.

    Science.gov (United States)

    Leelahavarong, Pattara; Chaikledkaew, Usa; Hongeng, Suradej; Kasemsup, Vijj; Lubell, Yoel; Teerawattananon, Yot

    2010-07-16

    Hematopoietic stem cell transplantation (HSCT) is the only curative treatment available to severe thalassemic patients. The treatment, however, is very costly, particularly in the context of low and middle income countries, and no studies have been carried out to explore its economic justifiability. This study aimed to estimate the cost-utility of HSCT compared with blood transfusions combined with iron chelating therapy (BT-ICT) for severe thalassemia in Thailand, and to investigate the affordability of HSCT using a budget impact analysis. A Markov model was used to estimate the relevant costs and health outcomes over the patients' lifetimes taking a societal perspective as recommended by Thailand's health technology assessment guidelines. All future costs and outcomes were discounted at a rate of 3% per annum. Primary outcomes of interest were lifetime costs, quality adjusted life years (QALYs) gained, and the incremental cost-effectiveness ratio (ICER) in Thai baht (THB) per QALY gained. Compared to BT-ICT, the incremental cost-effectiveness ratio increased with patient age from 80,700 to 183,000 THB per QALY gained for related HSCT and 209,000 to 953,000 THB per QALY gained for unrelated HSCT among patients aged 1 to 15 years (US$1= 34 THB). The governmental budget impact analysis showed that providing 200 related HSCT to patients aged 1 to 10 years, in accordance with the current infrastructure limitations, would initially require approximately 90 million additional THB per year. At a societal willingness to pay of 100,000 THB per QALY gained, related HSCT was likely to be a cost-effective and affordable treatment for young children with severe thalassemia in Thailand.

  20. Does National Culture Impact Capital Budgeting Systems?

    OpenAIRE

    Peter J. Graham; Milind Sathye

    2017-01-01

    We examine how national culture impacts organisational selection of capital budgeting systems to develop our understanding of what influence a holistic formulation of national culture has on capital budgeting systems. Such an understanding is important as it would not only provide a clearer link between national culture and capital budgeting systems and advance extant literature but would also help multinational firms that have business relationships with Indonesian firms in suita...

  1. Economic evaluation and budget impact analysis of the surveillance program for hepatocellular carcinoma in Thai chronic hepatitis B patients.

    Science.gov (United States)

    Sangmala, Pannapa; Chaikledkaew, Usa; Tanwandee, Tawesak; Pongchareonsuk, Petcharat

    2014-01-01

    The incidence rate and the treatment costs of hepatocellular carcinoma (HCC) are high, especially in Thailand. Previous studies indicated that early detection by a surveillance program could help by down-staging. This study aimed to compare the costs and health outcomes associated with the introduction of a HCC surveillance program with no program and to estimate the budget impact if the HCC surveillance program were implemented. A cost utility analysis using a decision tree and Markov models was used to compare costs and outcomes during the lifetime period based on a societal perspective between alternative HCC surveillance strategies with no program. Costs included direct medical, direct non-medical, and indirect costs. Health outcomes were measured as life years (LYs), and quality adjusted life years (QALYs). The results were presented in terms of the incremental cost-effectiveness ratio (ICER) in Thai THB per QALY gained. One- way and probabilistic sensitivity analyses were applied to investigate parameter uncertainties. Budget impact analysis (BIA) was performed based on the governmental perspective. Semi-annual ultrasonography (US) and semi-annual ultrasonography plus alpha-fetoprotein (US plus AFP) as the first screening for HCC surveillance would be cost-effective options at the willingness to pay (WTP) threshold of 160,000 THB per QALY gained compared with no surveillance program (ICER=118,796 and ICER=123,451 THB/QALY), respectively. The semi-annual US plus AFP yielded more net monetary benefit, but caused a substantially higher budget (237 to 502 million THB) than semi-annual US (81 to 201 million THB) during the next ten fiscal years. Our results suggested that a semi-annual US program should be used as the first screening for HCC surveillance and included in the benefit package of Thai health insurance schemes for both chronic hepatitis B males and females aged between 40-50 years. In addition, policy makers considered the program could be feasible

  2. Targeted erlotinib for first-line treatment of advanced non-small cell lung cancer: a budget impact analysis.

    Science.gov (United States)

    Bajaj, Preeti S; Veenstra, David L; Goertz, Hans-Peter; Carlson, Josh J

    2014-08-01

    A recent phase III trial showed that patients with advanced non-small cell lung cancer (NSCLC) whose tumors harbor specific EGFR mutations significantly benefit from first-line treatment with erlotinib compared to chemotherapy. This study sought to estimate the budget impact if coverage for EGFR testing and erlotinib as first-line therapy were provided in a hypothetical 500,000-member managed care plan. The budget impact model was developed from a US health plan perspective to evaluate administration of the EGFR test and treatment with erlotinib for EGFR-positive patients, compared to non-targeted treatment with chemotherapy. The eligible patient population was estimated from age-stratified SEER incidence data. Clinical data were derived from key randomized controlled trials. Costs related to drug, administration, and adverse events were included. Sensitivity analyses were conducted to assess uncertainty. In a plan of 500,000 members, it was estimated there would be 91 newly diagnosed advanced NSCLC patients annually; 11 are expected to be EGFR-positive. Based on the testing and treatment assumptions, it was estimated that 3 patients in Scenario 1 and 6 patients in Scenario 2 receive erlotinib. Overall health plan expenditures would increase by $0.013 per member per month (PMPM). This increase is largely attributable to erlotinib drug costs, in part due to lengthened progression-free survival and treatment periods experienced in erlotinib-treated patients. EGFR testing contributes slightly, whereas adverse event costs mitigate the budget impact. The budget impact did not exceed $0.019 PMPM in sensitivity analyses. Coverage for targeted first-line erlotinib therapy in NSCLC likely results in a small budget impact for US health plans. The estimated impact may vary by plan, or if second-line or maintenance therapy, dose changes/interruptions, or impact on patients' quality-of-life were included.

  3. Budget impact analysis of apixaban versus other NOACs for the prevention of stroke in Italian atrial fibrillation patients

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    Lorenzo Pradelli

    2014-12-01

    Full Text Available OBJECTIVE: This study aims to perform a budget impact analysis of the use of three available novel oral anticoagulant agents (NOACs for preventing thromboembolic events in Italian patients with non‑valvular atrial fibrillation (NVAF.METHODS: Estimated Italian population of patients was run through a previously published lifetime decision tree/Markov model simulating their treatment with the available therapeutic options: dabigatran at two dose levels (110 mg/bid for the over 80 years old, 150 mg/bid for younger NVAF patients, rivaroxaban (20 mg/uid, and apixaban (5 mg/bid. Effectiveness and safety estimates derive from an adjusted indirect treatment comparison using warfarin as link. The main clinical events considered in the model are ischemic and hemorrhagic stroke, systemic thromboembolism, bleeds (both major and clinically relevant minor and cardiovascular hospitalizations, besides treatment discontinuations. Epidemiological data and unit costs, actualized to 2013, are collected from Italian published sources. The budget impact analysis evaluates the financial impact of apixaban introduction by comparing expected 1,2, and 3 years costs in hypothetical scenarios: with and without apixaban. Italian NVAF patient population estimation is based on official apixaban reimbursement criteria, applying the characteristics of the trial population to national epidemiologic data. Numbers of patients for each regimen are estimated by projecting share evolution. Sensitivity analysis is performed on an alternative non‑experimental population of NVAF patients.RESULTS: Among available NOACs, apixaban was expected to be the least expensive in an estimated patient population of 364,000 Italian patients, allowing for savings of € 1,180,549, € 3,841,429 and € 5,368,918 at 1,2, and 3 years, respectively. Results of the simulation run on an alternative non‑experimental population of NVAF patients yields comparable estimates.CONCLUSIONS: The different

  4. Varenicline treatment for smoking cessation in high risk patients: a budget impact analysis

    Directory of Open Access Journals (Sweden)

    Federico Spandonaro

    2017-10-01

    CONCLUSIONS: The financial impact on the Italian NHS of the reimbursement of varenicline for the treatment of high risk smoking population would be a sustainable healthcare policy, resulting in cost savings starting from the fourth year.

  5. Budget impact analysis on erythropoiesis-stimulating agents use for the management of chemotherapy-induced anaemia in Greece.

    Science.gov (United States)

    Nikolaidi, Eleftheria; Hatzikou, Magdalini; Geitona, Mary

    2013-07-16

    Chemotherapy-induced anaemia is a common and significant complication of chemotherapy treatment. Blood transfusion and administration of Erythropoiesis-Stimulating Agents (ESAs) either alone or in combination with iron are the most widely used therapeutic options. In Greece, ESAs are among the top ten therapeutic groups with the highest pharmaceutical expenditure, since they are fully reimbursed by social security funds. The objective of the study is to determine potential cost savings related with the use of biosimilar over originator ESAs for the management of the newly diagnosed chemotherapy-induced anemic patients. A budget impact analysis has been carried through the elaboration of national epidemiological, clinical and economic data. Epidemiological data derived from WHO (GLOBOCAN) and the European Cancer Anaemia Survey. Clinical data reflect oncology patients' disease management. ESAs consumption was based on data from the biggest social security fund (IKA). The administration of ESAs under different dosing schemes and time periods has been estimated by separating them in originators and biosimilars as well as by classifying anaemic patients in responders and non-responders. Cost analysis is based on newly diagnosed patients' alternative treatment scenarios. Treatment costs and prices are used in 2012 values. The Social Security Funds's perspective was undertaken. Based on the annual incidence rates, 2.551 newly diagnosed chemotherapy-induced anemic patients are expected to be treated with ESAs. Average cost of treatment on originators ESAs for responders is €2.887 for the 15-week ESAs treatment and €5.019 for non-responders, while on biosimilars €2.623 and €4.009 respectively. Treatment cost on biosimilars is 10.1% lower than originators for responders and 25.2% for non-responders. Budget impact estimates show that treating anemic patients with originator ESAs was estimated at €10.084.800 compared to €8.460.119 when biosimilar ESAs were used

  6. Antibacterial Treatment of Meticillin-Resistant Staphylococcus Aureus Complicated Skin and Soft Tissue Infections: a Cost and Budget Impact Analysis in Greek Hospitals

    OpenAIRE

    Athanasakis, Kostas; Petrakis, Ioannis; Ollandezos, Mark; Tsoulas, Christos; Patel, Dipen A.; Karampli, Eleftheria; Kyriopoulos, John

    2014-01-01

    Introduction Meticillin-resistant staphylococcus aureus (MRSA) is an important cause of antimicrobial-resistant infections worldwide. Its prevalence remains high in the Greek hospital setting. Complicated skin and soft tissue infections (cSSTIs) due to MRSA are associated with prolonged hospitalization, additional healthcare costs and significant morbidity. The purpose of this study was to conduct a cost analysis and a budget impact analysis relative to different management scenarios for MRSA...

  7. Budget impact analysis of the percutaneous septal occluder for treatment of ostium secundum atrial septal defects in the Brazilian Unified National Health System.

    Science.gov (United States)

    Senna, Kátia Marie Simões e; Sarti, Flavia Mori; Costa, Márcia Gisele Santos da; Nita, Marcelo Eidi; Santos, Marisa da Silva; Tura, Bernardo Rangel; Correia, Marcelo Goulart

    2015-08-01

    The aim of this study was to perform a budget impact analysis on the adoption of percutaneous occlusion of ostium secundum atrial septal defects in the Brazilian Unified National Health System. Costs were collected using micro-costing technique from medical records for each treatment technique (conventional surgery versus percutaneous septal occluder) at a public federal hospital specialized in high-complexity cardiology. The analysis showed that expenditures associated with percutaneous occlusion were lower than with conventional surgery, and sensitivity analysis confirmed the cost reduction in several scenarios, showing a significant budget impact with a 30% adoption rate for the percutaneous occluder (savings of approximately 1.5 million dollars per year). The study indicates that the adoption of the percutaneous septal occluder would mean cost savings of approximately 3.5 million dollars for the Brazilian public health system.

  8. Budget impact analysis of vaccination against Haemophilus influenzae type b as a part of a Pentavalent vaccine in the childhood immunization schedule of Iran.

    Science.gov (United States)

    Teimouri, Fatemeh; Kebriaeezadeh, Abbas; Zahraei, Seyed Mohsen; Gheiratian, MohammadMahdi; Nikfar, Shekoufeh

    2017-01-14

    Health decision makers need to know the impact of the development of a new intervention on the public health and health care costs so that they can plan for economic and financial objectives. The aim of this study was to determine the budget impact of adding Haemophilus influenzae type b (Hib) as a part of a Pentavalent vaccine (Hib-HBV-DTP) to the national childhood immunization schedule of Iran. An excel-based model was developed to determine the costs of including the Pentavalent vaccine in the national immunization program (NIP), comparing the present schedule with the previous one (including separate DTP and hepatitis B vaccines). The total annual costs included the cost of vaccination (the vaccine and syringe) and the cost of Hib treatment. The health outcome was the estimated annual cases of the diseases. The net budget impact was the difference in the total annual cost between the two schedules. Uncertainty about the vaccine effectiveness, vaccination coverage, cost of the vaccine, and cost of the diseases were handled through scenario analysis. The total cost of vaccination during 5 years was $18,060,463 in the previous program and $67,774,786 in the present program. Inclusion of the Pentavalent vaccine would increase the vaccination cost about $49 million, but would save approximately $6 million in the healthcare costs due to reduction of disease cases and treatment costs. The introduction of the Pentavalent vaccine resulted in a net increase in the healthcare budget expenditure across all scenarios from $43.4 million to $50.7 million. The results of this study showed that the inclusion of the Pentavalent vaccine in the NIP of Iran had a significant impact on the health care budget and increased the financial burden on the government. Budget impact of including Pentavalent vaccine in the national immunization schedule of Iranᅟ.

  9. Impact of orphan drugs on Latvian budget.

    Science.gov (United States)

    Logviss, Konstantins; Krievins, Dainis; Purvina, Santa

    2016-05-11

    Number of orphan medicinal products on the market and number of rare disease patients, taking these usually expensive products, are increasing. As a result, budget impact of orphan drugs is growing. This factor, along with the cost-effectiveness of orphan drugs, is often considered in the reimbursement decisions, directly affecting accessibility of rare disease therapies. The current study aims to assess the budget impact of orphan drugs in Latvia. Our study covered a 5-year period, from 2010 to 2014. Impact of orphan drugs on Latvian budget was estimated from the National Health Service's perspective. It was calculated in absolute values and relative to total pharmaceutical market and total drug reimbursement budget. A literature review was performed for comparison with other European countries. Orphan drug annual expenditure ranged between EUR 2.065 and 3.065 million, with total 5-year expenditure EUR 12.467 million. It constituted, on average, 0.84 % of total pharmaceutical market and 2.14 % of total drug reimbursement budget, respectively. Average annual per patient expenditures varied widely, from EUR 1 534 to EUR 580 952. The most costly treatment was enzyme replacement therapy (Elaprase) for MPS II. Glivec had the highest share (34 %) of the total orphan drug expenditure. Oncological drugs represented more than a half of the total orphan drug expenditure, followed by drugs for metabolic and endocrine conditions and medicines for cardiopulmonary diseases. Three indications: Ph+ CML, MPS II, and PAH accounted for nearly 90 % of the total orphan drug expenditure. Budget impact of orphan drugs in Latvia is very small. It increased slightly over a period of five years, due to the slight increase in the number of patients and the number of orphan drugs reimbursed. Current Latvian drug reimbursement system is not sufficient for most orphan drugs.

  10. Budget impact analysis of biosimilar infliximab (CT-P13) for the treatment of rheumatoid arthritis in six Central and Eastern European countries.

    Science.gov (United States)

    Brodszky, Valentin; Baji, Petra; Balogh, Orsolya; Péntek, Márta

    2014-05-01

    The first biosimilar monoclonal antibody (infliximab, CT-P13) was registered by the European Medicines Agency in 2013 for the treatment of several inflammatory conditions including rheumatoid arthritis (RA). Biosimilar infliximab is first being marketed in the Central and Eastern European countries. This paper presents the estimated budget impact of the introduction of biosimilar infliximab in RA over a 3-year time period in six selected countries, namely Bulgaria, the Czech Republic, Hungary, Poland, Romania and Slovakia. A prevalence-based model was constructed for budget impact analysis. Two scenarios were compared to the reference scenario (RSc) where no biosimilar infliximab is available: biosimilar scenario 1 (BSc1), where interchanging the originator infliximab with biosimilar infliximab is disallowed, and only patients who start new biological therapy are allowed to use biosimilar infliximab; as well as biosimilar scenario 2 (BSc2), where interchanging the originator infliximab with biosimilar infliximab is allowed, and 80% of patients treated with originator infliximab are interchanged to biosimilar infliximab. Compared to the RSc, the net savings are estimated to be €15.3 or €20.8 M in BSc1 and BSc2, respectively, over the 3 years. If budget savings were spent on reimbursement of additional biosimilar infliximab treatment, approximately 1,200 or 1,800 more patients could be treated in the six countries within 3 years in the two biosimilar scenarios, respectively. The actual saving is most sensitive to the assumption of the acquisition cost of the biosimilar drug and to the initial number of patients treated with biological therapy. The study focused on one indication (RA) and demonstrated that the introduction of biosimilar infliximab can lead to substantial budget savings in health care budgets. Further savings are expected for other indications where biosimilar medicines are implemented.

  11. Sediment Budget Analysis; Masonboro Inlet, North Carolina

    Science.gov (United States)

    2017-08-15

    ER D C/ CH L TR -1 7- 13 Regional Sediment Management (RSM) Program Sediment Budget Analysis; Masonboro Inlet, North Carolina Co as ta...ERDC/CHL TR-17-13 August 2017 Sediment Budget Analysis; Masonboro Inlet, North Carolina Kevin B. Conner U.S. Army Engineer District, Wilmington P...Engineers Washington, DC 20314-1000 Under Project 454632, “Sediment Budget Analysis, Masonboro Inlet, NC” ERDC/CHL TR-17-13 ii Abstract A

  12. Budget impact analysis of antiretroviral less drug regimen simplification in HIV-positive patients on the Italian National Health Service

    Directory of Open Access Journals (Sweden)

    Restelli U

    2014-09-01

    Full Text Available Umberto Restelli,1,2 Massimo Andreoni,3 Andrea Antinori,4 Marzia Bonfanti,2 Giovanni Di Perri,5 Massimo Galli,6 Adriano Lazzarin,7 Giuliano Rizzardini,8,9 Davide Croce1,2 1Department of Community Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 2Centro di Ricerca in Economia e Management in Sanità e nel Sociale (CREMS, Università Carlo Cattaneo – LIUC, Castellanza (VA, Italy; 3Clinical Infectious Diseases, Tor Vergata University (PTV, Rome, Italy; 4Clinical Department, National Institute for Infectious Diseases "L. Spallanzani," Rome, Italy; 5Department of Medical Sciences, Infectious Diseases, Amedeo di Savoia Hospital, Turin, Italy; 6Third Division of Infectious Diseases, "Luigi Sacco" Hospital, Milan, Italy; 7Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy; 8First and Second Divisions of Infectious Diseases, "Luigi Sacco" Hospital, Milan, Italy; 9School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Background: Deintensification and less drug regimen (LDR antiretroviral therapy (ART strategies have proved to be effective in terms of maintaining viral suppression in human immunodeficiency virus (HIV-positive patients, increasing tolerability, and reducing toxicity of antiretroviral drugs administered to patients. However, the economic impact of these strategies have not been widely investigated. The aim of the study is to evaluate the economic impact that ART LDR could have on the Italian National Health Service (INHS budget. Methods: A budget impact model was structured to assess the potential savings for the INHS by the use of ART LDR for HIV-positive patients with a 3 year perspective. Data concerning ART cost, patient distribution within different ARTs, and probabilities for patients to change ART on a yearly basis were collected within four Italian infectious diseases departments, providing

  13. CAUT Analysis of Federal Budget 2013

    Science.gov (United States)

    Canadian Association of University Teachers, 2013

    2013-01-01

    The 2013 federal Budget was delivered ironically the same day as the Parliamentary Budget Officer was in court seeking more information about the impact of the government's $5.2 billion in spending cuts announced last year. The lack of budgetary transparency and accountability has become a hallmark of the Conservative government. Anyone expecting…

  14. Age- and risk-related appropriateness of the use of available influenza vaccines in the Italian elderly population is advantageous: results from a budget impact analysis.

    Science.gov (United States)

    Barbieri, M; Capri, S; Waure, C DE; Boccalini, S; Panatto, D

    2017-12-01

    Nowadays, four different types of influenza vaccines are available in Italy: trivalent (TIV), quadrivalent (QIV), MF59-adjuvanted (aTIV) and intradermal TIV (idTIV) inactivated vaccines. Recently, a concept of the appropriateness (i.e. according to the age and risk factors) of the use of different vaccines has been established in Italy. We conducted a budget impact analysis of switching to a policy, in which the Italian elderly (who carry the major disease burden) received the available vaccines according to their age and risk profile. A novel budget impact model was constructed with a time horizon of one influenza season. In the reference scenario the cohort of Italian elderly individuals could receive either available vaccine according to 2017/18 season market share. The alternative scenario envisaged the administration of TIV/QIV to people aged 65-74 years and at low risk of developing influenza-related complications, while aTIV/idTIV were allocated to high-risk 65-74-year-olds and all subjects aged ≥ 75 years. Switching to the alternative scenario would result in both significant health benefits and net budget savings. Particularly, it would be possible to prevent an additional 8201 cases of laboratory-confirmed influenza, 988 complications, 355 hospitalizations and 14 deaths. Despite the alternative strategy being associated with slightly higher vaccination costs, the total savings derived from fewer influenza events completely resets this increase with net budget savings of € 0.13 million. An immunization policy in which influenza vaccines are administered according to the age and risk profile of Italian elderly individuals is advisable.

  15. Rapid diagnostic test for G6PD deficiency in Plasmodium vivax-infected men: a budget impact analysis based in Brazilian Amazon.

    Science.gov (United States)

    Peixoto, Henry Maia; Brito, Marcelo Augusto Mota; Romero, Gustavo Adolfo Sierra; Monteiro, Wuelton Marcelo; de Lacerda, Marcus Vinícius Guimarães; de Oliveira, Maria Regina Fernandes

    2017-01-01

    The aim of this study was to estimate the incremental budget impact (IBI) of a rapid diagnostic test to detect G6PDd in male patients infected with Plasmodium vivax in the Brazilian Amazon, as compared with the routine protocol recommended in Brazil which does not include G6PDd testing. The budget impact analysis was performed from the perspective of the Brazilian health system, in the Brazilian Amazon for the years 2013, 2014 and 2015. The analysis used a decision model to compare two scenarios: the first consisting of the routine recommended in Brazil which does not include prior diagnosis of dG6PD, and the second based on the use of RDT CareStart™ G6PD (CS-G6PD) in all male subjects diagnosed with vivax malaria. The expected implementation of the diagnostic test was 30% in the first year, 70% the second year and 100% in the third year. The analysis identified negative IBIs which were progressively smaller in the 3 years evaluated. The sensitivity analysis showed that the uncertainties associated with the analytical model did not significantly affect the results. A strategy based on the use of CS-G6PD would result in better use of public resources in the Brazilian Amazon. © 2016 John Wiley & Sons Ltd.

  16. Revisiting policy on chronic HCV treatment under the Thai Universal Health Coverage: An economic evaluation and budget impact analysis.

    Science.gov (United States)

    Rattanavipapong, Waranya; Anothaisintawee, Thunyarat; Teerawattananon, Yot

    2018-01-01

    Thailand is encountering challenges to introduce the high-cost sofosbuvir for chronic hepatitis C treatment as part of the Universal Health Care's benefit package. This study was conducted in respond to policy demand from the Thai government to assess the value for money and budget impact of introducing sofosbuvir-based regimens in the tax-based health insurance scheme. The Markov model was constructed to assess costs and benefits of the four treatment options that include: (i) current practice-peginterferon alfa (PEG) and ribavirin (RBV) for 24 weeks in genotype 3 and 48 weeks for other genotypes; (ii) Sofosbuvir plus peginterferon alfa and ribavirin (SOF+PEG-RBV) for 12 weeks; (iii) Sofosbuvir and daclatasvir (SOF+DCV) for 12 weeks; (iv) Sofosbuvir and ledipasvir (SOF+LDV) for 12 weeks for non-3 genotypes and SOF+PEG-RBV for 12 weeks for genotype 3 infection. Given that policy options (ii) and (iii) are for pan-genotypic infection, the cost of genotype testing was applied only for policy options (i) and (iv). Results reveal that all sofosbuvir-based regimens had greater quality adjusted life years (QALY) gains compared with the current treatment, therefore associated with lower lifetime costs and more favourable health outcomes. Additionally, among the three regimens of sofosbuvir, SOF+PEG-RBV for genotype 3 and SOF+LDV for non-3 genotype are the most cost-effective treatment option with the threshold of 160,000 THB per QALY gained. The results of this study had been used in policy discussion which resulted in the recent inclusion of SOF+PEG-RBV for genotype 3 and SOF+LDV for non-3 genotype in the Thailand's benefit package.

  17. Budget Impact Analysis of Oral Fisiogen Ferro Forte® versus Intravenous Iron for the Management of Iron Deficiency in Chronic Kidney Disease in Spain.

    Science.gov (United States)

    Darbà, Josep; Ascanio, Meritxell

    2018-06-22

    Iron deficiency is a frequent complication of chronic kidney disease (CKD) that is associated with a decrease in the quality of life of patients and an increase in the risk of other clinical complications. Iron therapy represents one of the fundamentals of patients with CKD. Sucrosomial ® oral iron allows Fisiogen Ferro Forte ® to be used in all patients who are intolerant to treatment by the oral route of administration, or who present with malabsorption of conventional oral iron preparations. The main objective of this study was to assess the economic impact of the oral iron Fisiogen Ferro Forte ® for the management of iron deficiency in CKD patients in Spain. A 4-year budget impact model was developed for the period 2017-2020 for CKD patients with iron deficiency who were candidates for intravenous iron due to a lack of response to oral iron, from the perspective of the Spanish healthcare system. Three subgroups of CKD patients were included in the analysis: predialysis, peritoneal dialysis, and post-transplant. The intravenous iron formulations Ferinject ® , Venofer ® , and Feriv ® were considered appropriate comparators to be used in the model. National data on the prevalence of CKD for the three subgroups of patients were obtained from the literature, and input data on drug utilization and outpatient hospitalizations associated with iron administration were obtained by consulting nephrologists. Nephrology experts were also asked about resources used during medical visits and monitoring tests. Based on the unit costs for each iron therapy and the resources used, the total treatment cost per patient associated with each product was obtained to estimate the global budget impact of increasing the use of Fisiogen Ferro Forte ® . The average annual budget savings due to an increase in Fisiogen Ferro Forte ® and a decrease in intravenous iron have been estimated at €398,685, €180,937, and €195,842 over 4 years for the predialysis, peritoneal dialysis

  18. Venous thrombo-embolism (VTE prevention of patients undergoing total hip and knee replacement: budget impact analysis of apixaban in Italy

    Directory of Open Access Journals (Sweden)

    Lorenzo Giovanni Mantovani

    2013-09-01

    Full Text Available BACKGROUND: Venous thromboembolism (VTE is a common and burdensome cardiovascular condition, frequently leading to severe complications and requiring high-cost healthcare interventions. New oral anticoagulants (nOACs have demonstrated to be efficacious and safe in VTE prevention of patients undergoing total hip replacement (THR and total knee replacement (TKR, a condition that is typically associated to cardiovascular disease. The Italian Healthcare Service (SSN has recently approved the latest nOAC, apixaban. The present article aims to evaluate its economic impact in the perspective of the Italian SSN.METHODS: We conducted a budget impact analysis to estimate clinical outcomes and economic consequences associated to the reimbursement of apixaban, in the prevention of VTE as a consequence of major orthopedic surgery, over a three-year time horizon. In our analysis we compared two alternative scenarios, with apixaban either reimbursed (Scenario B or not reimbursed (Scenario A by the Italian SSN, and estimated the difference of healthcare costs between the two scenarios. Only direct healthcare costs have been considered.RESULTS: According to market assumptions, it is estimated that 1.2%, 3.7%, and 6.5% of THR patients, and 1.2%, 3.8% and 6.7% of TKR patients, would be treated with apixaban over the first three years since launch. At the estimated daily cost of apixaban (€2.48/die, this would translate into a budget impact of €14.3 mln, €45.5 mln, and €81.4 mln at years 1, 2 and 3 since launch, respectively. This expenditure would be more than offset by savings, due to: i reduction of prescriptions of alternative treatment options (other nOACs, low-molecular weight heparins, fondaparinux; ii reduction of the economic burden attributable of CV complications of VTE. Finally, Scenario B resulted slightly favourable compared to Scenario A, leading to economic savings for about €50 thousands over three years. Sensitivity analyses confirmed

  19. Budget impact analysis of everolimus for the treatment of hormone receptor positive, human epidermal growth factor receptor-2 negative (HER2-) advanced breast cancer in the United States.

    Science.gov (United States)

    Xie, Jipan; Diener, Melissa; De, Gourab; Yang, Hongbo; Wu, Eric Q; Namjoshi, Madhav

    2013-01-01

    To estimate the budget impact of everolimus as the first and second treatment option after letrozole or anastrozole (L/A) failure for post-menopausal women with hormone receptor positive (HR+), human epidermal growth factor receptor-2 negative (HER2-) advanced breast cancer (ABC). Pharmacy and medical budget impacts (2011 USD) were estimated over the first year of everolimus use in HR+, HER2- ABC from a US payer perspective. Epidemiology data were used to estimate target population size. Pre-everolimus entry treatment options included exemestane, fulvestrant, and tamoxifen. Pre- and post-everolimus entry market shares were estimated based on market research and assumptions. Drug costs were based on wholesale acquisition cost. Patients were assumed to be on treatment until progression or death. Annual medical costs were calculated as the average of pre- and post-progression medical costs weighted by the time in each period, adjusted for survival. One-way and two-way sensitivity analyses were conducted to assess the model robustness. In a hypothetical 1,000,000 member plan, 72 and 159 patients were expected to be candidates for everolimus treatment as first and second treatment option, respectively, after L/A failure. The total budget impact for the first year post-everolimus entry was $0.044 per member per month [PMPM] (pharmacy budget: $0.058 PMPM; medical budget: -$0.014 PMPM), assuming 10% of the target population would receive everolimus. The total budget impacts for the first and second treatment options after L/A failure were $0.014 PMPM (pharmacy budget: $0.018; medical budget: -$0.004) and $0.030 PMPM (pharmacy budget: $0.040; medical budget: -$0.010), respectively. Results remained robust in sensitivity analyses. Assumptions about some model input parameters were necessary and may impact results. Increased pharmacy costs for HR+, HER2- ABC following everolimus entry are expected to be partially offset by reduced medical service costs. Pharmacy and total

  20. Economic analysis and budget impact of clostridial collagenase ointment compared with medicinal honey for treatment of pressure ulcers in the US

    Directory of Open Access Journals (Sweden)

    Mearns ES

    2017-08-01

    Full Text Available Elizabeth S Mearns,1 Michael Liang,1 Brendan L Limone,1 Adrienne M Gilligan,1 Jeffrey D Miller,1 Kathleen D Schaum,2 Curtis R Waycaster2 1Truven Health Analytics, an IBM Company, Cambridge, MA, USA; 2Smith & Nephew, Inc., Fort Worth, TX, USA Objectives: Pressure ulcer (PU treatment poses significant clinical and economic challenges to health-care systems. The aim of this study was to assess the cost-effectiveness and budget impact of enzymatic debridement with clostridial collagenase ointment (CCO compared with autolytic debridement with medicinal honey (MH for PU treatment from a US payer/Medicare perspective in the hospital outpatient department setting.Methods: A cost-effectiveness analysis using a Markov model was developed using a 1-week cycle length across a 1-year time horizon. The three health states were inflammation/senescence, granulation/proliferation (ie, patients achieving 100% granulation, and epithelialization. Data sources included the US Wound Registry, Medicare fee schedules, and other published clinical and cost studies about PU treatment.Results: In the base case analysis over a 1-year time horizon, CCO was the economically dominant strategy (ie, simultaneously conferring greater benefit at less cost. Patients treated with CCO experienced 22.7 quality-adjusted life weeks (QALWs at a cost of $6,161 over 1 year, whereas MH patients experienced 21.9 QALWs at a cost of $7,149. Patients treated with CCO achieved 11.5 granulation weeks and 6.0 epithelization weeks compared with 10.6 and 4.4 weeks for MH, respectively. The number of clinic visits was 40.1 for CCO vs 43.4 for MH, and the number of debridements was 12.3 for CCO compared with 17.6 for MH. Probabilistic sensitivity analyses determined CCO dominant in 72% of 10,000 iterations and cost-effective in 91%, assuming a benchmark willingness-to-pay threshold of $50,000/quality-adjusted life year ($962/QALW. The budget impact analysis showed that for every 1% of patients

  1. Budget Impact Analysis of Switching to Digital Mammography in a Population-Based Breast Cancer Screening Program: A Discrete Event Simulation Model

    Science.gov (United States)

    Comas, Mercè; Arrospide, Arantzazu; Mar, Javier; Sala, Maria; Vilaprinyó, Ester; Hernández, Cristina; Cots, Francesc; Martínez, Juan; Castells, Xavier

    2014-01-01

    Objective To assess the budgetary impact of switching from screen-film mammography to full-field digital mammography in a population-based breast cancer screening program. Methods A discrete-event simulation model was built to reproduce the breast cancer screening process (biennial mammographic screening of women aged 50 to 69 years) combined with the natural history of breast cancer. The simulation started with 100,000 women and, during a 20-year simulation horizon, new women were dynamically entered according to the aging of the Spanish population. Data on screening were obtained from Spanish breast cancer screening programs. Data on the natural history of breast cancer were based on US data adapted to our population. A budget impact analysis comparing digital with screen-film screening mammography was performed in a sample of 2,000 simulation runs. A sensitivity analysis was performed for crucial screening-related parameters. Distinct scenarios for recall and detection rates were compared. Results Statistically significant savings were found for overall costs, treatment costs and the costs of additional tests in the long term. The overall cost saving was 1,115,857€ (95%CI from 932,147 to 1,299,567) in the 10th year and 2,866,124€ (95%CI from 2,492,610 to 3,239,638) in the 20th year, representing 4.5% and 8.1% of the overall cost associated with screen-film mammography. The sensitivity analysis showed net savings in the long term. Conclusions Switching to digital mammography in a population-based breast cancer screening program saves long-term budget expense, in addition to providing technical advantages. Our results were consistent across distinct scenarios representing the different results obtained in European breast cancer screening programs. PMID:24832200

  2. The impact of late budgets on state government borrowing costs

    DEFF Research Database (Denmark)

    Andersen, Asger Lau; Lassen, David Dreyer; Nielsen, Lasse Holbøll Westh

    2014-01-01

    We analyze how a key component of fiscal governance, the ability of governments to pass a budget on time, affects government bond yield spreads. Based on a sample of 36 US states from 1988 to 1997, and using an original data set on budget enactment dates, we estimate that a 30. day budget delay h...... a cumulative impact that is equivalent to a one-time increase in the yield spread of around 10 basis points. States with sufficient liquidity incur no costs from late budgets, while unified governments face large penalties from not finishing a budget on time....

  3. Antibacterial Treatment of Meticillin-Resistant Staphylococcus Aureus Complicated Skin and Soft Tissue Infections: a Cost and Budget Impact Analysis in Greek Hospitals.

    Science.gov (United States)

    Athanasakis, Kostas; Petrakis, Ioannis; Ollandezos, Mark; Tsoulas, Christos; Patel, Dipen A; Karampli, Eleftheria; Kyriopoulos, John

    2014-12-01

    Meticillin-resistant staphylococcus aureus (MRSA) is an important cause of antimicrobial-resistant infections worldwide. Its prevalence remains high in the Greek hospital setting. Complicated skin and soft tissue infections (cSSTIs) due to MRSA are associated with prolonged hospitalization, additional healthcare costs and significant morbidity. The purpose of this study was to conduct a cost analysis and a budget impact analysis relative to different management scenarios for MRSA-cSSTIs from a hospital perspective. Equal efficacy was assumed for the pharmacotherapies under evaluation and resource use was elicited via an expert panel of seven local infectious disease specialists. The model was based on a previously published economic model that was adapted for the Greek hospital setting and included a decision tree for the management of hospitalized patients with MRSA-cSSTIs, which simulated costs and outcomes for the duration of hospitalization according to the therapeutic scenario. Inpatient costs consisted of hospitalization, diagnostic/laboratory testing, physician visits and antibiotic treatment. Current economic impact of MRSA-cSSTIs for the inpatient setting in Greek hospitals was estimated at €29,196,218. Total per patient cost according to first-line agent was €2,457, €2,762, €2,850, €3,494 and €3,094 and mean length of stay was 9.2, 12.5, 10.3, 13.0 and 14.0 days for linezolid, vancomycin, daptomycin, tigecycline, and teicoplanin, respectively. An estimated 10,287 MRSA-cSSTI patients are treated annually in Greek hospitals. Thus, increasing the use of linezolid by 11% over a 3-year period (current use 19%; 3 year projection 30%), for the management of MRSA-cSSTIs, could result in 3-year savings of €896,065. Management of MRSA-cSSTI requires intensive resource use; overall healthcare costs differ according to the chosen first-line treatment. In light of considerable budget constraints, development of hospital strategies which facilitate

  4. Impacts of budget deficit on output, inflation and balance of trade

    NARCIS (Netherlands)

    Wakeel, Iftkhar; Ullah, Kafait

    2013-01-01

    This paper tries to analyze the impacts of budget deficit on macroeconomic aspects of Pakistan. In fact the ways through which budget deficit is financed, can affect money supply, output, exchange rate and then foreign trade. Annual data for the period 1970-2010 has been taken for analysis. ADF test

  5. Cost utility, budget impact, and scenario analysis of racecadotril in addition to oral rehydration for acute diarrhea in children in Malaysia

    Directory of Open Access Journals (Sweden)

    Rautenberg TA

    2018-03-01

    Full Text Available Tamlyn Anne Rautenberg,1,2 Ute Zerwes,3 Way Seah Lee4 1IGES Institut GmbH, Berlin, Germany; 2Health Economics and HIV/AIDS Research Division (HEARD, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa; 3Assessment in Medicine GmbH, Lörrach, Germany; 4Department of Pediatrics, University Malaya, Kuala Lumpur, Malaysia Objective: To perform cost utility (CU and budget impact (BI analyses augmented by scenario analyses of critical model structure components to evaluate racecadotril as adjuvant to oral rehydration solution (ORS for children under 5 years with acute diarrhea in Malaysia.Methods: A CU model was adapted to evaluate racecadotril plus ORS vs ORS alone for acute diarrhea in children younger than 5 years from a Malaysian public payer’s perspective. A bespoke BI analysis was undertaken in addition to detailed scenario analyses with respect to critical model structure components.Results: According to the CU model, the intervention is less costly and more effective than comparator for the base case with a dominant incremental cost-effectiveness ratio of –RM 1,272,833/quality-adjusted life year (USD –312,726/quality-adjusted life year in favor of the intervention. According to the BI analysis (assuming an increase of 5% market share per year for racecadotril+ORS for 5 years, the total cumulative incremental percentage reduction in health care expenditure for diarrhea in children is 0.136578%, resulting in a total potential cumulative cost savings of –RM 73,193,603 (USD –17,983,595 over a 5-year period. Results hold true across a range of plausible scenarios focused on critical model components.Conclusion: Adjuvant racecadotril vs ORS alone is potentially cost-effective from a Malaysian public payer perspective subject to the assumptions and limitations of the model. BI analysis shows that this translates into potential cost savings for the Malaysian public health care system. Results hold true at evidence-based base

  6. Analysis of Budget deficit in Romania during 2000-2013

    OpenAIRE

    Moraru Camelia; Popovici Norina

    2014-01-01

    Worldwide, over time, the years of economic crisis were defined by significant increases in the levels of budget deficits. Discussions on sizing budget deficits, financing, especially the volume of public debt became more intense, both politically and academically. The impact of budget deficit on economic growth is a common theme found in the economic policies adopted. The present paper aims to analyze the evolution of budget deficit and the structural budget deficit in Romania during 2000-20...

  7. Budget impact analysis of liposomal amphotericin B and amphotericin B lipid complex in the treatment of invasive fungal infections in the United States.

    Science.gov (United States)

    Yang, Hongbo; Chaudhari, Paresh; Zhou, Zheng-Yi; Wu, Eric Q; Patel, Chad; Horn, David L

    2014-02-01

    Liposomal amphotericin B (L-AMB) and amphotericin B lipid complex (ABLC) are both indicated for treating invasive fungal infections (IFIs) caused by Aspergillus, Candida and Cryptococcus spp. among patients who are refractory to or intolerant of conventional amphotericin B (CAB). Prior studies have suggested similar efficacies but differences in adverse event (AE) profiles between L-AMB and ABLC. Our objective was to conduct a cost-minimisation and budget impact analysis for the treatment of IFIs with L-AMB and ABLC in a US hospital setting. A Microsoft® Excel-based budget impact model was developed to estimate the costs associated with using L-AMB and ABLC for the treatment of adult patients with Aspergillus, Candida and Cryptococcus spp. infections, who are refractory to or intolerant of CAB, during a hospital stay. The model was built from a hospital perspective, and included drug costs of L-AMB and ABLC, and costs for treating drug-related AEs (i.e. nephrotoxicity with/without dialysis, infusion-related reactions, anaphylaxis, hypomagnesaemia and hypokalaemia). Average sales price was used as the drug cost estimate in the base-case analyses. The treatment duration and rates of AEs for L-AMB and ABLC were mainly obtained from a retrospective study of these two drugs in the target population using the Cerner Health Facts data. Treatment costs of AEs were obtained from the publicly available sources. The budget impact ($US, year 2011 values) was evaluated for a hypothetical hospital with 100 administrations where L-AMB and ABLC are used for the treatment of the target population by changing the market share of L-AMB and ABLC from 32/68% to an anticipated market share of 60/40% in the base-case analysis. Sensitivity analyses were conducted by varying drug costs, rates of AEs, costs of AEs and anticipated market shares of L-AMB and ABLC. The estimated per-patient cost per hospital episode associated with L-AMB and ABLC use were $US14,563 and $US16,748, respectively

  8. [Cost effectiveness and budget impact analysis of inhaled nitric oxide in a neonatal unit from the perspective of the public health system].

    Science.gov (United States)

    Kilchemmann Fuentes, Carlos; Vallejos Vallejos, Carlos; Román Navarro, Andrés

    Inhaled nitric oxide (iNO) is currently the first-line therapy in severe hypoxaemic respiratory failure of the newborn. Most of regional neonatal centres in Chile do not have this therapeutic alternative. To determine the cost effectiveness of inhaled nitric oxide in the treatment of respiratory failure associated with pulmonary hypertension of the newborn compared to the usual care, including the transfer to a more complex unit. A clinical decision tree was designed from the perspective of Chilean Public Health Service. Incremental cost effectiveness rates (ICER) were calculated, deterministic sensitivity analysis was performed, and probabilistic budget impact was estimated using: TreeAge Pro Healthcare 2014 software. The iNO option leads to an increase in mean cost of $ 11.7 million Chilean pesos (€15,000) per patient treated, with an ICER compared with the usual care of $23 million pesos (€30,000) in case of death or ECMO avoided. By sensitising the results by incidence, it was found that from 7 cases and upwards treated annually, inhaled nitric oxide is less costly than the transfer to a more complex unit. From the perspective of a Chilean regional hospital, incorporating inhaled nitric oxide into the management of neonatal respiratory failure is the optimal alternative in most scenarios. Copyright © 2016 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. VAR—ANALYSIS OF GLOBAL FINANCIAL ECONOMIC CRISIS IMPACT ON PUBLIC BUDGET AND UNEMPLOYMENT: EVIDENCE FROM THE ECONOMY OF THE KYRGYZ REPUBLIC

    Directory of Open Access Journals (Sweden)

    Nargiza Bakytovna Alymkulova

    2016-12-01

    Full Text Available The Global financial crisis hit the economy of the Kyrgyz Republic by the third wave of its transmission in the early of 2009. The article examines the impact of the Global financial economic crisis on the public budget and unemployment of the Kyrgyz Republic. We analyzed the transmission of the crisis on the public budget firstly and its effect on unemployment level by using the vector autoregression approach (VAR and quarterly data for 2005–2013 within the framework of IS-LM model for small open economies with floating exchange rate. There is an inverse relationship between the public budget and remittances inflow, liquidity level, volume of deposits, and exchange rate. As a result of the study, the fall in remittances inflows, liquidity level of the banking system, depreciation of the national currency lead to an increase in public revenue. Therefore, the increase in public spending during the crisis period, with the aim of unemployment reduction, may be considered as a crucial policy. The study result allows to policy-makers to exactly know what channels of transmission mechanism transfer the Global crisis on the public budget and its effect on unemployment level of the republic in order to undertake anticrisis macroeconomic policy. The final result of the study indicates that the increase of unemployment level by 1 % requires the increase of public spending by 0.63 %.

  10. Model analysis of check dam impacts on long-term sediment and water budgets in southeast Arizona, USA

    Science.gov (United States)

    Norman, Laura M.; Niraula, Rewati

    2016-01-01

    The objective of this study was to evaluate the effect of check dam infrastructure on soil and water conservation at the catchment scale using the Soil and Water Assessment Tool (SWAT). This paired watershed study includes a watershed treated with over 2000 check dams and a Control watershed which has none, in the West Turkey Creek watershed, Southeast Arizona, USA. SWAT was calibrated for streamflow using discharge documented during the summer of 2013 at the Control site. Model results depict the necessity to eliminate lateral flow from SWAT models of aridland environments, the urgency to standardize geospatial soils data, and the care for which modelers must document altering parameters when presenting findings. Performance was assessed using the percent bias (PBIAS), with values of ±2.34%. The calibrated model was then used to examine the impacts of check dams at the Treated watershed. Approximately 630 tons of sediment is estimated to be stored behind check dams in the Treated watershed over the 3-year simulation, increasing water quality for fish habitat. A minimum precipitation event of 15 mm was necessary to instigate the detachment of soil, sediments, or rock from the study area, which occurred 2% of the time. The resulting watershed model is useful as a predictive framework and decision-support tool to consider long-term impacts of restoration and potential for future restoration.

  11. A budget impact analysis of parenteral iron treatments for iron deficiency anemia in the UK: reduced resource utilization with iron isomaltoside 1000.

    Science.gov (United States)

    Pollock, Richard F; Muduma, Gorden

    2017-01-01

    The reported prevalence of iron deficiency anemia (IDA) varies widely but estimates suggest that 3% of men and 8% of women have IDA in the UK. Parenteral iron is indicated for patients intolerant or unresponsive to oral iron or requiring rapid iron replenishment. This study evaluated differences in the cost of treating these patients with iron isomaltoside (Monofer ® , IIM) relative to other intravenous iron formulations. A budget impact model was developed to evaluate the cost of using IIM relative to ferric carboxymaltose (Ferinject ® , FCM), low molecular weight iron dextran (Cosmofer ® , LMWID), and iron sucrose (Venofer ® , IS) in patients with IDA. To establish iron need, iron deficits were modeled using a simplified dosing table. The base case analysis was conducted over 1 year in patients with IDA with mean bodyweight of 82.4 kg (SD 22.5 kg) and hemoglobin levels of 9.99 g/dL (SD 1.03 g/dL) based on an analysis of patient characteristics in IDA trials. Costs were modeled using UK health care resource groups. Using IIM required 1.3 infusions to correct the mean iron deficit, compared with 1.3, 1.8, and 7.7 with LMWID, FCM, and IS, respectively. Patients using IIM required multiple infusions in 35% of cases, compared with 35%, 77%, and 100% of patients with LMWID, FCM, and IS, respectively. Total costs were estimated to be GBP 451 per patient with IIM or LMWID, relative to GBP 594 with FCM (a GBP 143 or 24% saving with IIM) or GBP 2,600 with IS (a GBP 2,149 or 83% saving with IIM). Using IIM or LMWID in place of FCM or IS resulted in a marked reduction in the number of infusions required to correct iron deficits in patients with IDA. The reduction in infusions was accompanied by substantial reductions in cost relative to FCM and IS over 1 year.

  12. Use of Oritavancin in Moderate-to-Severe ABSSSI Patients Requiring IV Antibiotics: A U.S. Payer Budget Impact Analysis.

    Science.gov (United States)

    Jensen, Ivar S; Wu, Elizabeth; Fan, Weihong; Lodise, Thomas P; Nicolau, David P; Dufour, Scott; Cyr, Philip L; Sulham, Katherine A

    2016-06-01

    It is estimated that acute bacterial skin and skin structure infections (ABSSSI) account for nearly 10% of hospital admissions and 3.4-3.8 million emergency department visits per year in the United States. Analyses of hospital discharge records indicate 74% of ABSSSI admissions involve empiric treatment with methicillin-resistant Staphylococcus aureus (MRSA) active antibiotics. Analysis has shown that payer costs could be reduced if moderate-to-severe ABSSSI patients were treated to a greater extent in the observational unit followed by discharge to outpatient parenteral antibiotic therapy (OPAT). Oritavancin is a lipoglycopeptide antibiotic with bactericidal activity against gram-positive bacteria, including MRSA. To estimate the impact on a U.S. payer's budget of using single-dose oritavancin in ABSSSI patients with suspected MRSA involvement who are indicated for intravenous antibiotics. A decision analytic model based on current clinical practice was developed to estimate the economic value of decreased hospital resource consumption by using single-dose oritavancin over a 1-year time horizon. Use of antibiotics was informed by an analysis of the Premier Research Database. Demographic and clinical data were derived from a targeted literature review. Emergency department, observation, laboratory, and administration costs used were Medicare National Limitation amounts. Drug costs were 2014 wholesale acquisition costs. For a hypothetical U.S. payer with 1,000,000 members, it is expected that approximately 14,285 members per year will be diagnosed with ABSSSI severe enough to indicate intravenous antibiotics with MRSA activity. Based on this simulation, use of single-dose oritavancin in 26% of these patients was estimated to reduce the number of inpatient admissions, reduce length of stay for patients requiring admission, and reduce the number of days a patient needs to receive daily infusions in the OPAT clinic. The total patient days decreased from 171,125 to 133

  13. Budget Impact Analysis of Against Colorectal Cancer In Our Neighborhoods (ACCION): A Successful Community-Based Colorectal Cancer Screening Program for a Medically Underserved Minority Population.

    Science.gov (United States)

    Kim, Bumyang; Lairson, David R; Chung, Tong Han; Kim, Junghyun; Shokar, Navkiran K

    2017-06-01

    Given the uncertain cost of delivering community-based cancer screening programs, we developed a Markov simulation model to project the budget impact of implementing a comprehensive colorectal cancer (CRC) prevention program compared with the status quo. The study modeled the impacts on the costs of clinical services, materials, and staff expenditures for recruitment, education, fecal immunochemical testing (FIT), colonoscopy, follow-up, navigation, and initial treatment. We used data from the Against Colorectal Cancer In Our Neighborhoods comprehensive CRC prevention program implemented in El Paso, Texas, since 2012. We projected the 3-year financial consequences of the presence and absence of the CRC prevention program for a hypothetical population cohort of 10,000 Hispanic medically underserved individuals. The intervention cohort experienced a 23.4% higher test completion rate for CRC prevention, 8 additional CRC diagnoses, and 84 adenomas. The incremental 3-year cost was $1.74 million compared with the status quo. The program cost per person was $261 compared with $86 for the status quo. The costs were sensitive to the proportion of high-risk participants and the frequency of colonoscopy screening and diagnostic procedures. The budget impact mainly derived from colonoscopy-related costs incurred for the high-risk group. The effectiveness of FIT to detect CRC was critically dependent on follow-up after positive FIT. Community cancer prevention programs need reliable estimates of the cost of CRC screening promotion and the added budget impact of screening with colonoscopy. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  14. Budget impact analysis of sofosbuvir-based regimens for the treatment of HIV/HCV-coinfected patients in northern Italy: a multicenter regional simulation

    Directory of Open Access Journals (Sweden)

    Cenderello G

    2015-12-01

    Full Text Available Giovanni Cenderello,1 Stefania Artioli,2 Claudio Viscoli,3 Ambra Pasa,4 Mauro Giacomini,5 Barbara Giannini,5 Chiara Dentone,6 Laura Ambra Nicolini,3 Giovanni Cassola,1 Antonio Di Biagio31Infectious Diseases Unit EO, Ospedali Galliera, Genoa, 2Infectious Diseases Unit, ASL-5 Spezzina, La Spezia, 3Infectious Diseases Unit, AOU San Martino, IST, Genoa University, Genoa, 4IT Unit, Ospedali Galliera, Genoa, 5Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS, University of Genoa, Genova, 6Infectious Diseases Unit, ASL-1 Imperiese, Sanremo, Imperia, ItalyObjectives: Chronic hepatitis C virus (HCV is a leading cause of hospitalization and death in populations coinfected with human immunodeficiency virus (HIV. Sofosbuvir (SOF is a pan-genotypic drug that should be combined with other agents as an oral treatment for HCV. We performed a 5-year horizon budget impact analysis of SOF-based regimens for the management of HIV/HCV-coinfected patients.Methods: A multicenter, prospective evaluation was conducted, involving four Italian Infectious Diseases Departments (Galliera, San Martino, Sanremo, and La Spezia. All 1,005 genotype-coinfected patients (30% cirrhotics under observation were considered (patients in all disease-stages were considered: chronic hepatitis C, cirrhosis, transplant, hepatocellular carcinoma. Disease stage costs per patient were collected; the expected disease progression in the absence of treatment and sustained virological response (SVR success rate for SOF-based regimens were calculated based on the literature and expert opinion. Drug prices were based on what the National Health Service paid for them. The comparison of "no treatment" disease progression costs versus the economic impact of SOF-based regimens was investigated.Results: Over the following 5 years, the disease progression scenario resulted in direct costs of approximately €54 million. Assuming an SVR success rate of 90%, average SOF

  15. Doing more for less: identifying opportunities to expand public sector access to safe abortion in South Africa through budget impact analysis.

    Science.gov (United States)

    Lince-Deroche, Naomi; Harries, Jane; Constant, Deborah; Morroni, Chelsea; Pleaner, Melanie; Fetters, Tamara; Grossman, Daniel; Blanchard, Kelly; Sinanovic, Edina

    2018-02-01

    To estimate the costs of public-sector abortion provision in South Africa and to explore the potential for expanding access at reduced cost by changing the mix of technologies used. We conducted a budget impact analysis using public sector abortion statistics and published cost data. We estimated the total costs to the public health service over 10 years, starting in South Africa's financial year 2016/17, given four scenarios: (1) holding service provision constant, (2) expanding public sector provision, (3) changing the abortion technologies used (i.e. the method mix), and (4) expansion plus changing the method mix. The public sector performed an estimated 20% of the expected total number of abortions in 2016/17; 26% and 54% of all abortions were performed illegally or in the private sector respectively. Costs were lowest in scenarios where method mix shifting occurred. Holding the proportion of abortions performed in the public-sector constant, shifting to more cost-effective service provision (more first-trimester services with more medication abortion and using the combined regimen for medical induction in the second trimester) could result in savings of $28.1 million in the public health service over the 10-year period. Expanding public sector provision through elimination of unsafe abortions would require an additional $192.5 million. South Africa can provide more safe abortions for less money in the public sector through shifting the methods provided. More research is needed to understand whether the cost of expanding access could be offset by savings from averting costs of managing unsafe abortions. South Africa can provide more safe abortions for less money in the public sector through shifting to more first-trimester methods, including more medication abortion, and shifting to a combined mifepristone plus misoprostol regimen for second trimester medical induction. Expanding access in addition to method mix changes would require additional funds. Copyright

  16. [Fixed drug combinations in hypertension: a budget impact analysis for the Spanish Health System on the marketing of a fixed combination of olmesartan/amlodipine].

    Science.gov (United States)

    Belén Ferro-Rey, M; Roca-Cusachs, Alex; Sicras-Mainar, Antoni; Alvarez-Martín, Carlos; de Salas-Cansado, Marina

    2011-07-01

    To carry out a budget impact analysis (BIA) of olmesartan/amlodipine (20/5, 40/5 and 40/10mg) marketed as a fixed combination (FC) in its approved indication for the National Health System (NHS). We developed a decision tree model in order to estimate usual hypertension treatment algorithm in Spanish clinical practice. The BIA has been developed from the perspective of the NHS for a period of 3 years (years 2010-2012). Spanish hypertensive population ≥ 35 years old. Introduction into the market of a fixed combination (FC) olmesartan/amlodipine in Spain. Expected costs to be assumed by the Spanish NHS (RRP-VAT) for hypertensive population able to be treated with the FC versus currently assumed costs by the NHS with free combination olmesartan and amlodipine. Estimated pharmaceutical costs in hypertensive population treated with olmesartan and amlodipine (2 pills) would be €25.2M (1(st) year), €26.4M (2011), €27.6M (2012), with a total 3-year period of €79.2M. According to patient tree model, the population able to be treated with FC would be 71,283 patients (2010), with a growth rate of 4.8% in the successive years, which supposes an annual cost of €21.2M (2010), €21.8M (2011) and €22.4M (2012), with a total 3-year period of €65.4M. The BIA shows savings of €13.8M in a total 3-year period. The BIA of FC olmesartan/amlodipine could generate net savings of €13.8M for the NHS in the period ranging from years 2010 to 2012. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  17. A budget impact analysis comparing use of a modern fecal management system to traditional fecal management methods in two canadian hospitals.

    Science.gov (United States)

    Langill, Mike; Yan, Songkai; Kommala, Dheerendra; Michenko, Michael

    2012-12-01

    Research suggests that fecal management systems (FMS) offer advantages, including potential cost savings, over traditional methods of caring for patients with little or no bowel control and liquid or semi-liquid stool. A budget impact model accounting for material costs of managing fecal incontinence was developed, and 1 year of experiential data from two hospitals' ICUs were applied to it. Material costs were estimated for traditional methods (ie, use of absorbent briefs/pads, skin cleansers, moisturizers) and compared with material costs of using a modern FMS for both average (normal-range weight) and complex (bariatric with wounds) ICU patients at hospital 1 and any ICU patient at hospital 2. Reductions in daily material costs per ICU patient using FMS versus traditional methods were reported by hospital 1 ($93.74 versus $143.89, average patient; $150.55 versus $476.41, complex patient) and by hospital 2 ($61.15 versus $104.85 per patient). When extrapolated to the total number of patients expected to use FMS at each institution, substantial annual cost savings were projected (hospital 1: $57,216; hospital 2: $627,095). In addition, total nursing time per day for managing fecal incontinence (ie, changing, cleaning, repositioning patients, changing pads, linens, and the like) was estimated at hospital 1, showing substantial reductions with FMS (120 minutes versus 348 minutes for average patients; 240 minutes versus 760 minutes for complex). Nursing time was not included in cost calculations to keep the analysis conservative. Results of this study suggest the materials cost of using the FMS in ICU patients was substantially lower than the cost of traditional fecal incontinence management protocols of care in both hospitals. Comparative studies using patient level data, materials, and nursing time costs, as well as complication rates, are warranted.

  18. Budget impact analysis of rivaroxaban vs. warfarin anticoagulation strategy for direct current cardioversion in non-valvular atrial fibrillation patients: the MonaldiVert Economic Study.

    Science.gov (United States)

    Russo, Vincenzo; Rago, Anna; Papa, Andrea A; Bianchi, Valter; Tavoletta, Vincenzo; DE Vivo, Stefano; Cavallaro, Ciro; Nigro, Gerardo; D'Onofrio, Antonio

    2018-02-01

    Rivaroxaban is the first novel oral anticoagulant to receive regulatory approval for non-valvular atrial fibrillation (NVAF) patients who require cardioversion. The MonaldiVert real life experience showed positive benefit-risk profile of short term rivaroxaban administration for transesophageal echocardiogram guided cardioversion in patients who had not achieved adequate pre-procedural vitamin K antagonist (VKA) anticoagulation. Aim of our study was to perform a budget impact analysis of MonaldiVert anticoagulation strategy for direct current cardioversion in NVAF patients and to compare the following costs borne by the Regional Healthcare System (RHS) with those for a hypothetical cohort of identical patients underwent from the beginning to early rivaroxaban treatment before direct current cardioversion. The mean costs per each NVAF patient treated with VKA strategy and rivaroxaban rescue strategy were € 134.53 and € 189.83, respectively. Considering a hypothetical scenario in which all study population would be treated from the beginning with rivaroxaban (rivaroxaban early strategy), the mean cost per patient would have been € 81.11. The total cost borne by the RHS, including the cost of the cardioversion procedure, for the two therapeutic strategies carried out at Monaldi Hospital (VKA strategy and Rivaroxaban rescue strategy) was € 88,458.53. The total cost would be borne by the RHS for rivaroxaban early strategy, if applied to all study population, would have been € 69,989.15 with a saving of € 18,469.38 compared to the actually applied strategy. Rivaroxaban rescue strategy for transesophageal echocardiography guided direct current cardioversion in NVAF patients, who had not achieved adequate pre-procedural VKA anticoagulation, is an effective and safe strategy, which allows to not delay the procedure, reducing times and wastage of cardioversion slots, without substantial costs increase.

  19. Placental Growth Factor (PlGF in Women with Suspected Pre-Eclampsia Prior to 35 Weeks' Gestation: A Budget Impact Analysis.

    Directory of Open Access Journals (Sweden)

    Suzy Duckworth

    Full Text Available To model the resource implications of placental growth factor (PlGF testing in women with suspected pre-eclampsia prior to 35 weeks' gestation as part of a management algorithm, compared with current practice.Data on resource use from 132 women with suspected pre-eclampsia prior to 35 weeks' gestation, enrolled in a prospective observational cohort study evaluating PlGF measurement within antenatal assessment units within two UK consultant-led maternity units was extracted by case note review. A decision analytic model was developed using these data to establish the budget impact of managing women with suspected pre-eclampsia for two weeks from the date of PlGF testing, using a clinical management algorithm and reference cost tariffs. The main outcome measures of resource use (numbers of outpatient appointments, ultrasound investigations and hospital admissions were correlated to final diagnosis and used to calculate comparative management regimes.The mean cost saving associated with the PlGF test (in the PlGF plus management arm was £35,087 (95% CI -£33,181 to -£36,992 per 1,000 women. This equated to a saving of £582 (95% CI -552 to -£613 per woman tested. In 94% of iterations, PlGF testing was associated with cost saving compared to current practice.This analysis suggests PlGF used as part of a clinical management algorithm in women presenting with suspected pre-eclampsia prior to 35 weeks' gestation could provide cost savings by reducing unnecessary resource use. Introduction of PlGF testing could be used to direct appropriate resource allocation and overall would be cost saving.

  20. A cost-effectiveness and budget impact analysis of first-line fidaxomicin for patients with Clostridium difficile infection (CDI) in Germany.

    Science.gov (United States)

    Watt, Maureen; McCrea, Charles; Johal, Sukhvinder; Posnett, John; Nazir, Jameel

    2016-10-01

    Clostridium difficile infection (CDI) represents a significant economic healthcare burden, especially the cost of recurrent disease. Fidaxomicin produced significantly lower recurrence rates and higher sustained cure rates in clinical trials. We evaluated the cost-effectiveness and budget impact of fidaxomicin compared with vancomycin in Germany in the first-line treatment of patient subgroups with CDI at increased risk of recurrence. A semi-Markov model was used to compare the cost-effectiveness and budget impact of fidaxomicin vs. vancomycin from a payer perspective in Germany. The model cycle length was 10 days. The time horizon was 1 year. Model inputs were probability of clinical cure, 30-day probability of recurrence, and 30-day attributable mortality based on evidence from two randomized controlled trials comparing fidaxomicin and vancomycin in patients with CDI. Cost-effectiveness outcomes were cost per quality-adjusted life year gained, cost per bed-day saved, and cost per recurrence avoided. Despite higher drug acquisition costs, fidaxomicin was dominant in the cancer subgroup (less costly and more effective) and cost-effective in the other subgroups, with incremental cost-effectiveness ratios vs. vancomycin ranging from €26,900 to €44,500. Hospitalization costs of the first-line treatment of CDI with fidaxomicin vs. vancomycin were lower in every patient subgroup, resulting in budget impacts ranging from -€1325 (in patients ≥65 years) to -€2438 (in cancer patients). Reductions in the cost of treating recurrence with fidaxomicin ranged from -€574.32 per patient in those receiving concomitant antibiotics to -€1500.68 per patient in renally impaired patients. In patient subgroups with CDI at increased recurrence risk, fidaxomicin was cost-effective vs. vancomycin, and less costly and more effective in patients with cancer.

  1. A Methodological Review of US Budget-Impact Models for New Drugs.

    Science.gov (United States)

    Mauskopf, Josephine; Earnshaw, Stephanie

    2016-11-01

    A budget-impact analysis is required by many jurisdictions when adding a new drug to the formulary. However, previous reviews have indicated that adherence to methodological guidelines is variable. In this methodological review, we assess the extent to which US budget-impact analyses for new drugs use recommended practices. We describe recommended practice for seven key elements in the design of a budget-impact analysis. Targeted literature searches for US studies reporting estimates of the budget impact of a new drug were performed and we prepared a summary of how each study addressed the seven key elements. The primary finding from this review is that recommended practice is not followed in many budget-impact analyses. For example, we found that growth in the treated population size and/or changes in disease-related costs expected during the model time horizon for more effective treatments was not included in several analyses for chronic conditions. In addition, all drug-related costs were not captured in the majority of the models. Finally, for most studies, one-way sensitivity and scenario analyses were very limited, and the ranges used in one-way sensitivity analyses were frequently arbitrary percentages rather than being data driven. The conclusions from our review are that changes in population size, disease severity mix, and/or disease-related costs should be properly accounted for to avoid over- or underestimating the budget impact. Since each budget holder might have different perspectives and different values for many of the input parameters, it is also critical for published budget-impact analyses to include extensive sensitivity and scenario analyses based on realistic input values.

  2. Budget Impact Analysis of PCSK9 Inhibitors for the Management of Adult Patients with Heterozygous Familial Hypercholesterolemia or Clinical Atherosclerotic Cardiovascular Disease.

    Science.gov (United States)

    Mallya, Usha G; Boklage, Susan H; Koren, Andrew; Delea, Thomas E; Mullins, C Daniel

    2018-01-01

    The aim of this study was to assess the budget impact of introducing the proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) alirocumab and evolocumab to market for the treatment of adults with heterozygous familial hypercholesterolemia or clinical atherosclerotic cardiovascular (CV) disease requiring additional lowering of low-density lipoprotein cholesterol (LDL-C). A 3-year model estimated the costs of lipid-modifying therapy (LMT) and CV events to a hypothetical US health plan of 1 million members, comparing two scenarios-with and without the availability of PCSK9i as add-on therapy to statins. Proportions of patients with uncontrolled LDL-C despite receiving statins, and at risk of CV events, were estimated from real-world data. Total undiscounted annual LMT costs (2017 prices, including PCSK9i costs of $14,563.50), dispensing and healthcare costs, including the costs of CV events, were estimated for all prevalent patients in the target population, based on baseline risk factors. Maximum PCSK9i utilization of 1-5% over 3 years according to risk group (following the same pattern as current ezetimibe use), and 5-10% as a secondary scenario, were assumed. Total healthcare budget impacts per target patient (and per member) per month for years 1, 2 and 3 were $3.62($0.10), $7.22($0.20) and $10.79($0.30), respectively, assuming 1-5% maximum PCSK9i utilization, and $15.81($0.44), $31.52($0.88) and $47.12($1.31), respectively, assuming 5-10% utilization. Results were sensitive to changes in model timeframe, years to maximum PCSK9i utilization and PCSK9i costs. The budget impact of PCSK9i as add-on therapy to statins for patients with hypercholesterolemia is relatively low compared with published estimates for other specialty biologics. Drug cost rebates and discounts are likely to further reduce budget impact.

  3. A budget impact analysis of parenteral iron treatments for iron deficiency anemia in the UK: reduced resource utilization with iron isomaltoside 1000

    Directory of Open Access Journals (Sweden)

    Pollock RF

    2017-08-01

    Full Text Available Richard F Pollock,1 Gorden Muduma2 1Ossian Health Economics and Communications GmbH, Basel, Switzerland; 2Pharmacosmos A/S, Holbaek, Denmark Background and aims: The reported prevalence of iron deficiency anemia (IDA varies widely but estimates suggest that 3% of men and 8% of women have IDA in the UK. Parenteral iron is indicated for patients intolerant or unresponsive to oral iron or requiring rapid iron replenishment. This study evaluated differences in the cost of treating these patients with iron isomaltoside (Monofer®, IIM relative to other intravenous iron formulations. Methods: A budget impact model was developed to evaluate the cost of using IIM relative to ferric carboxymaltose (Ferinject®, FCM, low molecular weight iron dextran (Cosmofer®, LMWID, and iron sucrose (Venofer®, IS in patients with IDA. To establish iron need, iron deficits were modeled using a simplified dosing table. The base case analysis was conducted over 1 year in patients with IDA with mean bodyweight of 82.4 kg (SD 22.5 kg and hemoglobin levels of 9.99 g/dL (SD 1.03 g/dL based on an analysis of patient characteristics in IDA trials. Costs were modeled using UK health care resource groups. Results: Using IIM required 1.3 infusions to correct the mean iron deficit, compared with 1.3, 1.8, and 7.7 with LMWID, FCM, and IS, respectively. Patients using IIM required multiple infusions in 35% of cases, compared with 35%, 77%, and 100% of patients with LMWID, FCM, and IS, respectively. Total costs were estimated to be GBP 451 per patient with IIM or LMWID, relative to GBP 594 with FCM (a GBP 143 or 24% saving with IIM or GBP 2,600 with IS (a GBP 2,149 or 83% saving with IIM. Conclusion: Using IIM or LMWID in place of FCM or IS resulted in a marked reduction in the number of infusions required to correct iron deficits in patients with IDA. The reduction in infusions was accompanied by substantial reductions in cost relative to FCM and IS over 1 year. Keywords: iron

  4. Global volcanic emissions: budgets, plume chemistry and impacts

    Science.gov (United States)

    Mather, T. A.

    2012-12-01

    Over the past few decades our understanding of global volcanic degassing budgets, plume chemistry and the impacts of volcanic emissions on our atmosphere and environment has been revolutionized. Global volcanic emissions budgets are needed if we are to make effective use of regional and global atmospheric models in order to understand the consequences of volcanic degassing on global environmental evolution. Traditionally volcanic SO2 budgets have been the best constrained but recent efforts have seen improvements in the quantification of the budgets of other environmentally important chemical species such as CO2, the halogens (including Br and I) and trace metals (including measurements relevant to trace metal atmospheric lifetimes and bioavailability). Recent measurements of reactive trace gas species in volcanic plumes have offered intriguing hints at the chemistry occurring in the hot environment at volcanic vents and during electrical discharges in ash-rich volcanic plumes. These reactive trace species have important consequences for gas plume chemistry and impacts, for example, in terms of the global fixed nitrogen budget, volcanically induced ozone destruction and particle fluxes to the atmosphere. Volcanically initiated atmospheric chemistry was likely to have been particularly important before biological (and latterly anthropogenic) processes started to dominate many geochemical cycles, with important consequences in terms of the evolution of the nitrogen cycle and the role of particles in modulating the Earth's climate. There are still many challenges and open questions to be addressed in this fascinating area of science.

  5. Stress Analysis in Managing the Region’s Budget Risks

    Directory of Open Access Journals (Sweden)

    Natalya Pavlovna Pazdnikova

    2014-09-01

    Full Text Available The article addresses the implementation of budget risk management methods into the practices of governmental authorities. Drawing on the example of a particular region the article aims to demonstrate the possible methods of budget risk management. The authors refine the existing approaches to the notion of risk in its relation to budget system by introducing the notion of “budget risk.” Here the focus is the risk of default of budget spending in full which causes underfunding of territories and decrease in quality of life in the region. The authors have particularized the classification of budget risks and grouped together the criteria and factors which significantly influence the assessment and choice of method to manage budget risks. They hypothesize that budget risk is a financial risk. Therefore, the methods of financial risks management can be applied to budget risks management. The authors suggest a methodological approach to risk assessment based on correlation and regression analysis of program financing. The application of Kendall rank correlation coefficient allowed to assess the efficiency of budget spending on the implementation of state programs in Perm Krai. Two clusters — “Nature management and infrastructure” and “Public security” — turned out to be in the zone of high budget risk. The method of stress analysis, which consists in calculating Value at Risk (VaR, was applied to budget risks that in terms of probability are classified as critical. In order to assess risk as probability rate, the amount of Perm Krai deficit budget was calculated as induced variable from budget revenues and spending. The results demonstrate that contemporary management of public resources in the regions calls for the implementation of new management tools of higher quality and budget risk management is one of them.

  6. Estimating the budget impact of orphan drugs in Sweden and France 2013-2020.

    Science.gov (United States)

    Hutchings, Adam; Schey, Carina; Dutton, Richard; Achana, Felix; Antonov, Karolina

    2014-02-13

    The growth in expenditure on orphan medicinal products (OMP) across Europe has been identified as a concern. Estimates of future expenditure in Europe have suggested that OMPs could account for a significant proportion of total pharmaceutical expenditure in some countries, but few of these forecasts have been well validated. This analysis aims to establish a robust forecast of the future budget impact of OMPs on the healthcare systems in Sweden and France. A dynamic forecasting model was created to estimate the budget impact of OMPs in Sweden and France between 2013 and 2020. The model used historical data on OMP designation and approval rates to predict the number of new OMPs coming to the market. Average OMP sales were estimated for each year post-launch by regression analysis of historical sales data. Total forecast sales were compared with expected sales of all pharmaceuticals in each country to quantify the relative budget impact. The model predicts that by 2020, 152 OMPs will have marketing authorization in Europe. The base case OMP budget impacts are forecast to grow from 2.7% in Sweden and 3.2% in France of total drug expenditure in 2013 to 4.1% in Sweden and 4.9% in France by 2020. The principal driver of expenditure growth is the number of new OMPs obtaining OMP designation. This is tempered by the slowing success rate for new approvals and the loss of intellectual property protection on existing orphan medicines. Given the forward-looking nature of the analysis, uncertainty exists around model parameters and sensitivity analysis found peak year budget impact varying between 2% and 11%. The budget impact of OMPs in Sweden and France is likely to remain sustainable over time and a relatively small proportion of total pharmaceutical expenditure. This forecast could be affected by changes in the success rate for OMP approvals, average cost of OMPs, and the type of companies developing OMPs.

  7. Estimating the budget impact of orphan drugs in Sweden and France 2013–2020

    Science.gov (United States)

    2014-01-01

    Background The growth in expenditure on orphan medicinal products (OMP) across Europe has been identified as a concern. Estimates of future expenditure in Europe have suggested that OMPs could account for a significant proportion of total pharmaceutical expenditure in some countries, but few of these forecasts have been well validated. This analysis aims to establish a robust forecast of the future budget impact of OMPs on the healthcare systems in Sweden and France. Methods A dynamic forecasting model was created to estimate the budget impact of OMPs in Sweden and France between 2013 and 2020. The model used historical data on OMP designation and approval rates to predict the number of new OMPs coming to the market. Average OMP sales were estimated for each year post-launch by regression analysis of historical sales data. Total forecast sales were compared with expected sales of all pharmaceuticals in each country to quantify the relative budget impact. Results The model predicts that by 2020, 152 OMPs will have marketing authorization in Europe. The base case OMP budget impacts are forecast to grow from 2.7% in Sweden and 3.2% in France of total drug expenditure in 2013 to 4.1% in Sweden and 4.9% in France by 2020. The principal driver of expenditure growth is the number of new OMPs obtaining OMP designation. This is tempered by the slowing success rate for new approvals and the loss of intellectual property protection on existing orphan medicines. Given the forward-looking nature of the analysis, uncertainty exists around model parameters and sensitivity analysis found peak year budget impact varying between 2% and 11%. Conclusion The budget impact of OMPs in Sweden and France is likely to remain sustainable over time and a relatively small proportion of total pharmaceutical expenditure. This forecast could be affected by changes in the success rate for OMP approvals, average cost of OMPs, and the type of companies developing OMPs. PMID:24524281

  8. Ulipristal acetate for pre-operative treatment of moderate-to-severe uterine fibroids in women of reproductive age in The Netherlands: cost minimization analysis and budget impact analysis.

    Science.gov (United States)

    Zakiyah, N; van Asselt, A D I; Postma, M J

    2017-03-01

    Ulipristal acetate has been found to be non-inferior to other pre-operative treatments of uterine fibroids, particularly leuprolide. The objective of this study was to assess the pharmacoeconomic profile of ulipristal acetate compared to leuprolide for the pre-operative treatment of moderate-to-severe uterine fibroids in women of reproductive age in The Netherlands. The analysis was performed and applied within the framework of the ulipristal acetate submission for reimbursement in 2012. A decision model was developed to compare the total costs of ulipristal acetate compared to leuprolide, the standard care in The Netherlands. The target population of this study corresponded to the type of patients included in the PEARL II clinical trial; i.e. women of reproductive age requiring pre-operative treatment for uterine fibroids. Sensitivity analysis was implemented to assess uncertainties. Data regarding costs, effects, and other input parameters were obtained from relevant published literatures, the Dutch Healthcare Insurance Board, and expert opinion obtained by means of a panel of experts from several medical centers in The Netherlands. In The Netherlands, the total costs of ulipristal acetate and leuprolide were estimated at €4,216,027 and €4,218,095, respectively. The annual savings of ulipristal acetate were, therefore, estimated at €2,068. The major driver of this cost difference was the cost of administration for leuprolide. Sensitivity analyses showed that ulipristal acetate mostly remained cost-saving over a range of assumptions. The budget impact analysis indicated that the introduction of ulipristal acetate was estimated to result in cost savings in the first 3 years following the introduction. The results of this study were used in the decision on reimbursement of ulipristal acetate according to the Dutch Reference Pricing system in 2012. Ulipristal acetate was cost saving compared to leuprolide and has the potential to provide substantial savings on

  9. Analysis of Health Sector Budget of Nepal.

    Science.gov (United States)

    Dulal, R K; Magar, A; Karki, S D; Khatiwada, D; Hamal, P K

    2014-01-01

    Primarily, health sector connects two segments - medicine and public health, where medicine deals with individual patients and public health with the population health. Budget enables both the disciplines to function effectively. The Interim Constitution of Nepal, 2007 has adapted the inspiration of federalism and declared the provision of basic health care services free of cost as a fundamental right, which needs strengthening under foreseen federalism. An observational retrospective cohort study, aiming at examining the health sector budget allocation and outcome, was done. Authors gathered health budget figures (2001 to 2013) and facts published from authentic sources. Googling was done for further information. The keywords for search used were: fiscal federalism, health care, public health, health budget, health financing, external development partner, bilateral and multilateral partners and healthcare accessibility. The search was limited to English and Nepali-language report, articles and news published. Budget required to meet the population's need is still limited in Nepal. The health sector budget could not achieve even gainful results due to mismatch in policy and policy implementation despite of political commitment. Since Nepal is transforming towards federalism, an increased complexity under federated system is foreseeable, particularly in the face of changed political scenario and its players. It should have clear goals, financing policy and strict implementation plans for budget execution, task performance and achieving results as per planning. Additionally, collection of revenue, risk pooling and purchasing of services should be better integrated between central government and federated states to horn effectiveness and efficiency.

  10. The French National Authority for Health (HAS) Guidelines for Conducting Budget Impact Analyses (BIA).

    Science.gov (United States)

    Ghabri, Salah; Autin, Erwan; Poullié, Anne-Isabelle; Josselin, Jean Michel

    2018-04-01

    Budget impact analysis (BIA) provides short- and medium-term estimates on changes in budgets and health outcomes resulting from the adoption of new health interventions. The purpose of this study is to present the newly developed French National Authority for Health (HAS) guidelines on budget impact analysis as follows: process, literature review, recommendations and comparisons with other guidelines. The development process of the HAS guidelines included a literature review (search dates: January 2000 to June 2016), a retrospective investigation of BIA previously submitted to HAS, a public consultation, international expert reviews and approval from the HAS Board and the Economic and Public Health Evaluation Committee of HAS. Documents identified in the literature review included 12 national guidelines, 5 recommendations for good practices developed by national and international society of health economics and 14 methodological publications including recommendations for conducting BIA. Based on its research findings, HAS developed its first BIA guidelines, which include recommendations on the following topics: BIA definition, perspective, populations, time horizon, compared scenarios, budget impact models, costing, discounting, choice of clinical data, reporting of results and uncertainty exploration. It is expected that the HAS BIA guidelines will enhance the usefulness, quality and transparency of BIA submitted by drug manufacturers to HAS. BIA is becoming an essential part of a comprehensive economic assessment of healthcare interventions in France, which also includes cost-effectiveness analysis and equity of access to healthcare.

  11. Rapid Budget Analysis of the Agricultural Sector for the General Budget Support Annual Review 2010/11

    OpenAIRE

    Francken, Nathalie; Zorya, S

    2010-01-01

    The main objective of the budget analysis chapter is to provide an overall assessment of how well the approved budget allocations in 2010-11 align with the strategic objectives and with sector strategic priorities of the Second National Strategy for Growth and Reduction of Poverty (known by its Kiswahili acronym, MKUKUTA II). It also assesses the consistency of the actual spending and approved budget in 2009-10. In evaluating the alignment of the budget and MKUKUTA's strategic objectives and ...

  12. Capturing Budget Impact Considerations Within Economic Evaluations: A Systematic Review of Economic Evaluations of Rotavirus Vaccine in Low- and Middle-Income Countries and a Proposed Assessment Framework.

    Science.gov (United States)

    Carvalho, Natalie; Jit, Mark; Cox, Sarah; Yoong, Joanne; Hutubessy, Raymond C W

    2018-01-01

    In low- and middle-income countries, budget impact is an important criterion for funding new interventions, particularly for large public health investments such as new vaccines. However, budget impact analyses remain less frequently conducted and less well researched than cost-effectiveness analyses. The objective of this study was to fill the gap in research on budget impact analyses by assessing (1) the quality of stand-alone budget impact analyses, and (2) the feasibility of extending cost-effectiveness analyses to capture budget impact. We developed a budget impact analysis checklist and scoring system for budget impact analyses, which we then adapted for cost-effectiveness analyses, based on current International Society for Pharmacoeconomics and Outcomes Research Task Force recommendations. We applied both budget impact analysis and cost-effectiveness analysis checklists and scoring systems to examine the extent to which existing economic evaluations provide sufficient evidence about budget impact to enable decision making. We used rotavirus vaccination as an illustrative case in which low- and middle-income countries uptake has been limited despite demonstrated cost effectiveness. A systematic literature review was conducted to identify economic evaluations of rotavirus vaccine in low- and middle-income countries published between January 2000 and February 2017. We critically appraised the quality of budget impact analyses, and assessed the extension of cost-effectiveness analyses to provide useful budget impact information. Six budget impact analyses and 60 cost-effectiveness analyses were identified. Budget impact analyses adhered to most International Society for Pharmacoeconomics and Outcomes Research recommendations, with key exceptions being provision of undiscounted financial streams for each budget period and model validation. Most cost-effectiveness analyses could not be extended to provide useful budget impact information; cost

  13. A Content Analysis of Defense Budget Rhetoric

    Science.gov (United States)

    2011-06-01

    budget favored a programmatic and fiscal orientation (see Mayar , 1993; Art, 1985; Blackmon, 1975) Kanter examined the changes made to the President’s...views federal agencies. Shull examined the interaction between presidential support for agencies and Congress’ reaction to the President’s position on...micromanagement. “Micromanagement is best viewed as a problem of competition among political actors for policy control” ( Mayar , 1993, p. 294). In

  14. Economic Growth and Budget Constraints: EU Countries Panel Data Analysis

    Directory of Open Access Journals (Sweden)

    Zimčík Petr

    2016-06-01

    Full Text Available The aim of this paper is to identify the impacts of different taxes and expenditures on economic growth. The research is focused on 20 selected European Union Member States. These countries are equally divided into four groups based on their average tax burden as presented in the World Tax Index. A comparison of fiscal attributes among these groups is important for the analysis. Annual government finance data from the years 1995 to 2012 are used for an empirical study. The indicators observed are real GDP change, the composition and volume of total government expenditures, tax quotas of individual taxes and total budget balance. These indicators are used within an endogenous growth model together with capital stock and an approximation of human capital. A panel regression with fixed effects is used as an analytic tool. The main results are that an increase in social contributions, property, production and personal income tax quotas has an adverse effect on economic growth.

  15. Financial impact of spinal cord stimulation on the healthcare budget: a comparative analysis of costs in Canada and the United States.

    Science.gov (United States)

    Kumar, Krishna; Bishop, Sharon

    2009-06-01

    Many institutions with spinal cord stimulation (SCS) programs fail to realize that besides the initial implantation cost, budgetary allocation must be made to address annual maintenance costs as well as complications as they arise. Complications remain the major contributing factor to the overall expense of SCS. The authors present a formula that, when applied, provides a realistic representation of the actual costs necessary to implant and maintain SCS systems in Canada and the US. The authors performed a retrospective analysis of 197 cases involving SCS (161 implanted and 36 failed trial stimulations) between 1995 and 2006. The cost of patient workup, initial implantation, annual maintenance, and resources necessary to resolve complications were assessed for each case and a unit cost applied. The total cost allocated for each case was determined by summing across healthcare resource headings. Using the same parameters, the unit cost was calculated in both Canadian (CAD) and US dollars (USD) at 2007 prices. The cost of implanting a SCS system in Canada is $21,595 (CAD), in US Medicare $32,882 (USD), and in US Blue Cross Blue Shield (BCBS) $57,896 (USD). The annual maintenance cost of an uncomplicated case in Canada is $3539 (CAD), in US Medicare $5071 (USD), and in BCBS $7277 (USD). The mean cost of a complication was $5191 in Canada (range $136-18,837 [CAD]). In comparison, in the US the figures were $9649 (range $381-28,495) for Medicare and $21,390 (range $573-54,547) for BCBS (both USD). Using these calculations a formula was derived as follows: the annual maintenance cost (a) was added to the average annual cost per complication per patient implanted (b); the sum was then divided by the implantation cost (c); and the result was multiplied by 100 to obtain a percentage (a + b / c x 100). To make this budgetary cap universally applicable, the results from the application of the formula were averaged, resulting in an 18% premium. For budgeting purposes the

  16. Regional Investment Policy Under The Impact Of Budget Limitations And Economic Sanctions

    OpenAIRE

    Avramenko, Yelena S.; Vlasov, Semyon V.; Lukyanov, Sergey A.; Temkina, Irina M.

    2018-01-01

    This article presents the results of research on the impact which budget limitations and economic sanctions have had on regional investment policy External sanctions and sluggish economic growth have affected the social and economic development of the region. Relying on the results of comparative and statistical analysis, the article demonstrates the need for altering the focus of current investment policy from quantitative growth to qualitative enhancement. The article analyses a new trend i...

  17. An Empirical Analysis of the Budget Deficit

    Directory of Open Access Journals (Sweden)

    Ioan Talpos

    2007-11-01

    Full Text Available Economic policies and, particularly, fiscal policies are not designed and implemented in an “empty space”: the structural characteristics of the economic systems, the institutional architecture of societies, the cultural paradigm and the power relations between different social groups define the borders of these policies. This paper tries to deal with these borders, to describe their nature and the implications of their existence to the fiscal policies’ quality and impact at a theoretical level as well as at an empirical one. The main results of the proposed analysis support the ideas that the mentioned variables matters both for the social mandate entrusted by the society to the state and thus to the role and functions of the state and for the economic growth as a support of the resources collected at distributed by the public authorities.

  18. The Impact of External Public Audit on the Budget Deficit

    Directory of Open Access Journals (Sweden)

    Alexandra Vasile

    2014-05-01

    Full Text Available Objectives: Public imbalances can cause extensive problems both on public finances and economy. Regardless of the constitution and destination of funds it is absolutely necessary to verify their correct accounting, collection type and expense in accordance with applicable regulations, and if due attention is paid to obtain an optimal balance between resources and results. Therefore it is useful to study the role of public audit in the formation and use of public funds to indicate its impact on the budget balance. Prior Work: This paper presents the evolution of synthetic budgetary indicators during 2010 - 2013 and the impact that the external public audit had on the budget deficit. Approach: In order to highlight the importance and necessity of public audit activity it has been analyzed its influence in the formation and use of public funds and the extent of implementation of the recommendations made in the audit reports. Results: In the study conducted we have set out several conclusions regarding definite reality according to which financial resources materialize a large part of GDP, so that advocates for public performance of the audit. Implications: The need for public audit can be viewed through the prism of the three classes of economic and financial interests, namely: the interests of public entities, third party interests of consumers of public goods and services and state interests. Value: This paper highlights the importance and the impact of public external audit activity on public financial funds and invites the interested readers on the topic to get involved by providing feedback in order to improve this activity in Romania.

  19. Budget Impact Analysis of Afatinib for First-Line Treatment of Patients with Metastatic Non-Small Cell Lung Cancer with Epidermal Growth Factor Receptor Exon 19 Deletions or Exon 21 Substitution Mutations in a U.S. Health Plan.

    Science.gov (United States)

    Graham, Jonathan; Earnshaw, Stephanie; Burslem, Kate; Lim, Jonathan

    2018-06-01

    Afatinib is 1 of 3 tyrosine kinase inhibitors approved in the United States for the first-line treatment of patients with metastatic non-small cell lung cancer (NSCLC) whose tumors have epidermal growth factor receptor (EGFR) exon 19 deletions (del19) or exon 21 (L858R) substitution mutations. In clinical trials, afatinib has demonstrated improvement in progression-free survival versus standard chemotherapy and gefitinib. To analyze the impact of increases in afatinib treatment share on the cost and health outcomes in a commercial health plan in the United States. A decision model was developed to evaluate the budget impact of increases in afatinib share for the first-line treatment of patients with metastatic NSCLC with EGFR del19 or L858R substitution mutations over a 5-year time horizon. The model compared the total annual costs for a health plan with 1 million covered lives in a scenario in which afatinib share increased 5 percentage points annually to one in which all treatment shares remained constant over time. The number of patients eligible for treatment was estimated using published incidence data. Therapies included in the model were afatinib, erlotinib, gefitinib, and the chemotherapy doublet, pemetrexed in combination with cisplatin. The mean time spent by patients in progression-free and progressive disease states was based on survival data from clinical trials and a network meta-analysis. Therapy-related costs included monthly drug acquisition and administration costs and costs of managing adverse reactions. Disease management costs were also assessed in the model. Scenario analyses were performed to assess alternative scenarios of afatinib treatment share. Additionally, a one-way sensitivity analysis was performed to test the robustness of the model, given parameter uncertainty. Using the base-case parameter assumptions and a 5-percentage-point annual increase in afatinib treatment share, we estimated the total budget increases in years 1 through 5

  20. A public health and budget impact analysis of vaccinating the elderly and at-risk adults with the 23-valent pneumococcal polysaccharide vaccine or 13-valent pneumococcal conjugate vaccine in the UK.

    Science.gov (United States)

    Jiang, Yiling; Gauthier, Aline; Keeping, Sam; Carroll, Stuart

    2014-12-01

    Since the introduction of the routine childhood immunization, a change in epidemiology of pneumococcal disease has been seen in both children and adults. This study aimed to quantify the public health and budget impact of pneumococcal vaccination of the elderly and those in at risk groups in the UK. The model was adapted from a previous population-based Markov model. At-risk adults and the elderly were assumed to receive PPV23 or PCV13 vaccination or no vaccination. Over the study period (2012-2016), PPV23 vaccination led to a reduction in the number of invasive pneumococcal disease cases in most scenarios. The net budget impact ranged between £15 and £39 million (vs no vaccination) or between -£116 and -£93 million (vs PCV13). PPV23 vaccination program remains the optimal strategy from public health and budgetary perspectives despite epidemiological changes. PCV13 is likely to impose a significant budget with limited health benefits.

  1. Dutasteride plus tamsulosin fixed-dose combination first-line therapy versus tamsulosin monotherapy in the treatment of benign prostatic hyperplasia: a budget impact analysis in the Greek healthcare setting.

    Science.gov (United States)

    Geitona, Maria; Karabela, Pinelopi; Katsoulis, Ioannis A; Kousoulakou, Hara; Lyberopoulou, Eleni; Bitros, Eleftherios; Xaplanteris, Loukas; Papanicolaou, Sotiria

    2014-09-26

    The purpose of this study was to explore the budget impact of dutasteride plus tamsulosin fixed-dose combination (DUT + TAM FDC) versus tamsulosin monotherapy, in the treatment of patients with benign prostatic hyperplasia (BPH) from the perspective of the Greek healthcare insurance system. A Microsoft Excel-based model was developed to estimate the financial consequences of adopting DUT + TAM FDC within the Greek healthcare setting. The model, compared six mutually exclusive health states in two alternative treatment options: current standard of care and the introduction of DUT + TAM FDC in the market. The model used clinical inputs from the CombAT study; data on resource use associated with the management of BPH in Greece were derived from expert panel, and unit cost data were derived from official reimbursement tariffs. A payer perspective was taken into account. As patient distribution data between public and private sectors are not available in Greece two scenarios were investigated, considering the whole eligible population in each scenario. A 4 year time horizon was taken into account and included treatment costs, number of transurethral resections of the prostate (TURPs) and acute urinary retention (AUR) episodes avoided. The clinical benefit from the market adoption of DUT + TAM FDC in Greece was 1,758 TURPs and 972 episodes of AUR avoided cumulatively in a four year period. The increase in total costs from the gradual introduction of DUT + TAM FDC to the Greek healthcare system ranges from €1.3 million in the first year to €5.8 million in the fourth year, for the public sector, and €1.2 million to €4.0 million, for the private sector. This represents an increase of 1.91% to 7.94% for the public sector and 1.10% 3.29% in the private sector, during the 4-year time horizon. Budget impact analysis (BIA) results indicated that the gradual introduction of DUT + TAM FDC, would increase the overall budget of the disease, however providing

  2. The Impact on New Hampshire's Budget of Allowing Same-Sex Couples to Marry

    OpenAIRE

    Badgett, M.V. Lee; Sears, Brad; Kukura, Elizabeth

    2005-01-01

    This analysis, co-authored by the Institute for Gay and Lesbian Strategic Studies (IGLSS) and UCLA’s Williams Project on Sexual Orientation Law and Public Policy, estimates the impact of allowing same-sex couples to marry on New Hampshire’s state budget. Using the best data available, we estimate that allowing same-sex couples to marry will result in a net gain of approximately $500,000 each year for the State. This net impact will be the result of savings in expenditures on state means-teste...

  3. The Impact of Washington's Budget of Allowing Same-Sex Couples to Marry

    OpenAIRE

    Badgett, M.V. Lee; Sears, Brad; Kukura, Elizabeth; Lau, Holning S.

    2006-01-01

    This analysis estimates the impact of allowing same-sex couples to marry on Washington’s state budget. Using the best data available, we estimate that allowing same-sex couples to marry will result in a net gain of approximately $3.9 million to $5.7 million each year for the State. This net impact will result from savings in expenditures on state means-tested public benefits programs and from an increase in sales tax revenue from weddings and wedding-related tourism.

  4. Budget impact of rosiglitazone in type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Orietta Zaniolo

    2007-03-01

    Full Text Available BACKGROUND: in type 2 diabetes, the maintenance of non-diabetic glycaemic levels has been shown to decrease the onset of long term complications and consequently their high management costs. In order to achieve and maintain normal blood glucose levels, lifestyle interventions are highly cost/effective, but require good compliance, strong motivation and efforts by the patients. For this reason, a majority of patients needs to start pharmacological therapy shortly after diagnosis. Rosiglitazone, an insulin-sensitising drug, is indicated for subjects with inadequate glycaemic control both as monotherapy, in those contraindicated to metformin, especially if overweight, and as combination therapy with metformin, sulphanilureas or both. OBJECTIVES: rosiglitazone offers clinical advantages over the alternatives, decreasing and/or postponing the need for insulin treatment. Its high acquisition cost may therefore be totally or partially offset by the reduction in future health care resources consumption, and by short-term practical advantages, such as the decrease in the need for blood glucose monitoring and of adverse events. Aim of this study was to investigate the impact of the use of rosiglitazone in eligible diabetic patients on the National Health System budget. METHODS: for this scope an analytic model was implemented, which pathway may be summarized as follows: a estimate of the number type 2 diabetes patients living in Italy, grouped according to current therapeutic classes; b estimate of the number of patients with inadequate glycaemic control for each subgroup; c identification of patients eligible to rosiglitazone treatment; d identification of the comparator strategy for each patient sub-group; e comparison of costs for each couple of alternative options; f calculation of budget impact. RESULTS: use of rosiglitazone monotherapy instead of sulphanilurea monotherapy induces a mild costs increase. Combination treatment with rosiglitazone added

  5. Applications of stable isotope analysis to atmospheric trace gas budgets

    Directory of Open Access Journals (Sweden)

    Brenninkmeijer C. A.M.

    2009-02-01

    Full Text Available Stable isotope analysis has become established as a useful method for tracing the budgets of atmospheric trace gases and even atmospheric oxygen. Several new developments are briefly discussed in a systematic way to give a practical guide to the scope of recent work. Emphasis is on applications and not on instrumental developments. Processes and reactions are less considered than applications to resolve trace gas budgets. Several new developments are promising and applications hitherto not considered to be possible may allow new uses.

  6. Health and budget impact of combined HIV prevention - first results of the BELHIVPREV model.

    Science.gov (United States)

    Vermeersch, Sebastian; Callens, Steven; De Wit, Stéphane; Goffard, Jean-Christophe; Laga, Marie; Van Beckhoven, Dominique; Annemans, Lieven

    2018-02-01

    We developed a pragmatic modelling approach to estimate the impact of treatment as prevention (TasP); outreach testing strategies; and pre-exposure prophylaxis (PrEP) on the epidemiology of HIV and its associated pharmaceutical expenses. Our model estimates the incremental health (in terms of new HIV diagnoses) and budget impact of two prevention scenarios (outreach+TasP and outreach+TasP+PrEP) against a 'no additional prevention' scenario. Model parameters were estimated from reported Belgian epidemiology and literature data. The analysis was performed from a healthcare payer perspective with a 15-year-time horizon. It considers subpopulation differences, HIV infections diagnosed in Belgium having occurred prior to migration, and the effects of an ageing HIV population. Without additional prevention measures, the annual number of new HIV diagnoses rises to over 1350 new diagnoses in 2030 as compared to baseline, resulting in a budget expenditure of €260.5 million. Implementation of outreach+TasP and outreach+TasP+PrEP results in a decrease in the number of new HIV diagnoses to 865 and 663 per year, respectively. Respective budget impacts decrease by €20.6 million and €33.7 million. Foregoing additional investments in prevention is not an option. An approach combining TasP, outreach and PrEP is most effective in reducing the number of new HIV diagnoses and the HIV treatment budget. Our model is the first pragmatic HIV model in Belgium estimating the consequences of a combined preventive approach on the HIV epidemiology and its economic burden assuming other prevention efforts such as condom use and harm reduction strategies remain the same.

  7. The cost utility and budget impact of adjuvant racecadotril for acute diarrhea in children in Thailand

    Directory of Open Access Journals (Sweden)

    Rautenberg TA

    2017-07-01

    Full Text Available Tamlyn Anne Rautenberg,1,2 Ute Zerwes3 1IGES Institut, Berlin, Germany; 2Health Economics and HIV/AIDS Research Division (HEARD, School of Accounting, Economics and Finance, University of KwaZulu Natal, KwaZulu Natal, South Africa; 3Assessment in Medicine GmbH, Lörrach, Germany Objective: To evaluate the cost utility and the budget impact of adjuvant racecadotril for the treatment of acute diarrhea in children in Thailand. Methods: A cost utility model has been adapted to the context of Thailand to evaluate racecadotril plus oral rehydration solution (R+ORS versus oral rehydration solution (ORS alone for acute diarrhea in children <5 years old. The decision tree Excel model evaluates the costs and effects (quality-adjusted life years over a 6-day time horizon from a public health care payer’s perspective in Thailand. Deterministic sensitivity analysis and budget impact analysis have been undertaken. Results: According to the cost utility model, the intervention (R+ORS is less costly and more effective than the comparator (ORS for the base case with a dominant incremental cost-effectiveness ratio of −2,481,390฿ for the intervention. According to the budget impact analysis (assuming an increase of 5% market share for R+ORS over 5 years, the year-on-year reduction for diarrhea as a percentage of the total health care expenditure is −0.0027%, resulting in potential net cost savings of −35,632,482฿ over 5 years. Conclusion: Subject to the assumptions and limitations of the models, adjuvant racecadotril versus ORS alone is potentially cost-effective for children in Thailand and uptake could translate into savings for the Thailand public health care system. Keywords: economic evaluation, cost utility, decision analysis, health technology assessment

  8. Vaccines are different: A systematic review of budget impact analyses of vaccines.

    Science.gov (United States)

    Loze, Priscilla Magalhaes; Nasciben, Luciana Bertholim; Sartori, Ana Marli Christovam; Itria, Alexander; Novaes, Hillegonda Maria Dutilh; de Soárez, Patrícia Coelho

    2017-05-15

    Several countries require manufacturers to present a budget impact analysis (BIA), together with a cost-effectiveness analysis, to support national funding requests. However, guidelines for conducting BIA of vaccines are scarce. To analyze the methodological approaches used in published budget impact analysis (BIA) of vaccines, discussing specific methodological issues related to vaccines. This systematic review of the literature on BIA of vaccines was carried out in accordance with the Centre for Reviews and Dissemination - CRD guidelines. We searched multiple databases: MedLine, Embase, Biblioteca Virtual de Saúde (BVS), Cochrane Library, DARE Database, NHS Economic Evaluation Database (NHS EED), HTA Database (via Centre for Reviews and Dissemination - CRD), and grey literature. Two researchers, working independently, selected the studies and extracted the data. The methodology quality of individual studies was assessed using the ISPOR 2012 Budget Impact Analysis Good Practice II Task Force. A qualitative narrative synthesis was conducted. Twenty-two studies were reviewed. The most frequently evaluated vaccines were pneumococcal (41%), influenza (23%) and rotavirus (18%). The target population was stated in 21 studies (95%) and the perspective was clear in 20 (91%). Only 36% reported the calculations used to complete the BIA, 27% informed the total and disaggregated costs for each time period, and 9% showed the change in resource use for each time period. More than half of the studies (55%, n=12) reported less than 50% of the items recommended in the checklist. The production of BIA of vaccines has increased from 2009. The report of the methodological steps was unsatisfactory, making it difficult to assess the validity of the results presented. Vaccines specific issues should be discussed in international guidelines for BIA of vaccines, to improve the quality of the studies. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. The impact of budget deficit on the economic development of Romania

    OpenAIRE

    Mesea, Oana Elena

    2012-01-01

    This paper empirically analyzes the impact of budget deficit on the economic development of Romania. Using the OLS estimates for quarterly series for the period from 2001 to 2011, the results of the estimates prove that there is an indirect relationship between budget deficit and economic growth of Romania. According to the best statistically significant model from the three different model tested, we reached the result that one percent rise of budget deficit gives a 1.36 percent fall in real...

  10. The impact of the budget deficit on the currency and inflation in the transition economies

    OpenAIRE

    Petraq Milo

    2012-01-01

    This article investigates the causal linkage between budget deficit, monetary mass and inflation in the transition economies. It is focused on the impact of public expenditures growth on money supply growth, and it does not take in account the amount of budget deficit. We test the new hypothesis that inflation is primarily attributable to public finances imbalances. In our model, the money supply growth is function of budget deficit and GDP growth rate; and inflation is a function of money su...

  11. Estimating the Mediterranean Sea Water Budget: impact of RCM design

    Science.gov (United States)

    Somot, S.; Elguindi, N.; Sanchez-Gomez, E.; Herrmann, M.; Déqué, M.

    2009-09-01

    The Mediterranean Sea can be considered as a thermodynamic machine that exchanges water and heat with the Atlantic Ocean through the Strait of Gibraltar and with the atmosphere through its surface. Considering the Mediterranean Sea Water Budget (MSWB) multi-year mean, the Mediterranean basin looses water at the surface due to an excess of evaporation over freshwater input (precipitation, river runoff, Black Sea input). Moreover the MSWB largely drives the Mediterranean Sea water mass formation and therefore a large part of its thermohaline circulation. This could even have an impact on the characteristics of the Atlantic thermohaline circulation through the Mediterranean Outflow Waters that flow into the Atlantic at a depth of about 1000 m. From a climate point of view, the MSWB acts as a water source for the Mediterranean countries and therefore plays an important role on the water resources of the region. The regional physical characteristics of the Mediterranean basin (complex orography, strong land-sea contrast, land-atmosphere coupling, air-sea coupling, river inflow, Gibraltar Strait constraint and complex ocean bathymetry) strongly influence the various components of the MSWB. Moreover extreme precipitation events over land and strong evaporation events over the sea due to local winds can play a non-negligible role on the mean MSWB despite their small spatial and temporal scales. Therefore, modelling the mean behaviour, the interannual variability and the trends of the MSWB is a challenging task of the Regional Climate Model community in the context of climate change. It is actually one of the highlighted issues of the HyMex project planned for the 2010-2020 period. We propose here to start investigating some key scientific issues of the regional modelling of the Mediterranean Sea Water Budget using a wide range of regional climate simulations performed at Météo-France or in the framework of FP6 European projects (ENSEMBLES, CIRCE). The addressed

  12. Financial Analysis, Budgeting, Decision and Control

    Directory of Open Access Journals (Sweden)

    Mariana Rodica TIRLEA

    2013-12-01

    Full Text Available The economic processes taking place in the economic environment are stochastic processes that involve and imply risks, arising from product diversification, competition, financial derivatives transactions: swaps, futures, options and from the large number of actors involved in the stock market with a higher or a smaller uncertainty degree. Competition and competitiveness, led to major and rapid change in the business environment, they determined actors participating in the economy to find solutions and methods of collecting and processing data, in such a way that, after being transformed into information they quickly help based on their analysis in decision making, planning and financial forecasting, having an effect on increasing their economic efficiency. In these circumstances the financial analysis, decision, forecasting and control, should be based on quality information that should be a value creation source. The active nature of the financial function implies the existence of a substantially large share of financial analysis, financial decision, forecasting and control.

  13. Testing the macroeconomic impact of the budget deficit in EU Member States using linear regression with fixed effects

    Directory of Open Access Journals (Sweden)

    Dalian Marius DORAN

    2017-11-01

    Full Text Available The article aims to research impact of budget balance, whether surplus or deficit, on the main indicator characterizing the economic growth of a country, namely GDP and the inflation rate in the 27 European Union Member States and the United Kingdom. For this analysis was used panel data, taking into account the period from 2001 to 2015. The method used for the analysis is the linear regression with fixed effects and with Driscoll-Kraay standard errors. The dependent variables are the growth rate of real GDP and the inflation rate, and the independent variable is the budget balance (surplus or deficit. The results obtained after using econometric software Stata shows a positive impact of budget balance on growth in the European Union for the analyzed period.

  14. The impact of a budget deficit on inflation in Zimbabwe

    OpenAIRE

    Makochekanwa, Albert

    2008-01-01

    The Zimbabwean economy is one of the many numbers of countries that has experienced a relatively high fiscal deficit for a prolonged period with the result of a high inflationary environment. This paper examines the deficit-inflation nexus in the Zimbabwean economy and establishes the causal link that runs from the budget deficit to the inflation rate using Johansen (1991, 1995) cointegration technique over the period 1980 – 2005. Due to massive monetization of the budget deficit, significant...

  15. Impact of Budget Deficit on Inflation in Zimbabwe

    OpenAIRE

    Albert Makochekanwa

    2011-01-01

    The Zimbabwean economy is one of the countries that once experienced a relatively high fiscal deficit for a prolonged period which resulted in a hyper inflationary environment. This paper examines the deficit-inflation nexus in the Zimbabwean economy and establishes the causal link that runs from the budget deficit to the inflation rate using Johansen (1991, 1995) cointegration technique over the period 1980 to 2005. Due to massive monetization of the budget deficit, significant inflationary ...

  16. Impact of Climate Variability and Landscape Patterns on Water Budget and Nutrient Loads in a Peri-urban Watershed: A Coupled Analysis Using Process-based Hydrological Model and Landscape Indices.

    Science.gov (United States)

    Li, Chongwei; Zhang, Yajuan; Kharel, Gehendra; Zou, Chris B

    2018-06-01

    Nutrient discharge into peri-urban streams and reservoirs constitutes a significant pressure on environmental management, but quantitative assessment of non-point source pollution under climate variability in fast changing peri-urban watersheds is challenging. Soil and Water Assessment Tool (SWAT) was used to simulate water budget and nutrient loads for landscape patterns representing a 30-year progression of urbanization in a peri-urban watershed near Tianjin metropolis, China. A suite of landscape pattern indices was related to nitrogen (N) and phosphorous (P) loads under dry and wet climate using CANOCO redundancy analysis. The calibrated SWAT model was adequate to simulate runoff and nutrient loads for this peri-urban watershed, with Nash-Sutcliffe coefficient (NSE) and coefficient of determination (R 2 ) > 0.70 and percentage bias (PBIAS) between -7 and +18 for calibration and validation periods. With the progression of urbanization, forest remained the main "sink" landscape while cultivated and urban lands remained the main "source" landscapes with the role of orchard and grassland being uncertain and changing with time. Compared to 1984, the landscape use pattern in 2013 increased nutrient discharge by 10%. Nutrient loads modelled under wet climate were 3-4 times higher than that under dry climate for the same landscape pattern. Results indicate that climate change could impose a far greater impact on runoff and nutrient discharge in a peri-urban watershed than landscape pattern change.

  17. Impact of Climate Variability and Landscape Patterns on Water Budget and Nutrient Loads in a Peri-urban Watershed: A Coupled Analysis Using Process-based Hydrological Model and Landscape Indices

    Science.gov (United States)

    Li, Chongwei; Zhang, Yajuan; Kharel, Gehendra; Zou, Chris B.

    2018-06-01

    Nutrient discharge into peri-urban streams and reservoirs constitutes a significant pressure on environmental management, but quantitative assessment of non-point source pollution under climate variability in fast changing peri-urban watersheds is challenging. Soil and Water Assessment Tool (SWAT) was used to simulate water budget and nutrient loads for landscape patterns representing a 30-year progression of urbanization in a peri-urban watershed near Tianjin metropolis, China. A suite of landscape pattern indices was related to nitrogen (N) and phosphorous (P) loads under dry and wet climate using CANOCO redundancy analysis. The calibrated SWAT model was adequate to simulate runoff and nutrient loads for this peri-urban watershed, with Nash-Sutcliffe coefficient (NSE) and coefficient of determination ( R 2) > 0.70 and percentage bias (PBIAS) between -7 and +18 for calibration and validation periods. With the progression of urbanization, forest remained the main "sink" landscape while cultivated and urban lands remained the main "source" landscapes with the role of orchard and grassland being uncertain and changing with time. Compared to 1984, the landscape use pattern in 2013 increased nutrient discharge by 10%. Nutrient loads modelled under wet climate were 3-4 times higher than that under dry climate for the same landscape pattern. Results indicate that climate change could impose a far greater impact on runoff and nutrient discharge in a peri-urban watershed than landscape pattern change.

  18. Budget impact analysis of sFlt-1/PlGF ratio as prediction test in Italian women with suspected preeclampsia.

    Science.gov (United States)

    Frusca, Tiziana; Gervasi, Maria-Teresa; Paolini, Davide; Dionisi, Matteo; Ferre, Francesca; Cetin, Irene

    2017-09-01

    Preeclampsia (PE) is a pregnancy disease which represents a leading cause of maternal and perinatal mortality and morbidity. Accurate prediction of PE risk could provide an increase in health benefits and better patient management. To estimate the economic impact of introducing Elecsys sFlt-1/PlGF ratio test, in addition to standard practice, for the prediction of PE in women with suspected PE in the Italian National Health Service (INHS). A decision tree model has been developed to simulate the progression of a cohort of pregnant women from the first presentation of clinical suspicion of PE in the second and third trimesters until delivery. The model provides an estimation of the financial impact of introducing sFlt-1/PlGF versus standard practice. Clinical inputs have been derived from PROGNOSIS study and from literature review, and validated by National Clinical Experts. Resources and unit costs have been obtained from Italian-specific sources. Healthcare costs associated with the management of a pregnant woman with clinical suspicion of PE equal €2384 when following standard practice versus €1714 using sFlt-1/PlGF ratio test. Introduction of sFlt-1/PlGF into hospital practice is cost-saving. Savings are generated primarily through improvement in diagnostic accuracy and reduction in unnecessary hospitalization for women before PE's onset.

  19. A Budget Impact Model for Paclitaxel-eluting Stent in Femoropopliteal Disease in France

    International Nuclear Information System (INIS)

    De Cock, Erwin; Sapoval, Marc; Julia, Pierre; Lissovoy, Greg de; Lopes, Sandra

    2013-01-01

    The Zilver PTX drug-eluting stent (Cook Ireland Ltd., Limerick, Ireland) represents an advance in endovascular treatments for atherosclerotic superficial femoral artery (SFA) disease. Clinical data demonstrate improved clinical outcomes compared to bare-metal stents (BMS). This analysis assessed the likely impact on the French public health care budget of introducing reimbursement for the Zilver PTX stent. A model was developed in Microsoft Excel to estimate the impact of a progressive transition from BMS to Zilver PTX over a 5-year horizon. The number of patients undergoing SFA stenting was estimated on the basis of hospital episode data. The analysis from the payer perspective used French reimbursement tariffs. Target lesion revascularization (TLR) after primary stent placement was the primary outcome. TLR rates were based on 2-year data from the Zilver PTX single-arm study (6 and 9 %) and BMS rates reported in the literature (average 16 and 22 %) and extrapolated to 5 years. Net budget impact was expressed as the difference in total costs (primary stenting and reinterventions) for a scenario where BMS is progressively replaced by Zilver PTX compared to a scenario of BMS only. The model estimated a net cumulative 5-year budget reduction of €6,807,202 for a projected population of 82,316 patients (21,361 receiving Zilver PTX). Base case results were confirmed in sensitivity analyses. Adoption of Zilver PTX could lead to important savings for the French public health care payer. Despite higher initial reimbursement for the Zilver PTX stent, fewer expected SFA reinterventions after the primary stenting procedure result in net savings.

  20. A Budget Impact Model for Paclitaxel-eluting Stent in Femoropopliteal Disease in France

    Energy Technology Data Exchange (ETDEWEB)

    De Cock, Erwin, E-mail: erwin.decock@unitedbiosource.com [United BioSource Corporation, Peri- and Post-Approval Services (Spain); Sapoval, Marc, E-mail: Marc.sapoval2@egp.aphp.fr [Hopital Europeen Georges Pompidou, Universite Rene Descartes, Department of Cardiovascular and Interventional Radiology (France); Julia, Pierre, E-mail: pierre.julia@egp.aphp.fr [Hopital Europeen Georges Pompidou, Universite Rene Descartes, Cardiovascular Surgery Department (France); Lissovoy, Greg de, E-mail: gdelisso@jhsph.edu [Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management (United States); Lopes, Sandra, E-mail: Sandra.Lopes@CookMedical.com [Cook Medical, Health Economics and Reimbursement (Denmark)

    2013-04-15

    The Zilver PTX drug-eluting stent (Cook Ireland Ltd., Limerick, Ireland) represents an advance in endovascular treatments for atherosclerotic superficial femoral artery (SFA) disease. Clinical data demonstrate improved clinical outcomes compared to bare-metal stents (BMS). This analysis assessed the likely impact on the French public health care budget of introducing reimbursement for the Zilver PTX stent. A model was developed in Microsoft Excel to estimate the impact of a progressive transition from BMS to Zilver PTX over a 5-year horizon. The number of patients undergoing SFA stenting was estimated on the basis of hospital episode data. The analysis from the payer perspective used French reimbursement tariffs. Target lesion revascularization (TLR) after primary stent placement was the primary outcome. TLR rates were based on 2-year data from the Zilver PTX single-arm study (6 and 9 %) and BMS rates reported in the literature (average 16 and 22 %) and extrapolated to 5 years. Net budget impact was expressed as the difference in total costs (primary stenting and reinterventions) for a scenario where BMS is progressively replaced by Zilver PTX compared to a scenario of BMS only. The model estimated a net cumulative 5-year budget reduction of Euro-Sign 6,807,202 for a projected population of 82,316 patients (21,361 receiving Zilver PTX). Base case results were confirmed in sensitivity analyses. Adoption of Zilver PTX could lead to important savings for the French public health care payer. Despite higher initial reimbursement for the Zilver PTX stent, fewer expected SFA reinterventions after the primary stenting procedure result in net savings.

  1. Intravenous iron treatments for iron deficiency anemia in inflammatory bowel disease: a budget impact analysis of iron isomaltoside 1000 (Monofer) in the UK.

    Science.gov (United States)

    Pollock, R F; Muduma, G

    2017-12-01

    Iron deficiency is the leading cause of anemia in patients with inflammatory bowel disease (IBD). Intravenous iron is the first-line treatment for clinically active IBD or previous oral iron intolerance. The aim of the present study was to develop a comparative model of iron deficiency and delivery for iron isomaltoside (IIM), ferric carboxymaltose (FCM), low molecular weight iron dextran (LMWID), and iron sucrose (IS) in the treatment of iron deficiency anemia associated with IBD. Areas covered: A model was developed to evaluate iron delivery characteristics, resource use and costs associated with IIM, FCM, LMWID and IS. Iron deficiency was modeled using dosing tables and retreatments were modeled based on a pooled retrospective analysis. The analyses were conducted over 5 years in patients with IBD with mean bodyweight of 75.4 kg and hemoglobin levels of 10.77 g/dL based on observational data. Expert opinion: The modeling analysis showed that using IIM required 1.2 infusions (per treatment) to correct the mean iron deficit, compared with 1.6, 1.2, and 7.1 with FCM, LMWID and IS, respectively. Costs were estimated to be 2,518 pounds sterling (GBP) per patient with IIM or LMWID, relative to GBP 3,309 with FCM or GBP 14,382 with IS.

  2. A budget impact model for biosimilar infliximab in Crohn's disease in Bulgaria, the Czech Republic, Hungary, Poland, Romania, and Slovakia.

    Science.gov (United States)

    Brodszky, Valentin; Rencz, Fanni; Péntek, Márta; Baji, Petra; Lakatos, Péter L; Gulácsi, László

    2016-01-01

    To estimate the budget impact of the introduction of biosimilar infliximab for the treatment of Crohn's disease (CD) in Bulgaria, the Czech Republic, Hungary, Poland, Romania and Slovakia. A 3-year, prevalence-based budget impact analysis for biosimilar infliximab to treat CD was developed from third-party payers' perspective. The model included various scenarios depending on whether interchanging originator infliximab with biosimilar infliximab was allowed or not. Total cost savings achieved in biosimilar scenario 1 (interchanging not allowed) and BSc2 (interchanging allowed in 80% of the patients) were estimated to €8.0 million and €16.9 million in the six countries. Budget savings may cover the biosimilar infliximab therapy for 722-1530 additional CD patients. Introduction of biosimilar infliximab to treat CD may offset the inequity in access to biological therapy for CD between Central and Eastern European countries.

  3. Cost-utility and budget impact analysis of drug treatments in pulmonary arterial hypertension associated with congenital heart diseases in Thailand.

    Science.gov (United States)

    Thongsri, Watsamon; Bussabawalai, Thanaporn; Leelahavarong, Pattara; Wanitkun, Suthep; Durongpisitkul, Kritvikrom; Chaikledkaew, Usa; Teerawattananon, Yot

    2016-08-01

    This study aims to compare the lifetime costs and health outcomes of both first-line and sequential combination treatments with standard treatment for pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD) (PAH-CHD) patients. A cost-utility analysis was performed using a Markov model based on a societal perspective. One-way and probabilistic sensitivity analyses were performed to investigate the effect of parameter uncertainty. As first-line treatments, both beraprost (incremental cost-effectiveness ratio (ICER) = 192,752 and 201,308 Thai baht (THB) per quality-adjusted life year (QALY) gained) and sildenafil (ICER = 249,770 and 226,802 THB per QALY gained) seemed cost-effective for PAH-CHD patients aged ≤30 years in functional classes II and III, respectively, while no treatment was cost-effective for the sequential combination therapy. Sildenafil should be included in the National Drug List of Essential Medicines as the first-line treatment for PAH-CHD, and its price per dose should be negotiated to be reduced by 43-57%.

  4. Budget Analysis: Review of the Governor's Proposed Budget, 1999-00.

    Science.gov (United States)

    New York State Office of the Comptroller, Albany.

    This report provides an overview of the 1999-2000 executive budget for New York State. The budget calls for $72.7 billion in all funds spending and proposes that a $1.8 billion surplus from the 1998-99 fiscal year be used to fill budget gaps in fiscal years 2000-01 and 2001-02. The report focuses on spending for education, health and social…

  5. THE IMPACT OF SYSTEM OF BUDGET EQUILIBRATION ON MACROECONOMIC INDEXES OF RUSSIAN FEDERATION

    Directory of Open Access Journals (Sweden)

    E.V. Peshina

    2007-12-01

    Full Text Available Theoretical regulations of basic conceptions of budget equilibration are considered in the article and the position of budget deficit/proficit in a system of socioeconomics relations is grounded. Estimation of control mechanism of budget deficit and proficit in the system of socioeconomics relations was conducted. This estimation confirmed an analysis inference about large discontinuity and fragmentation, that is outboard, first of all in respect of strategy of financial policy, sum-total of using, at present, principles, methods and regulations of budgetary management. The article contains a description of basic directions of budgetary policy about optimization of budget deficit/proficit in Russian Federation.

  6. Analysis of the Capital Budgeting Practices: Serbian Case

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    Lidija Barjaktarovic

    2016-09-01

    Full Text Available This paper addresses two major research questions: which techniques firms in Serbia use for project evaluation, and how the Serbian companies calculate their cost of capital. The authors have created the questionnaire and the sample consisting of 65 companies that responded to the enquiry (out of 392 during the year 2015. The results showed that payback criterion is the most dominant capital budgeting technique used by firms in Serbia. Further, the results revealed that large firms as well as multinational firms are more inclined to use discounted cash flow capital budgeting techniques and other sophisticated techniques. Finally, the authors have concluded that the CAPM is not the dominant method for calculating cost of capital by the companies from the sample analyzing the overall sample. Consequently, skilled human capital, the adequate knowledge and developed procedures may contribute to accepting capital budgeting techniques such as discounted cash flow analysis and other sophisticated techniques by larger portion of the companies in Serbia. Finally, existence of perfect financial market is a necessary precondition for implementing all these contemporary financial concepts and its development has to be posed as one of the priorities in the years to come.

  7. Outcomes analysis of hospital management model in restricted budget conditions

    Directory of Open Access Journals (Sweden)

    Virsavia Vaseva

    2016-03-01

    Full Text Available Facing conditions of market economy and financial crisis, the head of any healthcare facility has to take adequate decisions about the cost-effective functioning of the hospital. Along with cost reduction, the main problem is how to maintain a high level of health services. The aim of our study was to analyse the quality of healthcare services after the implementation of control over expenses due to a reduction in the budgetary resources in Military Medical Academy (MMA, Sofia, Bulgaria. Data from the hospital information system and the Financial Department about the incomes and expenditures for patient treatment were used. We conducted a retrospective study on the main components of clinical indicators in 2013 to reveal the main problems in the hospital management. In 2014, control was imposed on the use of the most expensive medicines and consumables. Comparative analysis was made of the results of the medical services in MMA for 2013 and 2014. Our results showed that despite the limited budget in MMA over the last year, the policy of control over operational costs succeeded in maintaining the quality of healthcare services. While reducing the expenses for medicines, consumables and laboratory investigations by ∼26%, some quality criteria for healthcare services were observed to be improved by ∼9%. Financial crisis and budget reduction urge healthcare economists to create adequate economical instruments to assist the normal functioning of hospital facilities. Our analysis showed that when a right policy is chosen, better results may be achieved with fewer resources.

  8. Budget impact of pasireotide LAR for the treatment of acromegaly, a rare endocrine disorder.

    Science.gov (United States)

    Zhang, J J; Nellesen, D; Ludlam, W H; Neary, M P

    2016-01-01

    Acromegaly is a rare disorder characterized by the over-production of growth hormone (GH). Patients often experience a range of chronic comorbidities including hypertension, cardiac dysfunction, diabetes, osteoarthropathy, and obstructive sleep apnea. Untreated or inadequately controlled patients incur substantial healthcare costs, while normalization of GH levels may reduce morbidity and mortality rates to be comparable to the general population. To assess the 3-year budget impact of pasireotide LAR on a US managed care health plan following pasireotide LAR availability. Two separate economic models were developed: one from the perspective of an entire health plan and another from the perspective of a pharmacy budget. The total budget impact model includes costs of drug therapies and other costs for treatment, monitoring, management of adverse events, and comorbidities. The pharmacy cost calculator only considers drug costs. The total estimated budget impact associated with the introduction of pasireotide LAR is 0.31 cents ($0.0031) per member per month (PMPM) in the first year, 0.78 cents ($0.0078) in the second year, and 1.42 cents ($0.0142) in the third year following FDA approval. Costs were similar or lower from a pharmacy budget impact perspective. For each patient achieving disease control, cost savings from reduced comorbidities amounted to $10,240 per year. Published data on comorbidities for acromegaly are limited. In the absence of data on acromegaly-related costs for some comorbidities, comorbidity costs for the general population were used (may be under-estimates). The budget impact of pasireotide LAR is expected to be modest, with an expected increase of 1.42 cents PMPM on the total health plan budget in the third year after FDA approval. The efficacy of pasireotide LAR in acromegaly, as demonstrated in head-to-head trials compared with currently available treatment options, is expected to be associated with a reduction of the prevalence of

  9. ANALYSIS OF BUDGET DEFICIT AND ITS PROBLEMS IN LITHUANIA

    Directory of Open Access Journals (Sweden)

    F. Jaseviciene

    2015-10-01

    Full Text Available Budget deficit is one of the most important parts of macroeconomics. Since 1990, the government of the Lithuanian Republic has been faced with problems in balancing the budget deficit; most of the years, the country’s budget was deficit with the lack of incoming money flow. The budget deficit value in Lithuania has been a significant theme since 2004, when Lithuania became part of the European Union, and one of the liabilities was to insure the litas replacement with euro currency and the budget deficit was one of the Maastricht’s criteria. Also it is very important to maintain effective management of public finances. The government is responsible for managing the country’s budget in respect to various economical parameters, for example, GDP, inflation rate, unemployment rate, etc., in order to plan income level and distribute it to the relevant economic areas. Also, the budget deficit’s problems are revealed in this article.

  10. Water budget analysis and management for Bangkok Metropolis, Thailand.

    Science.gov (United States)

    Singkran, Nuanchan

    2017-09-01

    The water budget of the Bangkok Metropolis system was analyzed using a material flow analysis model. Total imported flows into the system were 80,080 million m 3 per year (Mm 3 y -1 ) including inflows from the Chao Phraya and Mae Klong rivers and rainwater. Total exported flows out of the system were 78,528 Mm 3 y -1 including outflow into the lower Chao Phraya River and tap water (TW) distributed to suburbs. Total rates of stock exchange (1,552 Mm 3 y -1 ) were found in the processes of water recycling, TW distribution, domestic use, swine farming, aquaculture, and paddy fields. Only 21% of the total amount of wastewater (1,255 Mm 3 y -1 ) was collected, with insufficient treatment capacity of about 415 Mm 3 y -1 . Domestic and business (industrial and commercial sectors) areas were major point sources, whereas paddy fields were a major non-point source of wastewater. To manage Bangkok's water budget, critical measures have to be considered. Wastewater treatment capacity and efficiency of wastewater collection should be improved. On-site wastewater treatment plants for residential areas should be installed. Urban planning and land use zoning are suggested to control land use activities. Green technology should be supported to reduce wastewater from farming.

  11. ANALYSIS OF BUDGET DEFICIT IN THE CANDIDATE COUNTRIES FOR EU MEMBERSHIP

    Directory of Open Access Journals (Sweden)

    Danijela Despotović

    2017-11-01

    Full Text Available The problems of deficit and debt are the traditional drivers of the recession in the past. Due to the high impact of the budget deficit to increase in indebtedness and deterioration of a macroeconomic performance, the European Union in Maastricht Treaty and later in the Pact of Stability and Growth strictly defined fiscal criteria which the member states should adhere to. Fiscal criteria are particularly important when it comes to candidate countries for EU membership. The aim of this paper is that, through theoretical and empirical basis perform a comparative analysis of the budget deficit in EU countries and candidates for membership in the EU, to rank the 34 countries according to the criteria of public finances and to show the causality between the candidate countries for membership of the EU and EU member states.

  12. Budgeting for School Media Centers.

    Science.gov (United States)

    Drott, M. Carl

    1978-01-01

    Describes various forms of budgets and discusses concepts in budgeting useful to supervisors of school media centers: line item budgets, capital budgets, creating budgets, the budget calendar, innovations, PPBS (Planning, Programing, Budgeting System), zero-based budgeting, cost-benefit analysis, benefits, benefit guidelines, and budgeting for the…

  13. Observational evidence for the impact of jet condensation trails upon the earths radiation budget

    Energy Technology Data Exchange (ETDEWEB)

    Meinert, D [GKSS-Forschungszentrum Geesthacht GmbH (Germany). Inst. fuer Atmosphaerenphysik

    1998-12-31

    Jet condensation trails have been classified in AVHRR images from a couple of month. It was tried to estimate their impact upon the radiation budget from the observed radiances. This has been performed by direct comparison of contrail image points to neighboring image points, assuming a slowly varying background. The classification method, basing on an artificial neural network for pattern recognition is explained. The details of the estimation of the net impact of contrails upon the radiation budget are shown by one example. (author) 5 refs.

  14. Observational evidence for the impact of jet condensation trails upon the earths radiation budget

    Energy Technology Data Exchange (ETDEWEB)

    Meinert, D. [GKSS-Forschungszentrum Geesthacht GmbH (Germany). Inst. fuer Atmosphaerenphysik

    1997-12-31

    Jet condensation trails have been classified in AVHRR images from a couple of month. It was tried to estimate their impact upon the radiation budget from the observed radiances. This has been performed by direct comparison of contrail image points to neighboring image points, assuming a slowly varying background. The classification method, basing on an artificial neural network for pattern recognition is explained. The details of the estimation of the net impact of contrails upon the radiation budget are shown by one example. (author) 5 refs.

  15. Open budget systems and participatory budgeting in Africa: A comparative analysis of Nigeria and Ghana, 2012 and 2015

    Directory of Open Access Journals (Sweden)

    Michael E. Nwokedi

    2017-10-01

    Full Text Available Nigeria and Ghana have so many things in common. Apart from sharing the same colonial history and being located in the same West African sub-region, they also practice the same executive presidential system of government. However, this study is an attempt to do a comparative analysis of the budgetary systems of both countries, with a view to understanding how open and transparent the processes are, and the extent to which they allow for public participation. The aim is to identify the differences and similarities (if any. The study was anchored on the Marxist theory of the state. Our analysis showed that in terms of openness and transparency of the system, budget processes in Ghana were more open and transparent both in 2012 and in 2015 than what obtained in Nigeria in those years. As regards public participation in the process, the study also discovered that the government of Ghana created more opportunities for the public to participate in the process than the government of Nigeria. The comprador bourgeois class in Nigeria, because of its interest in primitive accumulation, ensures that budgeting in Nigeria is its exclusive preserve. This is because it is through the budget that it allocates funds to service the interest of its members. Conversely, the national bourgeoisie in Ghana, to a large extent, carries the citizens along in the budget process. However, though Ghana has made appreciable progress in this regard, there is still room for improvement. Finally, the study made a case for participatory budgeting for both countries.

  16. Analysis & commentary. Health care reform is likely to widen federal budget deficits, not reduce them.

    Science.gov (United States)

    Holtz-Eakin, Douglas; Ramlet, Michael J

    2010-06-01

    The federal government faces a daunting fiscal outlook, which makes the budgetary impact of the Patient Protection and Affordable Care Act even more important. The official Congressional Budget Office (CBO) analysis indicates modest deficit reduction over the next ten years and beyond. We examine the underpinnings of the CBO's projection and conclude that it is built on a shaky foundation of omitted costs, premiums shifted from other entitlements, and politically dubious spending cuts and revenue increases. A more comprehensive and realistic projection suggests that the new reform law will raise the deficit by more than $500 billion during the first ten years and by nearly $1.5 trillion in the following decade.

  17. Water budget analysis of Agulu Lake in Anambra State, Nigeria ...

    African Journals Online (AJOL)

    The elements of water budget equation were analyzed for the Agulu lake area and underlying aquifers. The water budget implications for soil and gully erosion were evaluated in relation to the geological formations and hydrogeotechnics. Results show that rainfall constitutes the main source of precipitation. It ranges from ...

  18. Break-even Analysis: Tool for Budget Planning

    Science.gov (United States)

    Lohmann, Roger A.

    1976-01-01

    Multiple funding creates special management problems for the administrator of a human service agency. This article presents a useful analytic technique adapted from business practice that can help the administrator draw up and balance a unified budget. Such a budget also affords reliable overview of the agency's financial status. (Author)

  19. Predicting Nigeria budget allocation using regression analysis: A ...

    African Journals Online (AJOL)

    Budget is used by the Government as a guiding tool for planning and management of its resources to aid in effective decision-making. Data mining is one of the most vital areas of research with the objective of finding meaningful information from large datasets. The delay in the preparation of budget of the Federation by the ...

  20. [Usefulness of the budget and the balanced scorecard in managing Primary Care Centres. Impact on staff motivation].

    Science.gov (United States)

    Ramón-Jerónimo, Juan Manuel; Flórez-López, Raquel; Domínguez-Lario, Natalia

    2018-03-01

    To analyse the utility perceived by managers of centers of primary care about management tools (budget and balanced scorecard), together their impact on human resources motivation. Qualitative study (case study) based on grounded theory performed between January and June 2014. Units of Clinical Management of Primary Health (UGCAP) in Metropolitan Health Area of Seville, Spain. UGCAP managers and Health Area (CEO) managers. Data were collected through 8 semi-structured interviews using non-probabilistic intentional sampling with representation and sufficiency criteria of discourse. Interviews were recorded, literally transcripted and analysis through in-vivo codes. Both tools are fully implemented but differently used in primary care centers. Budget is perceived as a coercive management tool, which has been imposed for cost saving; however, it is scarcely adequate for day-by-day management. While balanced scorecard is a more flexible tool that allows identifying financial and welfare problems, budgeting limits heavily reduce the possibility of implementing adequate solutions. The policy of incentives is not adequate either, leading on de-motivation. This study shows that budgeting restrictions have led to a significant reduction in autonomy of Spanish Primary Care centers. Management decision making is much centralised, also focused on cost saving over quality of healthcare. As a result, two needs emerge for the future: increasing centers' autonomy and improving staff commitment through training and professional development programs. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  1. Estimating the budget impact of orphan medicines in Europe: 2010 - 2020

    Directory of Open Access Journals (Sweden)

    Milanova Tsveta

    2011-09-01

    Full Text Available Abstract Background Orphan drugs are a growing issue of importance to European healthcare policy makers. The success of orphan drug legislation in Europe has resulted in an increasing number of licensed medicines for rare diseases, and many more yet unlicensed products have received orphan drug designation. Increasingly the concerns amongst policy makers relate to issues of patient access and affordability, yet few studies have sought to estimate the future budget impact of orphan drugs. The aim of this study was to predict the total cost of orphan medicines in Europe between 2010 and 2020 as a percentage of total European pharmaceutical expenditure. Methods A disease-based epidemiological model was created based upon trends in the designation and approval of new orphan medicines, prevalence estimates for orphan diseases, and historical price and sales data for orphan drugs in Europe (defined as Eurozone + UK. The analysis incorporated two stages: 1 Predicting the number of diseases for which new orphan drugs will be approved over the next decade, based on an analysis of trends from the EU registry of orphan medicines; 2 Estimating the average ex-factory drug cost across an orphan disease life cycle, from the year in which the first orphan medicine is launched to the point where the first medicine loses marketing exclusivity. The two sets of information were combined to quantify the annual cost of orphan drugs from 2010 through 2020. Results The results from the model predicted a steady increase in the cumulative number of diseases for which an orphan drug is approved, averaging just over 5 new diseases per year over the next 10 years. The annual per patient cost of existing orphan drugs was seen to vary between €1,251 and €407,631, with the median cost being €32,242 per year. The share of the total pharmaceutical market represented by orphan drugs is predicted to increase from 3.3% in 2010 to a peak of 4.6% in 2016 after which it is

  2. Contrails over the U.S. and their potential impact on the radiation budget

    Energy Technology Data Exchange (ETDEWEB)

    Minnis, P [National Aeronautics and Space Administration, Hampton, VA (United States). Langley Research Center; Ayers, J K; Doelling, D R [Analytical Services and Materials, Inc., Hampton, VA (United States)

    1998-12-31

    A methodology for assessing the contrail impact on the radiation budget is developed to use data characterizing the frequency, areal coverage, optical depth, particle size, and altitude of contrails with observations of cloud and surface properties. The method is tested using various scenarios over the United States to estimate contrail-induced albedo changes based on current aircraft fuel usage statistics. The technique can be used for estimating infrared effects and the impact of future fuel-use rates. (author) 11 refs.

  3. Contrails over the U.S. and their potential impact on the radiation budget

    Energy Technology Data Exchange (ETDEWEB)

    Minnis, P. [National Aeronautics and Space Administration, Hampton, VA (United States). Langley Research Center; Ayers, J.K.; Doelling, D.R. [Analytical Services and Materials, Inc., Hampton, VA (United States)

    1997-12-31

    A methodology for assessing the contrail impact on the radiation budget is developed to use data characterizing the frequency, areal coverage, optical depth, particle size, and altitude of contrails with observations of cloud and surface properties. The method is tested using various scenarios over the United States to estimate contrail-induced albedo changes based on current aircraft fuel usage statistics. The technique can be used for estimating infrared effects and the impact of future fuel-use rates. (author) 11 refs.

  4. TENDENCIES IN THE DEVELOPMENT OF BUDGET REVENUES UNDER THE IMPACT OF TAX POLICY OF ROMANIA

    Directory of Open Access Journals (Sweden)

    DOBROTĂ GABRIELA

    2016-10-01

    Full Text Available Currently, the need to ensure sustainable development has become a central point of debates and of the economic policies. Obviously, the influence of the level of financial resources mobilized at the state level is crucial, reason for it is necessary to promote a sustainable fiscal policy. The purpose of this paper is to analyze the influence of fiscal policy measures on budget revenues, in terms of volume and their structure in Romania. Empirical researchs realised, reflected a longitudinal study that targeted budget income trends between 2006-2015, both in terms of total volume and in terms of revenues for each category of taxation. The results of this study demonstrate the use of a pro-cyclical fiscal policy, with negative effects in terms of the impact on the budget deficit and a poor correlation with other components of macroeconomic policy.

  5. Natural disturbance impacts on Canada's forest carbon budget

    International Nuclear Information System (INIS)

    Kurz, W.

    2004-01-01

    Wildfire and insect outbreaks are major determinants of forest dynamics in Canada, transferring carbon within the ecosystem, releasing carbon into the atmosphere and influencing post-disturbance carbon dynamics. This paper discusses the impacts of global climate change on natural disturbances. Higher temperatures and drier conditions are likely to increase burned areas in Canada and will also increase the impacts of insects, allowing for an expanded range and stressing their host species. Long-term changes in disturbance regimes have already affected Canada's forest age-class structure. Statistics of lower disturbance periods and carbon production were compared with periods of higher disturbance. Scenario analyses were conducted for the period of 1996 to 2032, assuming that annual insect and fire disturbance rates in timber-productive forests were 20 per cent higher and carbon production 20 per cent lower than base scenarios using average disturbance rates. It was concluded that these conditions could cause carbon stocks in Canada's forests to decline. The future carbon balance of Canada's forests will be affected by the rate of natural and human-induced disturbances. 4 refs

  6. Program Budgeting for a Graduate School Library.

    Science.gov (United States)

    Westerman, Mel

    Program budgeting, a method founded in the systems approach, allows control, management, and planning in the library system, and avoids the more comprehensive analysis required by zero-based budgeting. By evaluation of the impacts of the work accomplished by the library staff, the budgeted amounts can be justified or adjusted in subsequent years.…

  7. Impacto presupuestario del tratamiento antirretroviral: Reflexión desde las guías de GESIDA Budget impact analysis of antiretroviral therapy: A reflection based on the GESIDA guidelines

    Directory of Open Access Journals (Sweden)

    2012-12-01

    (ART in HIV-infected adults, developed by the Spanish AIDS Study Group (GESIDA and the National AIDS Plan, recommends initiating ART early in certain circumstances. The aim of this study was to estimate the budget impact of this recommendation by using the data from the VACH cohort. Methods: We considered a scenario in which all naïve asymptomatic patients would initiate ART if they had 500/µL if they were older than 55 years, or had high viral load, liver disease, chronic kidney disease or high cardiovascular risk. The study was designed as a cost analysis in terms of annual pharmaceutical expenditure. The only costs included were those relating to the ART combinations analyzed. To estimate these costs, we assumed that this guideline had a penetration of 80%, an adherence of 95% and 12% dropouts. Results: A total of 12,500 patients were reviewed. Of these, 1,127 (10% had not initiated ART; CD4 lymphocyte count was 350-500 in 294 (26.1% and > 500 in 685 (60.8%. If the new clinical practice guideline were applied, 45.2% of naïve patients (95% CI: 42.4%-48.2% would be advised to start ART. Carrying out this recommendation in hospitals of the VACH cohort would require an additional annual investment of € 3,270,975 and would increase the overall cost of antiretroviral drugs by 3%. Conclusions: In the framework of health economics, incorporating economic impact estimates - such as those performed in this study - into clinical practice guidelines would be advisable to increase their feasibility.

  8. Budget Impact of Enzalutamide for Chemotherapy-Naïve Metastatic Castration-Resistant Prostate Cancer.

    Science.gov (United States)

    Bui, Cat N; O'Day, Ken; Flanders, Scott; Oestreicher, Nina; Francis, Peter; Posta, Linda; Popelar, Breanna; Tang, Hong; Balk, Mark

    2016-02-01

    Prostate cancer is expected to account for approximately one quarter of all new diagnoses of cancer in American men in 2015. The cost of prostate cancer care is expected to reach $15.1 billion by the year 2020, up from $11.9 billion in 2010. Given the high burden of prostate cancer, health care payers are interested in quantifying the potential budget impact of new therapies. To estimate the budget impact of enzalutamide for the treatment of chemotherapy-naïve metastatic castration-resistant prostate cancer (mCRPC) from a U.S. payer perspective. A model was developed to assess the budget impact of enzalutamide for treatment of chemotherapy-naïve mCRPC patients in a hypothetical 1-million-member U.S. health plan over a 1-year time horizon. Comparators included abiraterone acetate, sipuleucel-T, radium Ra 223 dichloride, and docetaxel. Epidemiologic data, including National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) incidence rates, were used to estimate the number of chemotherapy-naïve mCRPC patients. Dosing, administration, duration of therapy, and adverse event rates were based on package inserts and pivotal studies. Drug costs were obtained from RED BOOK and Centers for Medicare & Medicaid Services (CMS) average sales price pricing files, costs of administration and monitoring from the CMS physician fee schedule, and adverse events from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project and published literature. Market shares were estimated for each comparator before and after adoption of enzalutamide. The incremental aggregate budget impact, per patient per year (PPPY), per patient per month (PPPM), and per member per month (PMPM), was calculated. One-way sensitivity analyses were performed. In a population of 115 chemotherapy-naïve mCRPC patients, adopting enzalutamide had an annual incremental budget impact of $510,641 ($4,426 PPPY, $369 PPPM, and $0.04 PMPM). Results were most sensitive to

  9. Statistical – Econometric Analysis of the Correlations between the Social Security Budget and the Main Macroeconomic Aggregates in Romania

    Directory of Open Access Journals (Sweden)

    Emilia ŢIŢAN

    2011-02-01

    Full Text Available This paper analyses the correlation between social security budget and the main macroeconomic indicators (like GDP, monthly average gross earnings, unemployment in Romania during the period 2000 – 2009. Romania faces a more severe economic recession than originally anticipated. Although the implementation of anti-crisis program was able to lead to normalization of financial conditions, the contraction of economic activity is higher than initial projections. Because of the great policy debate in Romania about the impact of the reduction of pensions and salaries and increases of taxations on the reduction of budget deficit, we have explained in our paper the basic sides of the balanced budget debate. There are three basic sides to the balanced budget debate. The traditionalists argue for a reduction of the budget deficit since it harms the economy. Another group holds the Ricardian view of government debt in believing that there is no real harm done to the economy by the national debt. A third group claims one way or another that the budget deficit is not an adequate measure of fiscal policy. We will argue which of these views is most reasonable, based on a study case. The study is based on official data published by the National Institute of Statistics, with the specification that they are transformed into real values in order to assure the data comparability. The methodology used is the correlation analysis, the factorial analysis and the regression analysis, in order to evaluate the impact of some macroeconomic policies on the budget deficit. Three hypotheses on macroeconomic policies are discussed in the paper and their influences on the budget deficit. The main problem in Romania was that the macroeconomic policies didn't give enough attention to budget deficit in order to keep it under control. This is the main cause of the actual unfavourable economical situation in Romania, with a huge budget deficit, with a decrease in economic activity

  10. Estimated Budget Impact of Increased Use of Mirabegron, A Novel Treatment for Overactive Bladder.

    Science.gov (United States)

    Perk, Sinem; Wielage, Ronald C; Campbell, Noll L; Klein, Timothy M; Perkins, Anthony; Posta, Linda M; Yuran, Thomas; Klein, Robert W; Ng, Daniel B

    2016-09-01

    Oral pharmacological treatment for overactive bladder (OAB) consists of antimuscarinics and the beta-3 adrenergic agonist mirabegron. Antimuscarinic adverse events (AEs) such as dry mouth, constipation, and blurry vision can result in frequent treatment discontinuation rates, leaving part of the OAB population untreated. Antimuscarinics also contribute to a patient's anticholinergic cognitive burden (ACB), so the Beers Criteria recommends cautious use of antimuscarinics in elderly patients who take multiple anticholinergic medications or have cognitive impairment. Since mirabegron does not affect the cholinergic pathways, it is unlikely to contribute to a patient's ACB. To estimate the health care costs associated with the pharmacological treatment of OAB with mirabegron and antimuscarinics from U.S. commercial payer and Medicare Advantage perspectives, using a budget impact model. For this budget impact model, 2 analyses were performed. The primary analysis estimated the budgetary impact of increasing the use of mirabegron in a closed patient cohort treated with oral pharmacological treatments. The secondary analysis modeled the economic impact in an open cohort by allowing untreated patients to begin treatment with mirabegron after potential contraindication, intolerance, or lack of effectiveness of antimuscarinics. The analyses were performed over a 3-year time horizon. The economic impact of increased mirabegron use was quantified using direct medical costs, including prescription costs and health resource utilization (HRU) costs. Costs of comorbidities included pharmacy and medical costs of treating OAB-related urinary tract infections (UTI), skin rashes, and depression. An analysis of a large single-site integrated health network database was commissioned to quantify ACB-related HRU in terms of the increases in yearly outpatient and emergency department visits. Based on this analysis, the model associated each unit increase in ACB score with increased HRU and

  11. Impact of the macroeconomic factors on university budgeting the US and Russia

    Science.gov (United States)

    Bogomolova, Arina; Balk, Igor; Ivachenko, Natalya; Temkin, Anatoly

    2017-10-01

    This paper discuses impact of macroeconomics factor on the university budgeting. Modern developments in the area of data science and machine learning made it possible to utilise automated techniques to address several problems of humankind ranging from genetic engineering and particle physics to sociology and economics. This paper is the first step to create a robust toolkit which will help universities sustain macroeconomic challenges utilising modern predictive analytics techniques.

  12. Managing healthcare budgets in times of austerity: the role of program budgeting and marginal analysis.

    Science.gov (United States)

    Mitton, Craig; Dionne, Francois; Donaldson, Cam

    2014-04-01

    Given limited resources, priority setting or choice making will remain a reality at all levels of publicly funded healthcare across countries for many years to come. The pressures may well be even more acute as the impact of the economic crisis of 2008 continues to play out but, even as economies begin to turn around, resources within healthcare will be limited, thus some form of rationing will be required. Over the last few decades, research on healthcare priority setting has focused on methods of implementation as well as on the development of approaches related to fairness and legitimacy and on more technical aspects of decision making including the use of multi-criteria decision analysis. Recently, research has led to better understanding of evaluating priority setting activity including defining 'success' and articulating key elements for high performance. This body of research, however, often goes untapped by those charged with making challenging decisions and as such, in line with prevailing public sector incentives, decisions are often reliant on historical allocation patterns and/or political negotiation. These archaic and ineffective approaches not only lead to poor decisions in terms of value for money but further do not reflect basic ethical conditions that can lead to fairness in the decision-making process. The purpose of this paper is to outline a comprehensive approach to priority setting and resource allocation that has been used in different contexts across countries. This will provide decision makers with a single point of access for a basic understanding of relevant tools when faced with having to make difficult decisions about what healthcare services to fund and what not to fund. The paper also addresses several key issues related to priority setting including how health technology assessments can be used, how performance can be improved at a practical level, and what ongoing resource management practice should look like. In terms of future

  13. Experimental and modeling study of the impact of vertical transport processes from the boundary-layer on the variability and the budget of tropospheric ozone

    International Nuclear Information System (INIS)

    Colette, A.

    2005-12-01

    Closing the tropospheric ozone budget requires a better understanding of the role of transport processes from the major reservoirs: the planetary boundary layer and the stratosphere. Case studies lead to the identification of mechanisms involved as well as their efficiency. However, their global impact on the budget must be addressed on a climatological basis. This manuscript is thus divided in two parts. First, we present case studies based on ozone LIDAR measurements performed during the ESCOMPTE campaign. This work consists in a data analysis investigation by means of a hybrid - Lagrangian study involving: global meteorological analyses, Lagrangian particle dispersion computation, and mesoscale, chemistry - transport, and Lagrangian photochemistry modeling. Our aim is to document the amount of observed ozone variability related to transport processes and, when appropriate, to infer the role of tropospheric photochemical production. Second, we propose a climatological analysis of the respective impact of transport from the boundary-layer and from the tropopause region on the tropospheric ozone budget. A multivariate analysis is presented and compared to a trajectography approach. Once validated, this algorithm is applied to the whole database of ozone profiles collected above Europe during the past 30 years in order to discuss the seasonal, geographical and temporal variability of transport processes as well as their impact on the tropospheric ozone budget. The variability of turbulent mixing and its impact on the persistence of tropospheric layers will also be discussed. (author)

  14. A Historical Analysis of the Biennial Budget Process

    Science.gov (United States)

    1988-04-01

    commissioned In April 1974. He received a Master of Arts (MA) in Business Management from Tne University of The Philippines in 1983, and, in 1987, complitcd... tardiness there isn’t any empirical evidence to support this con- tention. To fully understand why biennial budgeting will not solve the first * three

  15. ‘FLEXIBLE’ BUDGETS ARE ALREADY BUDGETING PROCESS ANALYSIS OF PRODUCTION COSTS FOR OIL AND FAT ENTERPRISES

    Directory of Open Access Journals (Sweden)

    V. Shvetz’

    2013-10-01

    Full Text Available The problems of methodological fundamentals of managerial accounting of manufacturing costs in information provision for budgeting, not only at the enterprise level, but also as it is required by current conditions of advanced control, in the context of structural production units of “responsibility centers” using “flexible” budgets, which are prepared during the manufacturing process are examined. Unlike a simple comparison of the regular budgets (scheduled amount of work divided by regulatory costs per unit, “flexible” budget makes adjustments to the planned budget because it represents the actual amount of work divided by regulatory costs, which is included with the comparison of the amount of work that are not fulfilled, or carried to a greater or lesser extent compared with the expected budget. Thus, “Flexible” budgets reveal the actual extent of the changes compared with the expected budget.

  16. THE ANALYSIS OF ACTORS IN THE MAKING OF THE BUDGET REVENUE OF REGIONAL COST

    Directory of Open Access Journals (Sweden)

    Muhammad Saad

    2015-07-01

    Full Text Available This article is the result of research on the analysis of the policy making of the budget revenues and shopping area of Makassar city fiscal year 2009. One part of this research use approach to the actors and the relationships between actors in policy making. Within the framework of the system of policy making of Budget income and Expenditure area (Budgets Makassar city, this research is the description of the analysis of the local government and actors People’s Representative Council District Makassar city as policy makers in making Grant Makassar city

  17. The impact of Earth system feedbacks on carbon budgets and climate response

    Science.gov (United States)

    Lowe, Jason A.; Bernie, Daniel

    2018-05-01

    A number of studies have examined the size of the allowable global cumulative carbon budget compatible with limiting twenty-first century global average temperature rise to below 2°C and below 1.5°C relative to pre-industrial levels. These estimates of cumulative emissions have a number of uncertainties including those associated with the climate sensitivity and the global carbon cycle. Although the IPCC fifth assessment report contained information on a range of Earth system feedbacks, such as carbon released by thawing of permafrost or methane production by wetlands as a result of climate change, the impact of many of these Earth system processes on the allowable carbon budgets remains to be quantified. Here, we make initial estimates to show that the combined impact from typically unrepresented Earth system processes may be important for the achievability of limiting warming to 1.5°C or 2°C above pre-industrial levels. The size of the effects range up to around a 350 GtCO2 budget reduction for a 1.5°C warming limit and around a 500 GtCO2 reduction for achieving a warming limit of 2°C. Median estimates for the extra Earth system forcing lead to around 100 GtCO2 and 150 GtCO2, respectively, for the two warming limits. Our estimates are equivalent to several years of anthropogenic carbon dioxide emissions at present rates. In addition to the likely reduction of the allowable global carbon budgets, the extra feedbacks also bring forward the date at which a given warming threshold is likely to be exceeded for a particular emission pathway. This article is part of the theme issue `The Paris Agreement: understanding the physical and social challenges for a warming world of 1.5°C above pre-industrial levels'.

  18. The impact of Earth system feedbacks on carbon budgets and climate response.

    Science.gov (United States)

    Lowe, Jason A; Bernie, Daniel

    2018-05-13

    A number of studies have examined the size of the allowable global cumulative carbon budget compatible with limiting twenty-first century global average temperature rise to below 2°C and below 1.5°C relative to pre-industrial levels. These estimates of cumulative emissions have a number of uncertainties including those associated with the climate sensitivity and the global carbon cycle. Although the IPCC fifth assessment report contained information on a range of Earth system feedbacks, such as carbon released by thawing of permafrost or methane production by wetlands as a result of climate change, the impact of many of these Earth system processes on the allowable carbon budgets remains to be quantified. Here, we make initial estimates to show that the combined impact from typically unrepresented Earth system processes may be important for the achievability of limiting warming to 1.5°C or 2°C above pre-industrial levels. The size of the effects range up to around a 350 GtCO 2 budget reduction for a 1.5°C warming limit and around a 500 GtCO 2 reduction for achieving a warming limit of 2°C. Median estimates for the extra Earth system forcing lead to around 100 GtCO 2 and 150 GtCO 2 , respectively, for the two warming limits. Our estimates are equivalent to several years of anthropogenic carbon dioxide emissions at present rates. In addition to the likely reduction of the allowable global carbon budgets, the extra feedbacks also bring forward the date at which a given warming threshold is likely to be exceeded for a particular emission pathway.This article is part of the theme issue 'The Paris Agreement: understanding the physical and social challenges for a warming world of 1.5°C above pre-industrial levels'. © 2018 The Author(s).

  19. Budget analysis of Escherichia coli at a southern Lake Michigan Beach

    Science.gov (United States)

    Thupaki, P.; Phanikumar, M.S.; Beletsky, D.; Schwab, D.J.; Nevers, M.B.; Whitman, R.L.

    2010-01-01

    Escherichia coli (EC) concentrations at two beaches impacted by river plume dynamics in southern Lake Michigan were analyzed using three-dimensional hydrodynamic and transport models. The relative importance of various physical and biological processes influencing the fate and transport of EC were examined via budget analysis and a first-order sensitivity analysis of model parameters. The along-shore advective fluxofEC(CFU/m2·s)was found to be higher compared to its crossshore counterpart; however, the sum of diffusive and advective components was of a comparable magnitude in both directions showing the importance of cross-shore exchange in EC transport. Examination of individual terms in the EC mass balance equation showed that vertical turbulent mixing in the water column dominated the overall EC transport for the summer conditions simulated. Dilution due to advection and diffusion accounted for a large portion of the total EC budget in the nearshore, and the net EC loss rate within the water column (CFU/m3·s) was an order of magnitude smaller compared to the horizontal and vertical transport rates. This result has important implications for modeling EC at recreational beaches; however, the assessment of the magnitude of EC loss rate is complicated due to the strong coupling between vertical exchange and depth-dependent EC loss processes such as sunlight inactivation and settling. Sensitivity analysis indicated that solar inactivation has the greatest impact on EC loss rates. Although these results are site-specific, they clearly bring out the relative importance of various processes involved.

  20. An Analysis of Change Mechanisms in Government Budgets on Science and Technology

    Science.gov (United States)

    Jung, C.

    2012-12-01

    Recent studies on policy changes have shown that there are limitations of incrementalism and that there no longer exists a general theory that can explain policy change. A number of studies have been conducted to examine policy changes in terms of drastic changes in budgets or policy agenda. According to the Punctuated Equilibrium Theory (PET), policy change is punctuated by long periods of stability, and large, but rare, changes due to shifts in society or the government. Although the reasons for these drastic changes are interpreted mainly from external events, the exact mechanisms of these changes are still not known. In this study, we assume that the punctuated budget changes are a result of not only external events but also the bureaucratic power of government departments. We attempt to identify the regularity of budget change pattern due to these internal characteristics (bureaucratic power). In order to understand budget changes caused by external events, especially for science and technology, the ARIMA-Intervention analysis was implemented. The results showed that the ARIMA-Intervention analysis explained the abrupt change in budget well. This means that a change in budget cannot be explained as incrementalism. Also, we analyzed the budget change kurtosis of government department along with various policy and organization types. Normally, a high kurtosis means there is a high probability of a punctuated equilibrium. The results show that science and technology agency as well as productive, delivery, and transfer agencies have a relatively high kurtosis.;

  1. The potential impact of municipal solid waste incinerators ashes on the anthropogenic osmium budget

    International Nuclear Information System (INIS)

    Funari, Valerio; Meisel, Thomas; Braga, Roberto

    2016-01-01

    Osmium release from Municipal Solid Waste Incinerators (MSWI), even if acknowledged to occur at least over the last fifteen years, remains overlooked in the majority of recent studies. We present the osmium concentration and 187 Os/ 188 Os isotopic measurements of different kinds of bottom and fly ash samples from MSWI plants and reference materials of incinerator fly ash (BCR176 and BCR176R). The analysis of the unknown ash samples shows a relatively wide range of 187 Os/ 188 Os ratios (0.24–0.70) and Os concentrations (from 0.026 ng/g to 1.65 ng/g). Osmium concentrations and isotopic signatures differ from those of other known Os sources, either natural or manmade, suggesting a mixture of both contributions in the MSWI feedstock material. Furthermore, the comparison between the BCR176 and the renewed BCR176R indicates a decrease in Os concentration of one order of magnitude over the years (from 1 to 0.1 ng/g) due to improved recycling efficiency of Os-bearing waste. The estimated annual amount of Os from a typical incinerator (using average Os values and MSWI mass balance) is 13.4 g/a. The osmium potentially released from MSWI smokestacks is predicted to be from 16 to 38 ng Os/m 2 /a, considering a medium size country having 50 MSWI facilities; therefore much higher than the naturally transported osmium from continental dust in the atmosphere (about 1 pg Os/m 2 /a). MSWI systems are considered one of the best options for municipal solid waste management in industrialised countries, but their contribution to the Os budget can be significant. - Highlights: • Bottom and fly ashes from municipal solid waste incinerators are investigated. • Their Os levels and Os isotopic signatures are discussed. • An estimate of Os release from incinerators and incinerated ashes is given. • Os contamination from incineration plants impacts the geochemical Os cycle.

  2. The impact of the UK 1993 budget proposals on oil and gas in the UKCS

    International Nuclear Information System (INIS)

    Kemp, A.G.; Rose, David; Hoevring, Mary; Reading, David

    1993-01-01

    The key features of the 1993 United Kingdom budget proposals for the reform of petroleum taxation as they relate to the upstream oil and gas industry are summarized. These fairly radical proposals will have far reaching effects. They are examined in terms of their impact on the following activities: ongoing production from existing producing fields; incremental investments in mature oil fields; development of existing discoveries; exploration, appraisal and development of new discoveries; development of new fields involving third-party tariffing; incremental investments and new contracts in mature gas fields; investment climate and confidence. (35 figures). (UK)

  3. Impact of biomass burning plume on radiation budget and atmospheric dynamics over the arctic

    Science.gov (United States)

    Lisok, Justyna; Pedersen, Jesper; Ritter, Christoph; Markowicz, Krzysztof M.; Malinowski, Szymon; Mazzola, Mauro; Udisti, Roberto; Stachlewska, Iwona S.

    2018-04-01

    The aim of the research was to determine the impact of July 2015 biomass burning event on radiative budget, atmospheric stratification and turbulence over the Arctic using information about the vertical structure of the aerosol load from the ground-based data. MODTRAN simulations indicated very high surface radiative cooling (forcing of -150 Wm-2) and a heating rate of up to 1.8 Kday-1 at 3 km. Regarding LES results, a turbulent layer at around 3 km was clearly seen after 48 h of simulation.

  4. The Impact of Creating Civil Unions for Same-Sex Couples on Delaware’s Budget

    OpenAIRE

    Herman, Jody L.; Konnoth, Craig J.; Badgett, M.V. Lee

    2011-01-01

    This report analyzes the impact on Delaware’s state budget of introducing civil union rights for same-sex couples. It estimates that a law recognizing civil unions between same-sex partners will cost the State $1.18 million over the three years following the measure, or only $390,000 per year. The costs and benefits accrued will change every year, as the number of same-sex couples entering civil unions each year will change. The State will see savings in expenditures on state means-tested pub...

  5. Budget impact from the incorporation of positron emission tomography ? computed tomography for staging lung cancers

    OpenAIRE

    Biz, Aline Navega; Caetano, Ros?ngela

    2015-01-01

    OBJECTIVE To estimate the budget impact from the incorporation of positron emission tomography (PET) in mediastinal and distant staging of non-small cell lung cancer.METHODS The estimates were calculated by the epidemiological method for years 2014 to 2018. Nation-wide data were used about the incidence; data on distribution of the disease´s prevalence and on the technologies’ accuracy were from the literature; data regarding involved costs were taken from a micro-costing study and from Brazi...

  6. Impact of biomass burning plume on radiation budget and atmospheric dynamics over the arctic

    Directory of Open Access Journals (Sweden)

    Lisok Justyna

    2018-01-01

    Full Text Available The aim of the research was to determine the impact of July 2015 biomass burning event on radiative budget, atmospheric stratification and turbulence over the Arctic using information about the vertical structure of the aerosol load from the ground–based data. MODTRAN simulations indicated very high surface radiative cooling (forcing of –150 Wm–2 and a heating rate of up to 1.8 Kday–1 at 3 km. Regarding LES results, a turbulent layer at around 3 km was clearly seen after 48 h of simulation.

  7. Uncertainty budget in internal monostandard NAA for small and large size samples analysis

    International Nuclear Information System (INIS)

    Dasari, K.B.; Acharya, R.

    2014-01-01

    Total uncertainty budget evaluation on determined concentration value is important under quality assurance programme. Concentration calculation in NAA or carried out by relative NAA and k0 based internal monostandard NAA (IM-NAA) method. IM-NAA method has been used for small and large sample analysis of clay potteries. An attempt was made to identify the uncertainty components in IM-NAA and uncertainty budget for La in both small and large size samples has been evaluated and compared. (author)

  8. Budget impact from the incorporation of positron emission tomography - computed tomography for staging lung cancers.

    Science.gov (United States)

    Biz, Aline Navega; Caetano, Rosângela

    2015-01-01

    To estimate the budget impact from the incorporation of positron emission tomography (PET) in mediastinal and distant staging of non-small cell lung cancer. The estimates were calculated by the epidemiological method for years 2014 to 2018. Nation-wide data were used about the incidence; data on distribution of the disease's prevalence and on the technologies' accuracy were from the literature; data regarding involved costs were taken from a micro-costing study and from Brazilian Unified Health System (SUS) database. Two strategies for using PET were analyzed: the offer to all newly-diagnosed patients, and the restricted offer to the ones who had negative results in previous computed tomography (CT) exams. Univariate and extreme scenarios sensitivity analyses were conducted to evaluate the influence from sources of uncertainties in the parameters used. The incorporation of PET-CT in SUS would imply the need for additional resources of 158.1 BRL (98.2 USD) million for the restricted offer and 202.7 BRL (125.9 USD) million for the inclusive offer in five years, with a difference of 44.6 BRL (27.7 USD) million between the two offer strategies within that period. In absolute terms, the total budget impact from its incorporation in SUS, in five years, would be 555 BRL (345 USD) and 600 BRL (372.8 USD) million, respectively. The costs from the PET-CT procedure were the most influential parameter in the results. In the most optimistic scenario, the additional budget impact would be reduced to 86.9 BRL (54 USD) and 103.8 BRL (64.5 USD) million, considering PET-CT for negative CT and PET-CT for all, respectively. The incorporation of PET in the clinical staging of non-small cell lung cancer seems to be financially feasible considering the high budget of the Brazilian Ministry of Health. The potential reduction in the number of unnecessary surgeries may cause the available resources to be more efficiently allocated.

  9. Budget impact from the incorporation of positron emission tomography – computed tomography for staging lung cancers

    Directory of Open Access Journals (Sweden)

    Aline Navega Biz

    2015-01-01

    Full Text Available OBJECTIVE To estimate the budget impact from the incorporation of positron emission tomography (PET in mediastinal and distant staging of non-small cell lung cancer.METHODS The estimates were calculated by the epidemiological method for years 2014 to 2018. Nation-wide data were used about the incidence; data on distribution of the disease´s prevalence and on the technologies’ accuracy were from the literature; data regarding involved costs were taken from a micro-costing study and from Brazilian Unified Health System (SUS database. Two strategies for using PET were analyzed: the offer to all newly-diagnosed patients, and the restricted offer to the ones who had negative results in previous computed tomography (CT exams. Univariate and extreme scenarios sensitivity analyses were conducted to evaluate the influence from sources of uncertainties in the parameters used.RESULTS The incorporation of PET-CT in SUS would imply the need for additional resources of 158.1 BRL (98.2 USD million for the restricted offer and 202.7 BRL (125.9 USD million for the inclusive offer in five years, with a difference of 44.6 BRL (27.7 USD million between the two offer strategies within that period. In absolute terms, the total budget impact from its incorporation in SUS, in five years, would be 555 BRL (345 USD and 600 BRL (372.8 USD million, respectively. The costs from the PET-CT procedure were the most influential parameter in the results. In the most optimistic scenario, the additional budget impact would be reduced to 86.9 BRL (54 USD and 103.8 BRL (64.5 USD million, considering PET-CT for negative CT and PET-CT for all, respectively.CONCLUSIONS The incorporation of PET in the clinical staging of non-small cell lung cancer seems to be financially feasible considering the high budget of the Brazilian Ministry of Health. The potential reduction in the number of unnecessary surgeries may cause the available resources to be more efficiently allocated.

  10. Impacts of Green Infrastructure on the Water Budget and Other Ecosystem Services in Subhumid Urban Areas

    Science.gov (United States)

    Feng, Y.; Burian, S. J.; Pardyjak, E.; Pomeroy, C. A.

    2014-12-01

    Green infrastructure (GI) measures have been well established as part of low-impact development approaches for stormwater (SW) management. The origin of the concepts, practices and the preponderance of research have taken place in humid climates. Recent work has begun to explore and adapt GI to subhumid and semi-arid climates, which experience warmer and drier periods. But much remains unknown about effects of GI on the water cycle and how to effectively implement to maximize ecosystem benefits. This research synthesizes observation and modeling to address questions related to changes in evapotranspiration (ET), SW runoff volume, and other water cycle processes from GI introduction in Salt Lake City, Utah, USA. First, the water budget of green roofs is being studied via weighing lysimeter systems on two rooftop gardens on the University of Utah campus. ET, outflow, and soil moisture have been measured for approximately one year. Up to this early summer, average ET rates for lysimeters of pure medium, Sedums, and Bluegrass are 1.85±1.01, 1.97±0.94, and 2.31±0.91 mm/d respectively; the maximum ET rate could reach 6.11 mm/d from Sedums. Over 2/3 of total rainfall and irrigation were slowly consumed via ET from green roof. Second, the observation studies are leading to new ET modeling techniques that are being incorporated into the U.S. EPA Storm Water Management Model (SWMM). The modified SWMM has been used to simulate ET, SW runoff volume, and overall water budget changes from GI implementation. Preliminary result shows that ET could account for 10% of the total inflows into bioretentions, and 25% of the inflows into landscapes; potential ET rates could vary up to 0.95 mm/hr across 53 subcatchments in the 29 acres catchment. The influence of various design factors for GI on SW runoff reduction and the water budget is also to be estimated. The application of the research is to analyze the water budget of the Red Butte Creek Watershed in Salt Lake City and to

  11. IMPACT OF EUROPEAN INTEGRATION PROCESSES ON THE NECESSITY OF LONG-TERM BUDGET PLANNING INTRODUCTION IN UKRAINE

    Directory of Open Access Journals (Sweden)

    Ganna Muzychenko

    2017-12-01

    Full Text Available The Association Agreement between Ukraine and the European Union was ratified in September 2014. Ukraine has undertaken to implement and enforce EU standards, including in the financial sphere, which are regulated by international law. The purpose of the study is to determine the impact of European integration processes on the necessity of the long-term budget forecasting process introduction into the budget process of Ukraine and the revelation of special budgetary rules regulated this process in the EU. The methodology. The list of requirements (budget procedures and rules for their introduction by law into the budget process of Ukraine was determined based on the generalization and systematization of normative legal acts that regulate the medium-term financial planning as the EU standard. The results showed that the long-term budget forecast developing procedure in the budget process will allow the government to timely identify the unfavourable trend in the state’s fiscal policy and introduce preventive measures, determine the full scale of economy’s and business’ reaction to the reforms’ introduction and new laws adoption, estimate fiscal space for fiscal policy implementation for coming years, take into consideration the budget forecast’s indicators during the annual adoption of budget decisions. The study defines the difference between the budget forecast and the planned budget: the forecast is for five years and more, the plan is for one year only; forecast indicators are not mandatory for implementation, they are only guidelines, and planned indicators are mandatory for implementation; the budget forecast is approved by the order of the Cabinet of Ministers of Ukraine and annually specified, the planned budget (for the current budget year is approved by the Verkhovna Rada of Ukraine by adopting the relevant law, amendments are an exception and also approved by law. The practical implementation. Governments of countries that

  12. Impact of a financial risk-sharing scheme on budget-impact estimations: a game-theoretic approach.

    Science.gov (United States)

    Gavious, Arieh; Greenberg, Dan; Hammerman, Ariel; Segev, Ella

    2014-06-01

    As part of the process of updating the National List of Health Services in Israel, health plans (the 'payers') and manufacturers each provide estimates on the expected number of patients that will utilize a new drug. Currently, payers face major financial consequences when actual utilization is higher than the allocated budget. We suggest a risk-sharing model between the two stakeholders; if the actual number of patients exceeds the manufacturer's prediction, the manufacturer will reimburse the payers by a rebate rate of α from the deficit. In case of under-utilization, payers will refund the government at a rate of γ from the surplus budget. Our study objective was to identify the optimal early estimations of both 'players' prior to and after implementation of the risk-sharing scheme. Using a game-theoretic approach, in which both players' statements are considered simultaneously, we examined the impact of risk-sharing within a given range of rebate proportions, on players' early budget estimations. When increasing manufacturer's rebate α to be over 50 %, then manufacturers will announce a larger number, and health plans will announce a lower number of patients than they would without risk sharing, thus substantially decreasing the gap between their estimates. Increasing γ changes players' estimates only slightly. In reaction to applying a substantial risk-sharing rebate α on the manufacturer, both players are expected to adjust their budget estimates toward an optimal equilibrium. Increasing α is a better vehicle for reaching the desired equilibrium rather than increasing γ, as the manufacturer's rebate α substantially influences both players, whereas γ has little effect on the players behavior.

  13. First-line HIV treatment: evaluation of backbone choice and its budget impact

    Directory of Open Access Journals (Sweden)

    Orietta Zaniolo

    2013-06-01

    Full Text Available OBJECTIVE: The gradual increase of persons living with HIV, mainly due to the reduced mortality achieved with effective antiretroviral therapies, calls for increased rationality and awareness in health resources consumption also during the early illness phases. Aim of this work is the estimation of the budget impact related to the variation in backbone prescribing trends in naïve patients.METHODS: Target population is the number of patients starting antiretroviral therapy each year, according to the Italian HIV surveillance registry, excluding patients receiving non-authorized or non-recommended regimens. We modeled 3-year mortality and durability rates on a dynamic cohort, basing on international literature. A prevalent patients analysis has also been conducted, for which the model is fed by a closed cohort consisting of all the patients without experience of virologic failure. The aim of this collateral analysis is to estimate the difference in current annual expenditures if the past prescription trends for patients starting therapy would have led to the evaluated hypothetical scenarios. Current Italian market shares of triple regimens containing first-choice or alternative backbones (tenofovir/emtricitabine, abacavir/lamivudine, tenofovir/lamivudine and zidovudine/lamivudine are compared to three hypothetical scenarios (base-case, minimum and maximum in which increasing shares of patients eligible to abacavir/lamivudine start first line treatment with this backbone. Annual cost for each regimen comprises drugs acquisition under hospital pricing rules, monitoring exams and preventive tests, valued basing on regional reimbursement tariffs.RESULTS: According to current prescribing trends, in the next three years about 13,000 patients starting HIV therapy will receive tenofovir/emtricitabine (83% of the target population, and minor portions other regimens (9% abacavir/lamivudine, 8% zidovudine/lamivudine. Patients that would be eligible to

  14. Impact of engineered zinc oxide nanoparticles on the energy budgets of Mytilus galloprovincialis

    Science.gov (United States)

    Muller, Erik B.; Hanna, Shannon K.; Lenihan, Hunter S.; Miller, Robert J.; Nisbet, Roger M.

    2014-11-01

    This paper characterizes the sublethal impact of engineered ZnO nanoparticles on the individual performance of the marine mussel Mytilus galloprovincialis within the context of Dynamic Energy Budget theory, thereby allowing an integrated evaluation of the impact of multiple stressors on various endpoints. Data include measurements of the impact of ZnO nanoparticles on body burden, feeding, respiration, shell length, biomass, and mortality of mussels kept in laboratory tanks for over 100 days. ZnO nanoparticles in the environment impair the mussels' feeding rate (EC50 for the maximum feeding rate is 1.5 mg ZnO nanoparticles L- 1). Zn accumulated in tissue increases respiration (EC50 for the respiration rate is 0.9 mg environmental ZnO nanoparticles L- 1 with the body burden having reached its ultimate level), indicating that maintenance processes are more affected by ZnO nanoparticles than feeding. The feeding regime constrained growth and biomass production to the extent that the impact of ZnO nanoparticles on these processes was undetectable, yet the remaining measurements allowed the estimation of the toxicity parameters. The toxicity representation, combined with the DEB model, allowed the calculation of the effect of the nanoparticles on the expected lifetime production of reproductive matter. EC50 for the expected lifetime production of reproductive matter is less than 0.25 mg ZnO nanoparticles L- 1, indicating that that the ecological impact of ZnO nanoparticle exposure is stronger than its impact on individual physiological rates.

  15. Precipitation recycling in West Africa - regional modeling, evaporation tagging and atmospheric water budget analysis

    Science.gov (United States)

    Arnault, Joel; Kunstmann, Harald; Knoche, Hans-Richard

    2015-04-01

    Many numerical studies have shown that the West African monsoon is highly sensitive to the state of the land surface. It is however questionable to which extend a local change of land surface properties would affect the local climate, especially with respect to precipitation. This issue is traditionally addressed with the concept of precipitation recycling, defined as the contribution of local surface evaporation to local precipitation. For this study the West African monsoon has been simulated with the Weather Research and Forecasting (WRF) model using explicit convection, for the domain (1°S-21°N, 18°W-14°E) at a spatial resolution of 10 km, for the period January-October 2013, and using ERA-Interim reanalyses as driving data. This WRF configuration has been selected for its ability to simulate monthly precipitation amounts and daily histograms close to TRMM (Tropical Rainfall Measuring Mission) data. In order to investigate precipitation recycling in this WRF simulation, surface evaporation tagging has been implemented in the WRF source code as well as the budget of total and tagged atmospheric water. Surface evaporation tagging consists in duplicating all water species and the respective prognostic equations in the source code. Then, tagged water species are set to zero at the lateral boundaries of the simulated domain (no inflow of tagged water vapor), and tagged surface evaporation is considered only in a specified region. All the source terms of the prognostic equations of total and tagged water species are finally saved in the outputs for the budget analysis. This allows quantifying the respective contribution of total and tagged atmospheric water to atmospheric precipitation processes. The WRF simulation with surface evaporation tagging and budgets has been conducted two times, first with a 100 km2 tagged region (11-12°N, 1-2°W), and second with a 1000 km2 tagged region (7-16°N, 6°W -3°E). In this presentation we will investigate hydro

  16. Budget Impact of a Comprehensive Nutrition-Focused Quality Improvement Program for Malnourished Hospitalized Patients.

    Science.gov (United States)

    Sulo, Suela; Feldstein, Josh; Partridge, Jamie; Schwander, Bjoern; Sriram, Krishnan; Summerfelt, Wm Thomas

    2017-07-01

    Nutrition interventions can alleviate the burden of malnutrition by improving patient outcomes; however, evidence on the economic impact of medical nutrition intervention remains limited. A previously published nutrition-focused quality improvement program targeting malnourished hospitalized patients showed that screening patients with a validated screening tool at admission, rapidly administering oral nutritional supplements, and educating patients on supplement adherence result in significant reductions in 30-day unplanned readmissions and hospital length of stay. To assess the potential cost-savings associated with decreased 30-day readmissions and hospital length of stay in malnourished inpatients through a nutrition-focused quality improvement program using a web-based budget impact model, and to demonstrate the clinical and fiscal value of the intervention. The reduction in readmission rate and length of stay for 1269 patients enrolled in the quality improvement program (between October 13, 2014, and April 2, 2015) were compared with the pre-quality improvement program baseline and validation cohorts (4611 patients vs 1319 patients, respectively) to calculate potential cost-savings as well as to inform the design of the budget impact model. Readmission rate and length-of-stay reductions were calculated by determining the change from baseline to post-quality improvement program as well as the difference between the validation cohort and the post-quality improvement program, respectively. As a result of improved health outcomes for the treated patients, the nutrition-focused quality improvement program led to a reduction in 30-day hospital readmissions and length of stay. The avoided hospital readmissions and reduced number of days in the hospital for the patients in the quality improvement program resulted in cost-savings of $1,902,933 versus the pre-quality improvement program baseline cohort, and $4,896,758 versus the pre-quality improvement program in the

  17. Multi-Year Program under Budget Constraints Using Multi-Criteria Analysis

    Directory of Open Access Journals (Sweden)

    Surya Adiguna

    2017-09-01

    Full Text Available Road investment appraisal requires joint consideration of multiple criteria which are related to engineering, economic, social and environmental impacts. The investment consideration could be based on the economic analysis but however for some factors, such as environmental, social, and political, are difficult to quantify in monetary term. The multi-criteria analysis is the alternative tool which caters the requirements of the issues above. The research, which is based on 102 class D and class E paved road sections in Kenya, is about to optimize road network investment under budget constraints by applying a multi-criteria analysis (MCA method and compare it with the conventional economic analysis. The MCA is developed from hierarchy structure which is considered as the analytical framework. The framework is based on selected criteria and weights which are assigned from Kenya road policy. The HDM-4 software is applied as decision-making tool to obtain the best investment alternatives and road work programs from both MCA and economic analysis. The road work programs will be the results from the analysis using both MCA and economic analysis within HDM-4 software to see the difference and compare the results between both programs. The results from MCA show 51 road sections need periodic work, which is overlay or resealing. Meanwhile, 51 others need rehabilitation or reconstruction. The five years road work program which based on economic analysis result shows that it costs almost Kenyan Shilling (KES 130 billion to maintain the class D and E paved road in Kenya. Meanwhile, the MCA only requires KES 59.5 billion for 5 years program. These results show huge margin between two analyses and somehow MCA result provides more efficient work program compared to economic analysis.

  18. Analysis of local budgets revenues in the Republic of Moldova: level, structure and dynamics for 2008-2014 years

    Directory of Open Access Journals (Sweden)

    Andrei PETROIA

    2015-12-01

    Full Text Available This paper consist largely of analysis of the local budgets revenues of the Republic of Moldova for the period of 2008-2014. The analysis can not offer many information in dynamics due to the few number of years, but we tried to make an analyze of the situation. Informational support of the work are the laws and regulations of the country; data provided by the Ministry of Finance, National Bureau of Statistics and the literature. The purpose of this paper is to approach each category of income and part of it, the time evolution of local budget revenues over several consecutive years of budget income distribution in the directions of the Republic of Moldova, and analysis of each component of the local budget. In this paper, we have analyzed in dynamics structure in total revenues of local budgets, in national public budget, in state budget and in GDP. The main components analyzed were: tax and non-tax revenues, revenues without grants and transfers, grants and transfers from the state budget. Also we have attracted special attention to direct and indirect taxes, as well as their components.The necessity of this study is to present a clear and concise form of the administrative-territorial units' budget feature, conceptual notions, policies which are reflected on local revenues in Moldova. This paper aims possibility of revising the budget system structure, improve financial relations within it and its evolution, but it does not reflect fully all matters related to the budget system.

  19. Cost-effectiveness and Budget Impact of Routine Use of Fractional Exhaled Nitric Oxide Monitoring for the Management of Adult Asthma Patients in Spain.

    Science.gov (United States)

    Sabatelli, L; Seppälä, U; Sastre, J; Crater, G

    Fractional exhaled nitric oxide (FeNO) is a marker for type 2 airway inflammation. The objective of this study was to evaluate the cost-effectiveness and budget impact of FeNO monitoring for management of adult asthma in Spain. A cost-effectiveness analysis model was used to evaluate the effect on costs of adding FeNO monitoring to asthma management. Over a 1-year period, the model estimated the incremental cost per quality-adjusted life year and incremental number of exacerbations avoided when FeNO monitoring was added to standard guideline-driven asthma care compared with standard care alone. Univariate and multivariate sensitivity analyses were applied to explore uncertainty in the model. A budget impact model was used to examine the impact of FeNO monitoring on primary care costs across the Spanish health system. The results showed that adding FeNO to standard asthma care saved €62.53 per patient-year in the adult population and improved quality-adjusted life years by 0.026 per patient-year. The budget impact analysis revealed a potential net yearly saving of €129 million if FeNO monitoring had been used in primary care settings in Spain. The present economic model shows that adding FeNO to the treatment algorithm can considerably reduce costs and improve quality of life when used to manage asthma in combination with current treatment guidelines.

  20. The potential impact of municipal solid waste incinerators ashes on the anthropogenic osmium budget

    Energy Technology Data Exchange (ETDEWEB)

    Funari, Valerio, E-mail: valerio.funari@unibo.it [Dipartimento di Scienze Biologiche, Geologiche e Ambientali (BiGeA), University of Bologna, Piazza di Porta San Donato 1, Bologna (Italy); Meisel, Thomas [General and Analytical Chemistry, Montanuniversität Leoben, Franz-Josef-Str. 18, Leoben (Austria); Braga, Roberto [Dipartimento di Scienze Biologiche, Geologiche e Ambientali (BiGeA), University of Bologna, Piazza di Porta San Donato 1, Bologna (Italy)

    2016-01-15

    Osmium release from Municipal Solid Waste Incinerators (MSWI), even if acknowledged to occur at least over the last fifteen years, remains overlooked in the majority of recent studies. We present the osmium concentration and {sup 187}Os/{sup 188}Os isotopic measurements of different kinds of bottom and fly ash samples from MSWI plants and reference materials of incinerator fly ash (BCR176 and BCR176R). The analysis of the unknown ash samples shows a relatively wide range of {sup 187}Os/{sup 188}Os ratios (0.24–0.70) and Os concentrations (from 0.026 ng/g to 1.65 ng/g). Osmium concentrations and isotopic signatures differ from those of other known Os sources, either natural or manmade, suggesting a mixture of both contributions in the MSWI feedstock material. Furthermore, the comparison between the BCR176 and the renewed BCR176R indicates a decrease in Os concentration of one order of magnitude over the years (from 1 to 0.1 ng/g) due to improved recycling efficiency of Os-bearing waste. The estimated annual amount of Os from a typical incinerator (using average Os values and MSWI mass balance) is 13.4 g/a. The osmium potentially released from MSWI smokestacks is predicted to be from 16 to 38 ng Os/m{sup 2}/a, considering a medium size country having 50 MSWI facilities; therefore much higher than the naturally transported osmium from continental dust in the atmosphere (about 1 pg Os/m{sup 2}/a). MSWI systems are considered one of the best options for municipal solid waste management in industrialised countries, but their contribution to the Os budget can be significant. - Highlights: • Bottom and fly ashes from municipal solid waste incinerators are investigated. • Their Os levels and Os isotopic signatures are discussed. • An estimate of Os release from incinerators and incinerated ashes is given. • Os contamination from incineration plants impacts the geochemical Os cycle.

  1. Modelling the impacts of barrier-island transgression and anthropogenic disturbance on blue carbon budgets

    Science.gov (United States)

    Theuerkauf, E. J.; Rodriguez, A. B.

    2017-12-01

    The size of backbarrier saltmarsh carbon reservoirs are dictated by transgressive processes, such as erosion and overwash, yet these processes are not included in blue carbon budgets. These carbon reservoirs are presumed to increase through time if marsh elevation is keeping pace with sea-level rise. However, changes in marsh width due to erosion and overwash can alter carbon budgets and reservoirs. To explore the impacts of these processes on transgressive barrier island carbon budgets and reservoirs we developed and tested a transect model. The model couples a carbon storage term driven by backbarrier marsh width and a carbon export term driven by ocean and backbarrier shoreline erosion. We tested the model using data collected from two transgressive barrier islands in North Carolina with different backbarrier settings. Core Banks is an undeveloped barrier island with a wide backbarrier marsh and lagoon, hence, landward migration of the island (rollover) is unimpeded. Barrier rollover is impeded at Onslow Beach as there is no backbarrier lagoon and the island is immediately adjacent to steeper mainland topography. Sediment cores were collected to determine carbon storage rates as well as the quantity of carbon exported from eroding marsh. Backbarrier marsh erosion rates, ocean shoreline erosion rates, and changes in marsh width were determined from aerial photographs. Output from the model indicated that hurricane erosion and overwash as well as human disturbance from the construction of the Intracoastal Waterway temporarily transitioned the Onslow Beach sites to carbon sources. Through time, the carbon reservoir at this barrier continued to decrease as carbon export outpaced carbon storage. The carbon reservoir will continue to exhaust as the ocean shoreline migrates landward given the inability for new marsh to form during island rollover. At Core Banks, barrier rollover is unimpeded and new saltmarsh can form during transgression. The Core Banks site only

  2. Budget impact of somatostatin analogs as treatment for metastatic gastroenteropancreatic neuroendocrine tumors in US hospitals

    Directory of Open Access Journals (Sweden)

    Ortendahl JD

    2017-08-01

    Full Text Available Jesse D Ortendahl,1 Sonia J Pulgar,2 Beloo Mirakhur,3 David Cox,3 Tanya GK Bentley,1 Alexandria T Phan4 1Health Economics, Partnership for Health, LLC, Beverly Hills, CA, USA; 2Health Economics and Outcomes Research, Ipsen Biopharmaceuticals, Basking Ridge, NJ, USA; 3Medical Affairs, Oncology, Ipsen Biopharmaceuticals, Basking Ridge, NJ, USA; 4GI Medical Oncology, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA Objective: With the introduction of new therapies, hospitals have to plan spending limited resources in a cost-effective manner. To assist in identifying the optimal treatment for patients with locally advanced or metastatic gastroenteropancreatic neuroendocrine tumors, budget impact modeling was used to estimate the financial implications of adoption and diffusion of somatostatin analogs (SSAs. Patients and methods: A hypothetical cohort of 500 gastroenteropancreatic neuroendocrine tumor patients was assessed in an economic model, with the proportion with metastatic disease treated with an SSA estimated using published data. Drug acquisition, preparation, and administration costs were based on national pricing databases and published literature. Octreotide dosing was based on published estimates of real-world data, whereas for lanreotide, real-world dosing was unavailable and we therefore used the highest indicated dosing. Alternative scenarios reflecting the proportion of patients receiving lanreotide or octreotide were considered to estimate the incremental budget impact to the hospital. Results: In the base case, 313 of the initial 500 gastroenteropancreatic neuroendocrine tumor patients were treated with an SSA. The model-predicted per-patient cost was US$83,473 for lanreotide and US$89,673 for octreotide. With a hypothetical increase in lanreotide utilization from 5% to 30% of this population, the annual model-projected hospital costs decreased by US$488,615. When varying the inputs in one-way sensitivity

  3. Economic benefits of safety-engineered sharp devices in Belgium - a budget impact model.

    Science.gov (United States)

    Hanmore, Emma; Maclaine, Grant; Garin, Fiona; Alonso, Alexander; Leroy, Nicolas; Ruff, Lewis

    2013-11-25

    Measures to protect healthcare workers where there is risk of injury or infection from medical sharps became mandatory in the European Union (EU) from May 2013. Our research objective was to estimate the net budget impact of introducing safety-engineered devices (SEDs) for prevention of needlestick injuries (NSIs) in a Belgian hospital. A 5-year incidence-based budget impact model was developed from the hospital inpatient perspective, comparing costs and outcomes with SEDs and prior-used conventional (non-safety) devices. The model accounts for device acquisition costs and costs of NSI management in 4 areas of application where SEDs are currently used: blood collection, infusion, injection and diabetes insulin administration. Model input data were sourced from the Institut National d'Assurance Maladie-Invalidité, published studies, clinical guidelines and market research. Costs are discounted at 3%. For a 420-bed hospital, 100% substitution of conventional devices by SEDs is estimated to decrease the cumulative 5-year incidence of NSIs from 310 to 75, and those associated with exposure to blood-borne viral diseases from 60 to 15. Cost savings from managing fewer NSIs more than offset increased device acquisition costs, yielding estimated 5-year overall savings of €51,710. The direction of these results is robust to a range of sensitivity and model scenario analyses. The model was most sensitive to variation in the acquisition costs of SEDs, rates of NSI associated with conventional devices, and the acquisition costs of conventional devices. NSIs are a significant potential risk with the use of sharp devices. The incidence of NSIs and the costs associated with their management can be reduced through the adoption of safer work practices, including investment in SEDs. For a Belgian hospital, the budget impact model reports that the incremental acquisition costs of SEDs are offset by the savings from fewer NSIs. The availability of more robust data for NSI reduction

  4. What is the budget impact of a new treatment or new health technology arriving on the market?

    Science.gov (United States)

    Dervaux, Benoit; Le Fur, Camille; Dubois, Sophie; Josseran, Anne

    2017-02-01

    In France, market access for innovative drugs (level I, II & III improvement of medical service rendered having significant impact on health insurance expenditure) involves medico-economic evaluation. In addition to cost-effectiveness analysis (CEA), budget impact analysis (BIA) can be performed, especially since the sustainability of the health insurance system has become a growing concern for all stakeholders. The members of the Giens 2016 round table discussed the contribution of BIA based on a review of the literature on distribution models, the participants' experiences including experience related to the modalities of hospital assessments, and examples from other countries. The round table established recommendations on four elements of interest: 1: the use of BIA from a contractual point of view - between manufacturers and the French Economic Committee for Health Products - during the price negotiations process, and from a prospective point of view within the framework of the annual review of budget expenditures; the definition of the target population and the rhythm of a health product's distribution are also major elements; 2: the interpretation of BIA results in light of CEA results: for what products and at what moment in the life cycle of these products; 3: the integration of the rhythm of a health product's distribution into the BIA; 4: preoccupations about how the level of health product implementation is integrated into the BIA in terms of opportunity cost and organisational quality for the promoter. Copyright © 2017 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.

  5. Estimation of Hepatitis C Disease Burden and Budget Impact of Treatment Using Health Economic Modeling.

    Science.gov (United States)

    Chhatwal, Jagpreet; Chen, Qiushi; Aggarwal, Rakesh

    2018-06-01

    Oral direct-acting antiviral agents have revolutionized treatment of hepatitis C virus (HCV) infection. Nonetheless, barriers exist to elimination of HCV as a public health threat including low uptake of treatment, limited budget allocations for HCV treatment, and low awareness rates of HCV status among infected people. Mathematical modeling provides a systematic framework to analyze and compare potential solutions and elimination strategies by simulating the HCV epidemic under different conditions. Such models evaluate impact of interventions in advance of implementation. This article describes key components of developing an HCV burden model and illustrates its use by simulating the HCV epidemic in the United States. Copyright © 2018 Elsevier Inc. All rights reserved.

  6. The Impacts of Budget Reductions on Indiana's Public Schools: The Impact of Budget Changes on Student Achievement, Personnel, and Class Size for Public School Corporations in the State of Indiana

    Science.gov (United States)

    Jarman, Del W.; Boyland, Lori G.

    2011-01-01

    In recent years, economic downturn and changes to Indiana's school funding have resulted in significant financial reductions in General Fund allocations for many of Indiana's public school corporations. The main purpose of this statewide study is to examine the possible impacts of these budget reductions on class size and student achievement. This…

  7. Budget Impact of Increasing Market Share of Patient Self-Testing and Patient Self-Management in Anticoagulation

    NARCIS (Netherlands)

    Stevanović, Jelena; Postma, Maarten J.; Le, Hoa H.

    Background: Patient self-testing (PST) and/or patient self-management (PSM) might provide better coagulation care than monitoring at specialized anticoagulation centers. Yet, it remains an underused strategy in the Netherlands. Methods: Budget-impact analyses of current and new market-share

  8. Budget impact and cost-effectiveness: can we afford precision medicine in oncology?

    Science.gov (United States)

    Doble, Brett

    2016-01-01

    Over the past decade there have been remarkable advancements in the understanding of the molecular underpinnings of malignancy. Methods of testing capable of elucidating patients' molecular profiles are now readily available and there is an increased desire to incorporate the information derived from such tests into treatment selection for cancer patients. This has led to more appropriate application of existing treatments as well as the development of a number of innovative and highly effective treatments or what is known collectively as precision medicine. The impact that precision medicine will have on health outcomes is uncertain, as are the costs it will incur. There is, therefore, a need to develop economic evidence and appropriate methods of evaluation to support its implementation to ensure the resources allocated to these approaches are affordable and offer value for money. The market for precision medicine in oncology continues to rapidly expand, placing an increased pressure on reimbursement decision-makers to consider the value and opportunity cost of funding such approaches to care. The benefits of molecular testing can be complex and difficult to evaluate given currently available economic methods, potentially causing a distorted appreciation of their value. Funding decisions of precision medicine will also have far-reaching implications, requiring the consideration of both patient and public perspectives in decision-making. Recommendations to improve the value proposition of precision medicine are, therefore, provided with the hopes of facilitating a better understanding of its impact on outcomes and the overall health budget.

  9. Cost-effectiveness and Budget Impact of Specialized Psychotherapy for Borderline Personality Disorder: A Synthesis of the Evidence.

    Science.gov (United States)

    Wetzelaer, Pim; Lokkerbo, Joran; Arntz, Arnoud; van Aselt, Thea; Smit, Filip; Evers, Silvia

    2017-12-01

    Specialized outpatient psychotherapy for patients with borderline personality disorder (BPD) is expected to reduce their use of other health care resources. It is currently unknown to what extent the costs of providing these interventions can be expected to be offset by a reduction in other health care costs in the Netherlands. To establish the cost-effectiveness and budget impact of specialized outpatient psychotherapy, the estimated incremental costs are synthesized with the estimated incremental effects. We have developed a method for the synthesis of all relevant evidence on clinical effectiveness as well as health care resource use. The aim of this article is to present a method for the synthesis of evidence for cost-effectiveness and budget impact analysis with a specific application to specialized outpatient psychotherapy for borderline personality disorder in the Netherlands. A systematic search of the English-language literature is performed to retrieve evidence on the clinical effectiveness and the health care resource use following 12 months of specialized outpatient psychotherapy for borderline personality disorder. The available evidence is used as an input for a model-based economic evaluation. Simulated patient-level data are used to provide overall estimates of the incremental costs and incremental effects, which serve to assess the cost-effectiveness and budget impact of specialized outpatient psychotherapy for borderline personality disorder in the Netherlands. The results indicate that specialized outpatient psychotherapy for BPD can be considered cost-effective and that its scaling up to Dutch national level would require an investment of 2.367 million (95% C.I.: 1,717,000 - 3,272,000) per 1,000 additional patients with BPD. Sensitivity analyses demonstrated the robustness of our findings in light of several uncertain components and assumptions in our calculations, but also their sensitivity to the choice of included studies based on the

  10. Cost-effectiveness and budget impact analyses of a colorectal cancer screening programme in a high adenoma prevalence scenario using MISCAN-Colon microsimulation model.

    Science.gov (United States)

    Arrospide, Arantzazu; Idigoras, Isabel; Mar, Javier; de Koning, Harry; van der Meulen, Miriam; Soto-Gordoa, Myriam; Martinez-Llorente, Jose Miguel; Portillo, Isabel; Arana-Arri, Eunate; Ibarrondo, Oliver; Lansdorp-Vogelaar, Iris

    2018-04-25

    The Basque Colorectal Cancer Screening Programme began in 2009 and the implementation has been complete since 2013. Faecal immunological testing was used for screening in individuals between 50 and 69 years old. Colorectal Cancer in Basque country is characterized by unusual epidemiological features given that Colorectal Cancer incidence is similar to other European countries while adenoma prevalence is higher. The object of our study was to economically evaluate the programme via cost-effectiveness and budget impact analyses with microsimulation models. We applied the Microsimulation Screening Analysis (MISCAN)-Colon model to predict trends in Colorectal Cancer incidence and mortality and to quantify the short- and long-term effects and costs of the Basque Colorectal Cancer Screening Programme. The model was calibrated to the Basque demographics in 2008 and age-specific Colorectal Cancer incidence data in the Basque Cancer Registry from 2005 to 2008 before the screening begun. The model was also calibrated to the high adenoma prevalence observed for the Basque population in a previously published study. The multi-cohort approach used in the model included all the cohorts in the programme during 30 years of implementation, with lifetime follow-up. Unit costs were obtained from the Basque Health Service and both cost-effectiveness analysis and budget impact analysis were carried out. The goodness-of-fit of the model adaptation to observed programme data was evidence of validation. In the cost-effectiveness analysis, the savings from treatment were larger than the added costs due to screening. Thus, the Basque programme was dominant compared to no screening, as life expectancy increased by 29.3 days per person. The savings in the budget analysis appeared 10 years after the complete implementation of the programme. The average annual budget was €73.4 million from year 2023 onwards. This economic evaluation showed a screening intervention with a major health gain

  11. Healthcare resource consumption for intermittent urinary catheterisation: cost-effectiveness of hydrophilic catheters and budget impact analyses.

    Science.gov (United States)

    Rognoni, Carla; Tarricone, Rosanna

    2017-01-17

    This study presents a cost-effectiveness analysis comparing hydrophilic coated to uncoated catheters for patients performing urinary intermittent catheterisation. A national budget impact analysis is also included to evaluate the impact of intermittent catheterisation for management of bladder dysfunctions over a period of 5 years. A Markov model (lifetime horizon, 1 year cycle length) was developed to project health outcomes (life years and quality-adjusted life years) and economic consequences related to patients using hydrophilic coated or uncoated catheters. The model was populated with catheter-related clinical efficacy data retrieved from randomised controlled trials and quality-of-life data (utility weights) from the literature. Cost data (EUR, 2015) were estimated on the basis of healthcare resource consumption derived from an e-survey addressed to key opinion leaders in the field. Italian Healthcare Service perspective. Patients with spinal cord injury performing intermittent urinary catheterisation in the home setting. Incremental cost-effectiveness and cost-utility ratios (ICER and ICUR) of hydrophilic coated versus uncoated catheters and associated healthcare budget impact. The base-case ICER and ICUR associated with hydrophilic coated catheters were €20 761 and €24 405, respectively. This implies that hydrophilic coated catheters are likely to be cost-effective in comparison to uncoated ones, as proposed Italian threshold values range between €25 000 and €66 400. Considering a market share at year 5 of 89% hydrophilic catheters and 11% uncoated catheters, the additional cost for Italy is approximately €12 million in the next 5 years (current market share scenario for year 0: 80% hydrophilic catheters and 20% uncoated catheters). Considered over a lifetime, hydrophilic coated catheters are potentially a cost-effective choice in comparison to uncoated ones. These findings can assist policymakers in evaluating intermittent

  12. Annuity payments can increase patient access to innovative cell and gene therapies under England's net budget impact test.

    Science.gov (United States)

    Jørgensen, Jesper; Kefalas, Panos

    2017-01-01

    Background: Cell and gene therapies have the potential to provide therapeutic breakthroughs, but the high costs of researching, developing, manufacturing and delivering them translate into prices that may challenge healthcare budgets. Various measures exist that aim to address the affordability challenge, including reducing price, limiting patient numbers and/or linking remuneration to product performance. Objective: To explore how the net budget impact test recently introduced in England can affect patient access to high-value, one-off cell and gene therapies, and how managed entry agreements can improve access. Methods: We use a hypothetical example where a new high-value, one-off therapy launches in an indication where it displaces a relatively low cost chronic treatment. We calculate the number of patients that can be treated without exceeding the £20 million net budget impact threshold, and compare results for scenarios where a full upfront payment is used, and where annuity-based payments are used. Results : Charging a full upfront payment at the time of treatment can lead to suboptimal patient access. Conclusion: Annuity-based payments in combination with an outcomes-based remuneration scheme reduce consequences of decision uncertainty and can increase patient access, without exceeding the net budget impact test.

  13. IMPACT OF EXTERNAL REIMBURSABLE FINANING ON VAT RECEIPTS IN THE STATE BUDGET OF THE REPUBLIC OF MOLDOVA

    Directory of Open Access Journals (Sweden)

    Marcel OLARI

    2017-04-01

    Full Text Available Under the current conditions, where rapid economic growth is an important prerequisite for improving the well-being of the population and reducing poverty, the state, being an important player on the economic arena of the Republic of Moldova, attracts external sources of reimbursable financing to support the budget and to carry out investment projects. Taking into account that these external sources increase the Central Government debt, generate the payment of certain interest, commissions, directly affect the expenditures of the state budget, I intended to investigate the impact of these reimbursable external sources on the one category of revenues of the state budget of the Republic of Moldova, (Value Added Tax receipts, in the light of the service and merchandise deliveries according to the transactions emerged from the contracted external reimbursable financing sources.

  14. Budget impact of polio immunization strategy for India: introduction of one dose of inactivated poliomyelitis vaccine and reductions in supplemental polio immunization.

    Science.gov (United States)

    Khan, M M; Sharma, S; Tripathi, B; Alvarez, F P

    2017-01-01

    To conduct a budget impact analysis (BIA) of introducing the immunization recommendations of India Expert Advisory Group (IEAG) for the years 2015-2017. The recommendations include introduction of one inactivated poliomyelitis vaccine (IPV) dose in the regular child immunization programme along with reductions in oral polio vaccine (OPV) doses in supplemental programmes. This is a national level analysis of budget impact of new polio immunization recommendations. Since the states of India vary widely in terms of size, vaccine coverage and supplemental vaccine needs, the study estimated the budget impact for each of the states of India separately to derive the national level budget impact. Based on the recommendations of IEAG, the BIA assumes that all children in India will get an IPV dose at 14 weeks of age in addition to the OPV and DPT (or Pentavalent-3) doses. Cost of introducing the IPV dose was estimated by considering vaccine price and vaccine delivery and administration costs. The cost savings associated with the reduction in number of doses of OPV in supplemental immunization were also estimated. The analysis used India-specific or international cost parameters to estimate the budget impact. Introduction of one IPV dose will increase the cost of vaccines in the regular immunization programme from $20 million to $47 million. Since IEAG recommends lower intensity of supplemental OPV vaccination, polio vaccine cost of supplemental programme is expected to decline from $72 million to $53 million. Cost of administering polio vaccines will also decline from $124 million to $105 million mainly due to the significantly lower intensity of supplemental polio vaccination. The net effect of adopting IEAG's recommendations on polio immunization turns out to be cost saving for India, reducing total polio immunization cost by $6 million. Additional savings could be achieved if India adopts the new policy regarding the handling of multi-dose vials after opening

  15. The water budget of heterogeneous areas : impact of soil and rainfall variability

    NARCIS (Netherlands)

    Kim, C.P.

    1995-01-01

    In this thesis the heterogeneity of the soil water budget components is investigated. Heterogeneity of soil hydraulic properties and rainfall rate are taken into account by using stochastic methods. The importance of lateral groundwater flow in causing heterogeneity of the water budget

  16. Beyond Zero Based Budgeting.

    Science.gov (United States)

    Ogden, Daniel M., Jr.

    1978-01-01

    Suggests that the most practical budgeting system for most managers is a formalized combination of incremental and zero-based analysis because little can be learned about most programs from an annual zero-based budget. (Author/IRT)

  17. The Impact of Internal Wave Seasonality on the Continental Shelf Energy Budget

    Science.gov (United States)

    Wihsgott, Juliane U.; Sharples, Jonathan; Hopkins, Joanne; Palmer, Matthew R.; Mattias Green, J. A.

    2017-04-01

    Heating-stirring models are widely used to simulate the timing and strength of stratification in continental shelf environments. Such models are based on bulk potential energy (PE) budgets: the loss of PE due to thermal stratification is balanced by wind and tidal mixing. The model often fails to accurately predict the observed vertical structure, as it only considers forces acting on the surface and bottom boundary of the water column. This highlights the need for additional internal energy sources to close this budget, and produce an accurate seasonal cycle of stratification. We present new results that test the impact of boundary layer and internal wave forcing on stratification and vertical density structure in continental shelves. A new series of continuous measurements of full water depth vertical structure, dynamics and meteorological data spanning 17 months (March'14-July'15) provide unprecedented coverage over a full seasonal cycle at a station 120 km north-east from the continental shelf break. We observe a highly variable but energetic internal wave field from the onset of stratification that suggests a continuous supply of internal PE. The heating-stirring model reproduces bulk characteristics of the seasonal cycle. While it accurately predicts the timing of the onset in spring and peak stratification in late summer there is a persistent 20 J m-3 positive offset between the model and observations throughout this period. By including a source of internal energy in the model we improve the prediction for the strength of stratification and the vertical distribution of heat. Yet a constant source of PE seems to result in a seasonal discrepancy resulting in too little mixing during strong stratification and too much mixing during transient periods. The discrepancy seen in the model is consistent with the seasonality observed in the internal wave field. We will establish the role that changing stratification (N2) exerts on the internal wave field and vice

  18. Audit of the global carbon budget: estimate errors and their impact on uptake uncertainty

    Science.gov (United States)

    Ballantyne, A. P.; Andres, R.; Houghton, R.; Stocker, B. D.; Wanninkhof, R.; Anderegg, W.; Cooper, L. A.; DeGrandpre, M.; Tans, P. P.; Miller, J. B.; Alden, C.; White, J. W. C.

    2015-04-01

    Over the last 5 decades monitoring systems have been developed to detect changes in the accumulation of carbon (C) in the atmosphere and ocean; however, our ability to detect changes in the behavior of the global C cycle is still hindered by measurement and estimate errors. Here we present a rigorous and flexible framework for assessing the temporal and spatial components of estimate errors and their impact on uncertainty in net C uptake by the biosphere. We present a novel approach for incorporating temporally correlated random error into the error structure of emission estimates. Based on this approach, we conclude that the 2σ uncertainties of the atmospheric growth rate have decreased from 1.2 Pg C yr-1 in the 1960s to 0.3 Pg C yr-1 in the 2000s due to an expansion of the atmospheric observation network. The 2σ uncertainties in fossil fuel emissions have increased from 0.3 Pg C yr-1 in the 1960s to almost 1.0 Pg C yr-1 during the 2000s due to differences in national reporting errors and differences in energy inventories. Lastly, while land use emissions have remained fairly constant, their errors still remain high and thus their global C uptake uncertainty is not trivial. Currently, the absolute errors in fossil fuel emissions rival the total emissions from land use, highlighting the extent to which fossil fuels dominate the global C budget. Because errors in the atmospheric growth rate have decreased faster than errors in total emissions have increased, a ~20% reduction in the overall uncertainty of net C global uptake has occurred. Given all the major sources of error in the global C budget that we could identify, we are 93% confident that terrestrial C uptake has increased and 97% confident that ocean C uptake has increased over the last 5 decades. Thus, it is clear that arguably one of the most vital ecosystem services currently provided by the biosphere is the continued removal of approximately half of atmospheric CO2 emissions from the atmosphere

  19. An Analysis of improvisational budgeting from calendar year 1990 to 1999

    OpenAIRE

    Buell, Richard C.

    2002-01-01

    Approved for public release, distribution is unlimited Improvisational budgeting represents an interruption to the normal budgeting process, resulting in costly delays to the defense Planning Programming and Budgeting Process (PPBS). A normal congressional budget process was characterized by Congress' ability to follow established procedures, complete their budget in a timely manner and fulfill their expected roles for applying incremental adjustments to the budget. The latent pro-spending...

  20. Analysis of stream temperature and heat budget in an urban river under strong anthropogenic influences

    Science.gov (United States)

    Xin, Zhuohang; Kinouchi, Tsuyoshi

    2013-05-01

    Stream temperature variations of the Tama River, which runs through highly urbanized areas of Tokyo, were studied in relation to anthropogenic impacts, including wastewater effluents, dam release and water withdrawal. Both long-term and longitudinal changes in stream temperature were identified and the influences of stream flow rate, temperature and volume of wastewater effluents and air temperature were investigated. Water and heat budget analyses were also conducted for several segments of the mainstream to clarify the relative impacts from natural and anthropogenic factors. Stream temperatures in the winter season significantly increased over the past 20 years at sites affected by intensive and warm effluents from wastewater treatment plants (WWTPs) located along the mainstream. In the summer season, a larger stream temperature increase was identified in the upstream reaches, which was attributable to the decreased flow rate due to water withdrawal. The relationship between air and stream temperatures indicated that stream temperatures at the upstream site were likely to be affected by a dam release, while temperatures in the downstream reaches have deviated more from air temperatures in recent years, probably due to the increased impacts of effluents from WWTPs. Results of the water and heat budget analyses indicated that the largest contributions to water and heat gains were attributable to wastewater effluents, while other factors such as groundwater recharge and water withdrawal were found to behave as energy sinks, especially in summer. The inflow from tributaries worked to reduce the impacts of dam release and the heat exchanges at the air-water interface contributed less to heat budgets in both winter and summer seasons for all river segments.

  1. An Analysis of Improvisational Budgeting from Calendar Year 1990 to 1999

    National Research Council Canada - National Science Library

    Buell, Richard

    2002-01-01

    ...). A normal congressional budget process was characterized by Congress' ability to follow established procedures, complete their budget in a timely manner and fulfill their expected roles for applying...

  2. Carbon budget of oligotrophic mires in the Southern Taiga of Western Siberia under anthropogenic impact

    Science.gov (United States)

    Golovatskaya, Eugenia; Dyukarev, Egor

    2010-05-01

    Role of peatlands in the global greenhouse gases budget is highly relevant. According to present estimates peatlands in undisturbed conditions act as a sink for the atmospheric carbon. Anthropogenic impact on peatlands (melioration, changes in land use, influence of underground water catchments) results in water table lowering, changing in vegetation cover, and degradation of peat deposit. Peatlands could provide a significant positive feedback for climate changes if warming and peatlands drying stimulates bulk soil organic matter decomposition which enhances CO2 release to the atmosphere. Western Siberian peatlands usually represented big bog massifs. Big peatlands have higher stability to external influence. Small peatlands have all signs of big bogs but react on changes in environmental variables more quickly. The present study is devoted to investigation of primary carbon fluxes (CO2 emission and net primary productivity) and carbon balance at oligotrophic bogs in native condition (key area "Bakchar") and under anthropogenic impact (key area "Ob'-Tom'"). The key area "Bakchar" is located between the Iksa and Bakchar rivers (56o58`N 82o36`E) at the Bakcharskoe bog (area 1400 km2). The key area "Ob'-Tom'"is located in the northern part of Ob' and Tom' interfluve (56o21`N 82o31`E). The "Bakchar" key area includes the following ecosystems: pine- shrub-sphagnum community, a similar community with stunted (low) pine trees, and sedge-sphagnum fen. Two small peatlands were studied at Ob' and Tom' interfluve. Kirsanovskoe bog includes pine- shrub-sphagnum community and sedge fen. Timiryazevskoe bog was represented by pine- shrub-sphagnum (TPSS) community and sedge fen. An infrared gas analyzer OPTOGAS 500.4 (OPTEC Corp., St.-Petersburg, Russia) attached to a static opaque plastic been used for carbon dioxide emission measurements. The net primary productivity was measured by clipping method (Golovatskaya and Dyukarev, Plant Soil 2009). Peatlands at "Ob'-Tom'" key area

  3. The Long Term Impact of Budget Deficits on Economic Growth In ...

    African Journals Online (AJOL)

    There were significant positive long-run relationships between the capital stock, ... however, be to use the budget to create the necessary public investments in capital ... linkages with agriculture and industry to generate good future returns.

  4. Estimating the impact of state budget cuts and redirection of prevention resources on the HIV epidemic in 59 California local health departments.

    Science.gov (United States)

    Lin, Feng; Lasry, Arielle; Sansom, Stephanie L; Wolitski, Richard J

    2013-01-01

    In the wake of a national economic downturn, the state of California, in 2009-2010, implemented budget cuts that eliminated state funding of HIV prevention and testing. To mitigate the effect of these cuts remaining federal funds were redirected. This analysis estimates the impact of these budget cuts and reallocation of resources on HIV transmission and associated HIV treatment costs. We estimated the effect of the budget cuts and reallocation for California county health departments (excluding Los Angeles and San Francisco) on the number of individuals living with or at-risk for HIV who received HIV prevention services. We used a Bernoulli model to estimate the number of new infections that would occur each year as a result of the changes, and assigned lifetime treatment costs to those new infections. We explored the effect of redirecting federal funds to more cost-effective programs, as well as the potential effect of allocating funds proportionately by transmission category. We estimated that cutting HIV prevention resulted in 55 new infections that were associated with $20 million in lifetime treatment costs. The redirection of federal funds to more cost-effective programs averted 15 HIV infections. If HIV prevention funding were allocated proportionately to transmission categories, we estimated that HIV infections could be reduced below the number that occurred annually before the state budget cuts. Reducing funding for HIV prevention may result in short-term savings at the expense of additional HIV infections and increased HIV treatment costs. Existing HIV prevention funds would likely have a greater impact on the epidemic if they were allocated to the more cost-effective programs and the populations most likely to acquire and transmit the infection.

  5. Global model simulations of the impact of ocean-going ships on aerosols, clouds, and the radiation budget

    Directory of Open Access Journals (Sweden)

    A. Lauer

    2007-10-01

    Full Text Available International shipping contributes significantly to the fuel consumption of all transport related activities. Specific emissions of pollutants such as sulfur dioxide (SO2 per kg of fuel emitted are higher than for road transport or aviation. Besides gaseous pollutants, ships also emit various types of particulate matter. The aerosol impacts the Earth's radiation budget directly by scattering and absorbing the solar and thermal radiation and indirectly by changing cloud properties. Here we use ECHAM5/MESSy1-MADE, a global climate model with detailed aerosol and cloud microphysics to study the climate impacts of international shipping. The simulations show that emissions from ships significantly increase the cloud droplet number concentration of low marine water clouds by up to 5% to 30% depending on the ship emission inventory and the geographic region. Whereas the cloud liquid water content remains nearly unchanged in these simulations, effective radii of cloud droplets decrease, leading to cloud optical thickness increase of up to 5–10%. The sensitivity of the results is estimated by using three different emission inventories for present-day conditions. The sensitivity analysis reveals that shipping contributes to 2.3% to 3.6% of the total sulfate burden and 0.4% to 1.4% to the total black carbon burden in the year 2000 on the global mean. In addition to changes in aerosol chemical composition, shipping increases the aerosol number concentration, e.g. up to 25% in the size range of the accumulation mode (typically >0.1 μm over the Atlantic. The total aerosol optical thickness over the Indian Ocean, the Gulf of Mexico and the Northeastern Pacific increases by up to 8–10% depending on the emission inventory. Changes in aerosol optical thickness caused by shipping induced modification of aerosol particle number concentration and chemical composition lead to a change in the shortwave radiation budget at the top of the

  6. Estimated Budget Impact of Adopting the Affordable Care Act's Required Smoking Cessation Coverage on United States Healthcare Payers.

    Science.gov (United States)

    Baker, Christine L; Ferrufino, Cheryl P; Bruno, Marianna; Kowal, Stacey

    2017-01-01

    Despite abundant information on the negative impacts of smoking, more than 40 million adult Americans continue to smoke. The Affordable Care Act (ACA) requires tobacco cessation as a preventive service with no patient cost share for all FDA-approved cessation medications. Health plans have a vital role in supporting smoking cessation by managing medication access, but uncertainty remains on the gaps between smoking cessation requirements and what is actually occurring in practice. This study presents current cessation patterns, real-world drug costs and plan benefit design data, and estimates the 1- to 5-year pharmacy budget impact of providing ACA-required coverage for smoking cessation products to understand the fiscal impact to a US healthcare plan. A closed cohort budget impact model was developed in Microsoft Excel ® to estimate current and projected costs for US payers (commercial, Medicare, Medicaid) covering smoking cessation medicines, with assumptions for coverage and smoking cessation product utilization based on current, real-world national and state-level trends for hypothetical commercial, Medicare, and Medicaid plans with 1 million covered lives. A Markov methodology with five health states captures quit attempt and relapse patterns. Results include the number of smokers attempting to quit, number of successful quitters, annual costs, and cost per-member per-month (PMPM). The projected PMPM cost of providing coverage for smoking cessation medications is $0.10 for commercial, $0.06 for Medicare, and $0.07 for Medicaid plans, reflecting a low incremental PMPM impact of covering two attempts ranging from $0.01 for Medicaid to $0.02 for commercial and Medicare payers. The projected PMPM impact of covering two quit attempts with access to all seven cessation medications at no patient cost share remains low. Results of this study reinforce that the impact of adopting the ACA requirements for smoking cessation coverage will have a limited near-term impact

  7. National Security Mission, Members and Budgeting in the United States and Australia: A Comparative Analysis

    Science.gov (United States)

    2011-06-01

    order for the budget to be formulated and approved. The budget process is summed up by the Australian Department of Finance and Deregulation : The...91 Australian Government: Department of Finance and Deregulation , Budget Process: The Australian Budget Process...Department of Energy (DOE) Insuring the integrity and safety of the country‘s nuclear weapons; promoting international nuclear safety; advancing

  8. Improving the quality of percutaneous revascularisation in patients with multivessel disease in Australia: cost-effectiveness, public health implications, and budget impact of FFR-guided PCI.

    Science.gov (United States)

    Siebert, Uwe; Arvandi, Marjan; Gothe, Raffaella M; Bornschein, Bernhard; Eccleston, David; Walters, Darren L; Rankin, James; De Bruyne, Bernard; Fearon, William F; Pijls, Nico H; Harper, Richard

    2014-06-01

    The international multicentre FAME Study (n=1,005) demonstrated significant health benefits for patients undergoing multivessel percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) measurement compared with angiography guidance alone (ANGIO). We determined the cost-effectiveness and the public health/budget impact for Australia. We performed a prospective economic evaluation comparing FFR vs. ANGIO in patients with multivessel disease based on original patient-level FAME data. We used Australian utilities (EQ-5D) and costs to calculate quality-adjusted life years (QALYs) and incremental cost-effectiveness adopting the societal perspective. The public health and budget impact from the payer's perspective was based on Australian PCI registries. Uncertainty was explored using deterministic sensitivity analyses and the bootstrap method (n=5,000 samples). The cost-effectiveness analysis showed that FFR was cost-saving and reduces costs by 1,776 AUD per patient during one year. Over a two-year time horizon, the public health impact ranged from 7.8 to 73.9 QALYs gained and the budget impact from 1.8 to 14.5 million AUD total cost savings. Sensitivity analyses demonstrated that FFR was cost-saving over a wide range of assumptions. FFR-guided PCI in patients with multivessel coronary disease substantially reduces cardiac events, improves QALYs and is cost-saving in the Australian health care system. Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  9. The cost-effectiveness and budget impact of stepwise addition of bolus insulin in the treatment of type 2 diabetes: evaluation of the FullSTEP trial.

    Science.gov (United States)

    Saunders, Rhodri; Lian, Jean; Karolicki, Boris; Valentine, William

    2014-12-01

    Abstract Background and aims: Intensification of basal insulin-only therapy in type 2 diabetes is often achieved through addition of bolus insulin 3-times daily. The FullSTEP trial demonstrated that stepwise addition (SWA) of bolus insulin aspart was non-inferior to full basal-bolus (FBB) therapy and reduced the rate of hypoglycemia. Here the cost-effectiveness and budget impact of SWA is evaluated. Cost-effectiveness and budget impact models were developed to assess the cost and quality-of-life (QoL) implications of intensification using SWA compared with FBB in the US setting. At assessment, SWA patients added one bolus dose to their current regimen if the HbA1c target was not met. SWA patients reaching three bolus doses used FBB event rates. Outcomes were evaluated at trial end and projected annually up to 5 years. Models captured hypoglycemic events, the proportion meeting HbA1c target, and self-measured blood glucose. Event rates and QoL utilities were taken from trial data and published literature. Costs were evaluated from a healthcare-payer perspective, reported in 2013 USD, and discounted (like clinical outcomes) at 3.5% annually. This analysis applies to patients with HbA1c 7.0-9.0% and body mass index Budget impact analysis estimated that, by moving from FBB to SWA, a health plan with 77,000 patients with type 2 diabetes, of whom 7.8% annually intensified to basal-bolus therapy, would save USD 1304 per intensifying patient over the trial period. SWA of bolus insulin should be considered a beneficial and cost-saving alternative to FBB therapy for the intensification of treatment in type 2 diabetes.

  10. Impact of shrinking measurement error budgets on qualification metrology sampling and cost

    Science.gov (United States)

    Sendelbach, Matthew; Sarig, Niv; Wakamoto, Koichi; Kim, Hyang Kyun (Helen); Isbester, Paul; Asano, Masafumi; Matsuki, Kazuto; Vaid, Alok; Osorio, Carmen; Archie, Chas

    2014-04-01

    When designing an experiment to assess the accuracy of a tool as compared to a reference tool, semiconductor metrologists are often confronted with the situation that they must decide on the sampling strategy before the measurements begin. This decision is usually based largely on the previous experience of the metrologist and the available resources, and not on the statistics that are needed to achieve acceptable confidence limits on the final result. This paper shows a solution to this problem, called inverse TMU analysis, by presenting statistically-based equations that allow the user to estimate the needed sampling after providing appropriate inputs, allowing him to make important "risk vs. reward" sampling, cost, and equipment decisions. Application examples using experimental data from scatterometry and critical dimension scanning electron microscope (CD-SEM) tools are used first to demonstrate how the inverse TMU analysis methodology can be used to make intelligent sampling decisions before the start of the experiment, and then to reveal why low sampling can lead to unstable and misleading results. A model is developed that can help an experimenter minimize the costs associated both with increased sampling and with making wrong decisions caused by insufficient sampling. A second cost model is described that reveals the inadequacy of current TEM (Transmission Electron Microscopy) sampling practices and the enormous costs associated with TEM sampling that is needed to provide reasonable levels of certainty in the result. These high costs reach into the tens of millions of dollars for TEM reference metrology as the measurement error budgets reach angstrom levels. The paper concludes with strategies on how to manage and mitigate these costs.

  11. Budget Options

    National Research Council Canada - National Science Library

    2000-01-01

    This volume-part of the Congressional Budget Office's (CBO's) annual report to the House and Senate Committees on the Budget-is intended to help inform policymakers about options for the federal budget...

  12. Cost-effectiveness and budget impact of the fixed-dose dual bronchodilator combination tiotropium–olodaterol for patients with COPD in the Netherlands

    Directory of Open Access Journals (Sweden)

    van Boven JF

    2016-09-01

    Full Text Available Job FM van Boven,1,2 Janwillem WH Kocks,2 Maarten J Postma1,3,4 1Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics, 2Department of General Practice, Groningen Research Institute for Asthma and COPD (GRIAC, 3Institute of Science in Healthy Aging & healthcaRE (SHARE, 4Department of Epidemiology, University Medical Center Groningen (UMCG, University of Groningen, Groningen, the Netherlands Purpose: The fixed-dose dual bronchodilator combination (FDC of tiotropium and olodaterol showed increased effectiveness regarding lung function and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD compared with the use of its mono-components. Yet, while effectiveness and safety have been shown, the health economic implication of this treatment is still unknown. The aim of this study was to assess the cost–utility and budget impact of tiotropium–olodaterol FDC in patients with moderate to very severe COPD in the Netherlands.Patients and methods: A cost–utility study was performed, using an individual-level Markov model. To populate the model, individual patient-level data (age, height, sex, COPD duration, baseline forced expiratory volume in 1 second were obtained from the tiotropium–olodaterol TOnado trial. In the model, forced expiratory volume in 1 second and patient-level data were extrapolated to utility and survival, and treatment with tiotropium–olodaterol FDC was compared with tiotropium. Cost–utility analysis was performed from the Dutch health care payer’s perspective using a 15-year time horizon in the base-case analysis. The standard Dutch discount rates were applied (costs: 4.0%; effects: 1.5%. Both univariate and probabilistic sensitivity analyses were performed. Budget impact was annually assessed over a 5-year time horizon, taking into account different levels of medication adherence.Results: As a result of cost increases, combined with quality-adjusted life-year (QALY

  13. Resolving the "Cost-Effective but Unaffordable" Paradox: Estimating the Health Opportunity Costs of Nonmarginal Budget Impacts.

    Science.gov (United States)

    Lomas, James; Claxton, Karl; Martin, Stephen; Soares, Marta

    2018-03-01

    Considering whether or not a proposed investment (an intervention, technology, or program of care) is affordable is really asking whether the benefits it offers are greater than its opportunity cost. To say that an investment is cost-effective but not affordable must mean that the (implicit or explicit) "threshold" used to judge cost-effectiveness does not reflect the scale and value of the opportunity costs. Existing empirical estimates of health opportunity costs are based on cross-sectional variation in expenditure and mortality outcomes by program budget categories (PBCs) and do not reflect the likely effect of nonmarginal budget impacts on health opportunity costs. The UK Department of Health regularly updates the needs-based target allocation of resources to local areas of the National Health Service (NHS), creating two subgroups of local areas (those under target allocation and those over). These data provide the opportunity to explore how the effects of changes in health care expenditure differ with available resources. We use 2008-2009 data to evaluate two econometric approaches to estimation and explore a range of criteria for accepting subgroup specific effects for differences in expenditure and outcome elasticities across the 23 PBCs. Our results indicate that health opportunity costs arising from an investment imposing net increases in expenditure are underestimated unless account is taken of likely nonmarginal effects. They also indicate the benefits (reduced health opportunity costs or increased value-based price of a technology) of being able to "smooth" these nonmarginal budget impacts by health care systems borrowing against future budgets or from manufacturers offering "mortgage" type arrangements. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  14. Guidelines for conducting pharmaceutical budget impact analyses for submission to public drug plans in Canada.

    Science.gov (United States)

    Marshall, Deborah A; Douglas, Patrick R; Drummond, Michael F; Torrance, George W; Macleod, Stuart; Manti, Orlando; Cheruvu, Lokanadha; Corvari, Ron

    2008-01-01

    Until now, there has been no standardized method of performing and presenting budget impact analyses (BIAs) in Canada. Nevertheless, most drug plan managers have been requiring this economic data to inform drug reimbursement decisions. This paper describes the process used to develop the Canadian BIA Guidelines; describes the Guidelines themselves, including the model template; and compares this guidance with other guidance on BIAs. The intended audience includes those who develop, submit or use BIA models, and drug plan managers who evaluate BIA submissions. The Patented Medicine Prices Review Board (PMPRB) initiated the development of the Canadian BIA Guidelines on behalf of the National Prescription Drug Utilisation Information System (NPDUIS). The findings and recommendations from a needs assessment with respect to BIA submissions were reviewed to inform guideline development. In addition, a literature review was performed to identify existing BIA guidance. The detailed guidance was developed on this basis, and with the input of the NPDUIS Advisory Committee, including drug plan managers from multiple provinces in Canada and a representative from the Canadian Agency for Drugs and Technologies in Health. A Microsoft Excel-based interactive model template was designed to support BIA model development. Input regarding the guidelines and model template was sought from each NPDUIS Advisory Committee member to ensure compatibility with existing drug plan needs. Decisions were made by consensus through multiple rounds of review and discussion. Finally, BIA guidance in Canadian provinces and other countries were compared on the basis of multiple criteria. The BIA guidelines consist of three major sections: Analytic Framework, Inputs and Data Sources, and Reporting Format. The Analytic Framework section contains a discussion of nine general issues surrounding BIAs (model design, analytic perspective, time horizon, target population, costing, scenarios to be compared

  15. Impacts of cloud overlap assumptions on radiative budgets and heating fields in convective regions

    Science.gov (United States)

    Wang, XiaoCong; Liu, YiMin; Bao, Qing

    2016-01-01

    Impacts of cloud overlap assumptions on radiative budgets and heating fields are explored with the aid of a cloud-resolving model (CRM), which provided cloud geometry as well as cloud micro and macro properties. Large-scale forcing data to drive the CRM are from TRMM Kwajalein Experiment and the Global Atmospheric Research Program's Atlantic Tropical Experiment field campaigns during which abundant convective systems were observed. The investigated overlap assumptions include those that were traditional and widely used in the past and the one that was recently addressed by Hogan and Illingworth (2000), in which the vertically projected cloud fraction is expressed by a linear combination of maximum and random overlap, with the weighting coefficient depending on the so-called decorrelation length Lcf. Results show that both shortwave and longwave cloud radiative forcings (SWCF/LWCF) are significantly underestimated under maximum (MO) and maximum-random (MRO) overlap assumptions, whereas remarkably overestimated under the random overlap (RO) assumption in comparison with that using CRM inherent cloud geometry. These biases can reach as high as 100 Wm- 2 for SWCF and 60 Wm- 2 for LWCF. By its very nature, the general overlap (GenO) assumption exhibits an encouraging performance on both SWCF and LWCF simulations, with the biases almost reduced by 3-fold compared with traditional overlap assumptions. The superiority of GenO assumption is also manifested in the simulation of shortwave and longwave radiative heating fields, which are either significantly overestimated or underestimated under traditional overlap assumptions. The study also pointed out the deficiency of constant assumption on Lcf in GenO assumption. Further examinations indicate that the CRM diagnostic Lcf varies among different cloud types and tends to be stratified in the vertical. The new parameterization that takes into account variation of Lcf in the vertical well reproduces such a relationship and

  16. Impact of climate change on tropospheric ozone and its global budgets

    Directory of Open Access Journals (Sweden)

    G. Zeng

    2008-01-01

    Full Text Available We present the chemistry-climate model UMCAM in which a relatively detailed tropospheric chemical module has been incorporated into the UK Met Office's Unified Model version 4.5. We obtain good agreements between the modelled ozone/nitrogen species and a range of observations including surface ozone measurements, ozone sonde data, and some aircraft campaigns.

    Four 2100 calculations assess model responses to projected changes of anthropogenic emissions (SRES A2, climate change (due to doubling CO2, and idealised climate change-associated changes in biogenic emissions (i.e. 50% increase of isoprene emission and doubling emissions of soil-NOx. The global tropospheric ozone burden increases significantly for all the 2100 A2 simulations, with the largest response caused by the increase of anthropogenic emissions. Climate change has diverse impacts on O3 and its budgets through changes in circulation and meteorological variables. Increased water vapour causes a substantial ozone reduction especially in the tropical lower troposphere (>10 ppbv reduction over the tropical ocean. On the other hand, an enhanced stratosphere-troposphere exchange of ozone, which increases by 80% due to doubling CO2, contributes to ozone increases in the extratropical free troposphere which subsequently propagate to the surface. Projected higher temperatures favour ozone chemical production and PAN decomposition which lead to high surface ozone levels in certain regions. Enhanced convection transports ozone precursors more rapidly out of the boundary layer resulting in an increase of ozone production in the free troposphere. Lightning-produced NOx increases by about 22% in the doubled CO2 climate and contributes to ozone production.

    The response to the increase of isoprene emissions shows that the change of ozone is largely determined by background NOx levels: high

  17. Impacts of Climate Change and Land use Changes on Land Surface Radiation and Energy Budgets

    Science.gov (United States)

    Land surface radiation and energy budgets are critical to address a variety of scientific and application issues related to climate trends, weather predictions, hydrologic and biogeophysical modeling, and the monitoring of ecosystem health and agricultural crops. This is an introductory paper to t...

  18. Congressional Budget Action for Fiscal Year 2012 and Its Impact on Education Funding. Issue Brief

    Science.gov (United States)

    Delisle, Jason

    2011-01-01

    The fiscal year 2012 budget process has been anything but typical or predictable. While fiscal year 2012 starts in just a few weeks on October 1, 2011, the annual appropriations process is far from complete, and funding for federal education programs has not yet been finalized. Nevertheless, congressional action in the months that have led up to…

  19. CDO budgeting

    Science.gov (United States)

    Nesladek, Pavel; Wiswesser, Andreas; Sass, Björn; Mauermann, Sebastian

    2008-04-01

    The Critical dimension off-target (CDO) is a key parameter for mask house customer, affecting directly the performance of the mask. The CDO is the difference between the feature size target and the measured feature size. The change of CD during the process is either compensated within the process or by data correction. These compensation methods are commonly called process bias and data bias, respectively. The difference between data bias and process bias in manufacturing results in systematic CDO error, however, this systematic error does not take into account the instability of the process bias. This instability is a result of minor variations - instabilities of manufacturing processes and changes in materials and/or logistics. Using several masks the CDO of the manufacturing line can be estimated. For systematic investigation of the unit process contribution to CDO and analysis of the factors influencing the CDO contributors, a solid understanding of each unit process and huge number of masks is necessary. Rough identification of contributing processes and splitting of the final CDO variation between processes can be done with approx. 50 masks with identical design, material and process. Such amount of data allows us to identify the main contributors and estimate the effect of them by means of Analysis of variance (ANOVA) combined with multivariate analysis. The analysis does not provide information about the root cause of the variation within the particular unit process, however, it provides a good estimate of the impact of the process on the stability of the manufacturing line. Additionally this analysis can be used to identify possible interaction between processes, which cannot be investigated if only single processes are considered. Goal of this work is to evaluate limits for CDO budgeting models given by the precision and the number of measurements as well as partitioning the variation within the manufacturing process. The CDO variation splits according to

  20. Cost effectiveness and budget impact of natalizumab in patients with relapsing multiple sclerosis.

    Science.gov (United States)

    Chiao, Evelyn; Meyer, Kellie

    2009-06-01

    Disease-modifying therapy (DMT) is the largest single-cost item that contributes to the total per-patient cost of multiple sclerosis (MS), a disabling disorder of the central nervous system. Natalizumab is the most recent DMT to be approved for the treatment of relapsing MS and may be an attractive alternative to interferon beta and glatiramer acetate (GA). To determine from the perspective of a United States payer (1) the incremental cost effectiveness of natalizumab compared with other DMTs and (2) the budgetary impact of utilization of natalizumab for the treatment of relapsing MS. A combined cost effectiveness and budget impact model was developed. Model inputs were drug acquisition costs (wholesale acquisition cost), costs of drug administration and monitoring, costs of treating relapses, anticipated reduction in relapse rates after 2 years of therapy, and estimated market utilization of natalizumab. Outcomes included total 2-year costs of therapy per patient, costs per relapse avoided for each treatment, and overall 2-year costs to the health plan and per member per month (PMPM) costs. Drug acquisition costs are in 2008 US dollars, and all other costs were inflated to 2008 US dollars when necessary. Univariate sensitivity analyses were performed to determine the model inputs with the greatest influence on the cost per relapse avoided for natalizumab. The overall 2-year cost of therapy per patient was $72,120 for natalizumab, $56,790 for intramuscular (IM) interferon beta-1a (IFNbeta-1a), $56,773 for IFNbeta-1b, $57,180 for GA, and $58,538 for subcutaneous (SC) IFNbeta-1a. The cost per relapse avoided was lowest for natalizumab at $56,594, followed by $87,791 for IFNbeta-1b, $93,306 for IM IFNbeta-1a, $96,178 for SC IFNbeta-1a, and $103,665 for GA. The incremental cost-effectiveness ratios of natalizumab relative to IM IFNbeta-1a, IFNbeta-1b, GA, and SC IFNbeta-1a were $23,029, $24,452, $20,671, and $20,403 per additional relapse avoided, respectively. An

  1. [Care for elderly patients in Africa: Analysis of the financial implications of the SESAME plan on the budget of the regional hospital center in Thies, Senegal].

    Science.gov (United States)

    Faye, A; Diousse, P; Seck, I; Diongue, M; Ndiaye, P; Diagne-Camara, M; Tal-Dia, A; Dia, La

    2010-04-01

    The SESAME plan has been implemented at the Thies Regional Hospital Center (TRHC) for one year. The purpose of this study was to analyze the financial implications of the plan on the hospital budget for the sustainability of care for persons aged 60 and over. This descriptive study included analysis of budget data from October 2006 to September 2007 plus information obtained by interviewing the accountant and head of SESAME plan. The number of patients managed, sources of CHRT funding, grants from various SESAME plan partners, and expenditures for each partner were determined. The weight of the SESAME plan in the CHRT operating budget was determined by calculating the ratio of the overall cost of care for elderly persons in relation to the hospital's revenues and SESAME grants. During the study period, the CHRT received a total of 17375 elderly persons including 89% with no pension or social security. The institute pension scheme (IPRES) covered 21% of the plan as compared to 79% for the state. Utilization plan grants in relation to funding source was 41% for IPRES and 124% for the State. The total cost of services provided to beneficiaries of the SESAME plan exceeded the aggregate amount by 26 083 847 CFA francs. The weight of the SESAME plan in the operating cost of the CHRT was 17%. Prefinancing a plan to cover elderly care in hospitals should be sufficient to prevent deficits from impacting negatively on the operating budget of the hospital.

  2. Impact of the zebra mussel Dreissena polymorpha invasion on the budget of suspended material in a shallow lagoon ecosystem

    Science.gov (United States)

    Daunys, Darius; Zemlys, Petras; Olenin, Sergej; Zaiko, Anastasija; Ferrarin, Christian

    2006-05-01

    The role of the zebra mussel Dreissena polymorpha in redistribution of total particulate material (TPM) between the water column and bottom sediment was estimated using the TPM budget for a mussel bed in the Curonian lagoon, the Baltic Sea. Seasonal clearance rates were derived from the TPM budget assuming two resuspension scenarios: no resuspension and full resuspension of biodeposits. Estimated clearance rates for both scenarios were compared with the rates calculated from the population clearance rate model. Seasonal clearance rates estimated using the population model (1.1 and 11.8 l g-1 SFDW day-1) fitted well into the interval of seasonal clearance rates calculated from TPM budgets assuming no resuspension of biodeposits (3.2 and 21.4 l g SFDW-1 day-1). In the scenario with biodeposits resuspension clearance rates were much higher (57.4 and 148.9 g SFDW-1 day-1). The ratio of clearance to residence time was highly dependent on the fate of biodeposits. Therefore its use in interpretation of the species impact on TPM was limited. An alternative measure based on the ratio of the amount of TPM biodeposited to TPM transported into the bed was used. It was found that zebra mussels are able to deposit between 10 and 30% of the incoming TPM, and the amount of biodeposited material was correlated with water residence time. Results indicate that the impact of zebra mussels on TPM in the lagoon is small relative to the high transport rates of TPM over the bed. However, annual biosedimentation rate (~590 g m-2) in the mussel bed was higher than physical deposition rate (~380 g m-2) in accumulation areas devoid of large suspension feeders. We suggest that a local impact due to enhanced availability of organic material to other trophic groups of associated benthic organisms may be more significant than effects on TPM pathways at an ecosystem scale.

  3. A synthesis of the impact of Russian forests on the global carbon budget for 1961-1998

    International Nuclear Information System (INIS)

    Shvidenko, Anatoly; Nilsson, Sten

    2003-01-01

    An attempt is made to synthesize the current understanding of the impact of Russian forests on the global carbon (C) budget for the period 1961-1998 (37 years), based on a detailed inventory of pools and fluxes in 1988-1992, and a historical reconstruction of a full forest carbon budget for 1961-1998. All major intermediate indicators of the budget (phytomass, net primary production, impact of disturbances, soil respiration, etc.) were independently estimated and compared with earlier reported results. During the entire period, the C pools of Russian forest land (FL, 882.0 106 ha in 1998) increased by 433 Tg C/yr, of which 153 Tg C/yr are accumulated in live biomass, 57 Tg C/yr in above- and below-ground dead wood, and 223 Tg C/yr are sequestered in soil. A significant part of this increase deals with land-cover changes. The annual average C uptake by the FL from the atmosphere, defined by a flux-based method, is estimated to be 322 Tg C/yr for 1961-1998. The lateral transport to the lithosphere and hydrosphere comprised 47 Tg C/yr (including charcoal), which is considered part of the 'missing C sink.' The uncertainties (excluding unrecognized biases) of averages for the entire period are estimated to be in the range of ±5-8% and ±24% for major fluxes out/into the atmosphere and for net ecosystem exchange, respectively (a priori confidential probability of 0.9). If the impact of land-cover change is excluded, the average annual sink in 1961-1998, estimated by both pool- and flux-based methods, was 268 ± 94 and 272 ± 68 Tg C/yr, respectively. The reported results are in line with recent estimates for Northern Eurasia made by inverse modeling at the continental scale, if land classes other than forests contribute to the total sink of terrestrial vegetation

  4. Exploratory Water Budget Analysis of A Transitional Premontane Cloud Forest in Costa Rica Through Undergraduate Research

    Science.gov (United States)

    Washington-Allen, R. A.; Buckwalter, E. H.; Moore, G. W.; Burns, J. N.; Dennis, A. R.; Dodge, O.; Guffin, E. C.; Morris, E. R.; Oien, R. P.; Orozco, G.; Peterson, A.; Teale, N. G.; Shibley, N. C.; Tourtellotte, N.; Houser, C.; Brooks, S. D.; Brumbelow, J. K.; Cahill, A. T.; Frauenfeld, O. W.; Gonzalez, E.; Hallmark, C. T.; McInnes, K. J.; Miller, G. R.; Morgan, C.; Quiring, S. M.; Rapp, A. D.; Roark, E.; Delgado, A.; Ackerson, J. P.; Arnott, R.

    2012-12-01

    The ecohydrology of transitional premontane cloud forests is not well understood. This problem is being addressed by a NSF Research Experience for Undergraduates (REU) study at the Texas A&M University Soltis Center for Research & Education in Costa Rica. Exploratory analysis of the water budget within a 20-ha watershed was used to connect three faculty-mentored research areas in ecohydrology, climate, and soil sciences and highlight the roles of 12 undergraduate researchers from 12 different universities. The water budget model is Q = Pn - E - T + ΔG + ΔS where Q = runoff, Pn = net precipitation, E = evaporation, T = transpiration, and ΔG and ΔS are change in groundwater soil water storage, respectively. Additionally, Pn = Pg - I = Tf + Sf + D, where Pg = gross precipitation, I/ΔI = canopy interception or storage, Tf = throughfall, Sf = stemflow, and D = canopy drip. The following terms were well understood Pg (satellite = 34-mm and tower = 38.1-mm) and Q from a recently constructed v-notch weir. We moderately understand Tf + D (30.9-mm from an array of forest rain gages), ΔI (7.2-mm) related to Sf, and T (10.4-mm measured with sapflow sensors). We found that soils were clay loam to silty loam textured Andisols on saprolitic tuft with a mean potential ΔS of 398 mm H2O under laboratory conditions, but in the field the following terms are almost completely unknown and require further field studies including E, ΔG, and ΔS. Recent installation of piezometers will address ΔG. Temporal scaling of measurements to a 1-week period was a challenge as well as the construction, deployment and calibration of instruments. However, this exploration allowed us to determine measurement uncertainties in the water budget, e.g., E, and to set future areas of research to address these uncertainties.

  5. Use of programme budgeting and marginal analysis to set priorities for local NHS dental services: learning from the north east of England.

    Science.gov (United States)

    Holmes, R D; Steele, J G; Exley, C; Vernazza, C R; Donaldson, C

    2018-05-03

    Priority setting is necessary where competing demands exceed the finite resources available. The aim of the study was to develop and test a prioritization framework based upon programme budgeting and marginal analysis (PBMA) as a tool to assist National Health Service (NHS) commissioners in their management of resources for local NHS dental services. Twenty-seven stakeholders (5 dentists, 8 commissioners and 14 patients) participated in a case-study based in a former NHS commissioning organization in the north of England. Stakeholders modified local decision-making criteria and applied them to a number of different scenarios. The majority of financial resources for NHS dental services in the commissioning organization studied were allocated to primary care dental practitioners' contracts in perpetuity, potentially constraining commissioners' abilities to shift resources. Compiling the programme budget was successful, but organizational flux and difficulties engaging local NHS commissioners significantly impacted upon the marginal analysis phase. NHS dental practitioners' contracts resemble budget-silos which do not facilitate local resource reallocation. 'Context-specific' factors significantly challenged the successful implementation and impact of PBMA. A local PBMA champion embedded within commissioning organizations should be considered. Participants found visual depiction of the cost-value ratio helpful during their initial priority setting deliberations.

  6. Projected change in East Asian summer monsoon by dynamic downscaling: Moisture budget analysis

    Science.gov (United States)

    Jung, Chun-Yong; Shin, Ho-Jeong; Jang, Chan Joo; Kim, Hyung-Jin

    2015-02-01

    The summer monsoon considerably affects water resource and natural hazards including flood and drought in East Asia, one of the world's most densely populated area. In this study, we investigate future changes in summer precipitation over East Asia induced by global warming through dynamical downscaling with the Weather Research and Forecast model. We have selected a global model from the Coupled Model Intercomparison Project Phase 5 based on an objective evaluation for East Asian summer monsoon and applied its climate change under Representative Concentration Pathway 4.5 scenario to a pseudo global warming method. Unlike the previous studies that focused on a qualitative description of projected precipitation changes over East Asia, this study tried to identify the physical causes of the precipitation changes by analyzing a local moisture budget. Projected changes in precipitation over the eastern foothills area of Tibetan Plateau including Sichuan Basin and Yangtze River displayed a contrasting pattern: a decrease in its northern area and an increase in its southern area. A local moisture budget analysis indicated the precipitation increase over the southern area can be mainly attributed to an increase in horizontal wind convergence and surface evaporation. On the other hand, the precipitation decrease over the northern area can be largely explained by horizontal advection of dry air from the northern continent and by divergent wind flow. Regional changes in future precipitation in East Asia are likely to be attributed to different mechanisms which can be better resolved by regional dynamical downscaling.

  7. A budget-impact and cost-effectiveness model for second-line treatment of major depression.

    Science.gov (United States)

    Malone, Daniel C

    2007-07-01

    Depressed patients who initially fail to achieve remission when placed on a selective serotonin reuptake inhibitor (SSRI) may require a second treatment. The purpose of this study was to evaluate the effectiveness, cost, cost-effectiveness, and budget impact of second-line pharmacologic treatment for major depressive disorder (MDD). A cost-effectiveness analysis was conducted to evaluate second-line therapies (citalopram, escitalopram, fluoxetine, paroxetine, paroxetine controlled release [CR], sertraline, and venlafaxine extended release [XR]) for the treatment of depression. Effectiveness data were obtained from published clinical studies. The primary outcome was remission defined as a score of 7 or less on the Hamilton Rating Scale for Depression (HAM-D) or a score of 10 or less on the montgomery-Asberg Depression Rating Scale (MADRS) depression rating scales. The wholesale acquisition cost (WAC) for medications and medical treatment costs for depression were included. The perspective was derived from a managed care organization (MCO) with 500,000 members, a 1.9% annual incidence of depression, and treatment duration of 6 months. Assumptions included: second-line treatment is not as effective as first-line treatment, WAC price reflects MCO costs, and side effects were identical. Sensitivity analyses were conducted to determine variables that influenced the results. Second-line remission rates were 20.4% for venlafaxine XR, 16.9% for sertraline, 16.4% for escitalopram, 15.1% for generic SSRIs (weighted average), and 13.6% for paroxetine CR. Pharmacy costs ranged from $163 for generic SSRIs to $319 for venlafaxine SR. Total cost per patient achieving remission was $14,275 for venlafaxine SR, followed by $16,100 for escitalopram. The incremental cost-effectiveness ratio (ICER) for venlafaxine SR compared with generic SSRIs was $2,073 per patient achieving remission, followed by escitalopram with an ICER of $3,566. The model was most sensitive to other therapies

  8. Wave energy budget analysis in the Earth's radiation belts uncovers a missing energy.

    Science.gov (United States)

    Artemyev, A V; Agapitov, O V; Mourenas, D; Krasnoselskikh, V V; Mozer, F S

    2015-05-15

    Whistler-mode emissions are important electromagnetic waves pervasive in the Earth's magnetosphere, where they continuously remove or energize electrons trapped by the geomagnetic field, controlling radiation hazards to satellites and astronauts and the upper-atmosphere ionization or chemical composition. Here, we report an analysis of 10-year Cluster data, statistically evaluating the full wave energy budget in the Earth's magnetosphere, revealing that a significant fraction of the energy corresponds to hitherto generally neglected very oblique waves. Such waves, with 10 times smaller magnetic power than parallel waves, typically have similar total energy. Moreover, they carry up to 80% of the wave energy involved in wave-particle resonant interactions. It implies that electron heating and precipitation into the atmosphere may have been significantly under/over-valued in past studies considering only conventional quasi-parallel waves. Very oblique waves may turn out to be a crucial agent of energy redistribution in the Earth's radiation belts, controlled by solar activity.

  9. Analysis of Water and Energy Budgets and Trends Using the NLDAS Monthly Data Sets

    Science.gov (United States)

    Vollmer, Bruce E.; Rui, Hualan; Mocko, David M.; Teng, William L.; Lei, Guang-Dih

    2012-01-01

    The North American Land Data Assimilation System (NLDAS) is a collaborative project between NASA GSFC, NOAA, Princeton University, and the University of Washington. NLDAS has created surface meteorological forcing data sets using the best-available observations and reanalyses. The forcing data sets are used to drive four separate land-surface models (LSMs), Mosaic, Noah, VIC, and SAC, to produce data sets of soil moisture, snow, runoff, and surface fluxes. NLDAS hourly data, accessible from the NASA GES DISC Hydrology Data Holdings Portal, http://disc.sci.gsfc.nasa.gov/hydrology/data-holdings, are widely used by various user communities in modeling, research, and applications, such as drought and flood monitoring, watershed and water quality management, and case studies of extreme events. More information is available at http://ldas.gsfc.nasa.gov/. To further facilitate analysis of water and energy budgets and trends, NLDAS monthly data sets have been recently released by NASA GES DISC.

  10. Macroeconomic Factors Affecting Budget Deficit in Pakistan: A Time Series Analysis

    Directory of Open Access Journals (Sweden)

    Ayesha Mushtaq

    2013-10-01

    Full Text Available The objective of the study is to empirically investigate the relationship between budget deficit and macroeconomic factors i.e., financial development indicator, economic growth, changes in price level and real exchange rate, by using data from1980-2011 for Pakistan. The results reveal that there is a positive and significant relationship between real effective exchange rate and budget deficit on one hand, while economic growth and financial development indicator with reference to budget deficit on the other hand. Changes in price level have a significant and negative relationship with the budget deficit in Pakistan.

  11. Cost-effectiveness and budget impact of the fixed-dose dual bronchodilator combination tiotropium-olodaterol for patients with COPD in the Netherlands.

    Science.gov (United States)

    van Boven, Job Fm; Kocks, Janwillem Wh; Postma, Maarten J

    2016-01-01

    The fixed-dose dual bronchodilator combination (FDC) of tiotropium and olodaterol showed increased effectiveness regarding lung function and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD) compared with the use of its mono-components. Yet, while effectiveness and safety have been shown, the health economic implication of this treatment is still unknown. The aim of this study was to assess the cost-utility and budget impact of tiotropium-olodaterol FDC in patients with moderate to very severe COPD in the Netherlands. A cost-utility study was performed, using an individual-level Markov model. To populate the model, individual patient-level data (age, height, sex, COPD duration, baseline forced expiratory volume in 1 second) were obtained from the tiotropium-olodaterol TOnado trial. In the model, forced expiratory volume in 1 second and patient-level data were extrapolated to utility and survival, and treatment with tiotropium-olodaterol FDC was compared with tiotropium. Cost-utility analysis was performed from the Dutch health care payer's perspective using a 15-year time horizon in the base-case analysis. The standard Dutch discount rates were applied (costs: 4.0%; effects: 1.5%). Both univariate and probabilistic sensitivity analyses were performed. Budget impact was annually assessed over a 5-year time horizon, taking into account different levels of medication adherence. As a result of cost increases, combined with quality-adjusted life-year (QALY) gains, results showed that tiotropium-olodaterol FDC had an incremental cost-effectiveness ratio of €7,004/QALY. Without discounting, the incremental cost-effectiveness ratio was €5,981/QALY. Results were robust in univariate and probabilistic sensitivity analyses. Budget impact was estimated at €4.3 million over 5 years assuming 100% medication adherence. Scenarios with 40%, 60%, and 80% adherence resulted in lower 5-year incremental cost increases of €1.7, €2

  12. Late Budgets

    DEFF Research Database (Denmark)

    Andersen, Asger Lau; Lassen, David Dreyer; Nielsen, Lasse Holbøll Westh

    are negative rather than positive; and when there is divided government. We test the hypotheses of the model using a unique data set of late budgets for US state governments, based on dates of budget approval collected from news reports and a survey of state budget o¢ cers for the period 1988...

  13. A Fiscal Cliff: The Current U.S. Federal Budget, Potential Cuts, and Impacts on Science Funding

    Science.gov (United States)

    Uhlenbrock, K. M.; Landau, E. A.; Hankin, E. R.

    2012-12-01

    As lawmakers on Capitol Hill face challenges to reach an agreement on how to cut the deficit while growing the economy, scientists must join the discussion and outline the serious impacts cuts to federal science programs will have on our society. Consistent and sustained federal science funding (discretionary spending) is an ever increasing struggle with the rising costs of mandatory spending and decrease in revenues. In 2011 Congress passed the Budget Control Act, which will require automatic across-the-board cuts, known as sequestration, and will take effect on 2 January 2013. Estimated cuts of $1.2 trillion and discretionary spending caps set at Fiscal Year 2012 levels will trigger non-defense program cuts of 9.8% in the first year as reported by the Congressional Research Service. Funding from non-defense program agencies such as NSF, NASA, DOE, NOAA, USGS, and others drive science and technological innovation, support public safety, create jobs, educate generations of scientists, stimulate the economy, protect our environment, and enrich lives. With non-defense discretionary programs representing less than one-fifth of the federal budget, severe cuts to these programs will not alleviate our deficit, but instead restrict our growth.

  14. Observations of the thermal environment on Red Sea platform reefs: a heat budget analysis

    KAUST Repository

    Davis, K. A.

    2011-03-11

    Hydrographic measurements were collected on nine offshore reef platforms in the eastern Red Sea shelf region, north of Jeddah, Saudi Arabia. The data were analyzed for spatial and temporal patterns of temperature variation, and a simple heat budget analysis was performed with the goal of advancing our understanding of the physical processes that control temperature variability on the reef. In 2009 and 2010, temperature variability on Red Sea reef platforms was dominated by diurnal variability. The daily temperature range on the reefs, at times, exceeded 5°C-as large as the annual range of water temperature on the shelf. Additionally, our observations reveal the proximity of distinct thermal microclimates within the bounds of one reef platform. Circulation on the reef flat is largely wave driven. The greatest diurnal variation in water temperature occurs in the center of larger reef flats and on reefs protected from direct wave forcing, while smaller knolls or sites on the edges of the reef flat tend to experience less diurnal temperature variability. We found that both the temporal and spatial variability in water temperature on the reef platforms is well predicted by a heat budget model that includes the transfer of heat at the air-water interface and the advection of heat by currents flowing over the reef. Using this simple model, we predicted the temperature across three different reefs to within 0.4°C on the outer shelf using only information about bathymetry, surface heat flux, and offshore wave conditions. © 2011 Springer-Verlag.

  15. A Qualitative Evaluation of Program Budgeting and Marginal Analysis in a Canadian Pediatric Tertiary Care Institution.

    Science.gov (United States)

    Smith, Neale; Mitton, Craig; Hiltz, Mary-Ann; Campbell, Matthew; Dowling, Laura; Magee, J Fergall; Gujar, Shashi Ashok

    2016-10-01

    Hospitals in Canada are being asked by governments to improve efficiency and do more with fewer resources. Healthcare decision makers are thus driven to find better ways to manage budgets and deliver on their mission. Formal processes of priority setting and resource allocation (PSRA) are one means to this end. This paper reports an evaluation of one such approach, Program Budgeting and Marginal Analysis (PBMA), as applied at a children and women's tertiary care facility in Nova Scotia, Canada. A brief evaluation conducted immediately after the conclusion of the PBMA process was supplemented with a larger retrospective evaluation. The retrospective evaluation included 26 face-to-face individual interviews with senior and middle managers who took part in PBMA. Interview transcripts were analyzed against a template consisting of 19 elements of structure, process, attitudes, and outcomes associated with high performance in PSRA. Respondents had a good experience with the implementation of PBMA, and considered it an improvement over past practice. Success was attributed to effective leadership, and substantial efforts to engage staff members. Understanding of economic and ethical principles of decision making was reportedly increased. Areas for improvement included ensuring that everyone participated in good faith, better communication of final results, and stronger follow-through to determine if anticipated changes and benefits in fact occurred. The evaluation framework employed here proved useful in assessing the quality of this resource allocation exercise. The results are directly useful to local decision makers, and the identified strengths and weaknesses are broadly consistent with those reported in studies of other organizations.

  16. Summary and Analysis of President Obama's Education Budget Request, Fiscal Year 2012: Issue Brief

    Science.gov (United States)

    New America Foundation, 2011

    2011-01-01

    President Barack Obama submitted his third budget request to Congress on February 14th, 2011. The detailed budget request includes proposed funding levels for federal programs and agencies in aggregate for the upcoming 10 fiscal years, and specific fiscal year 2012 funding levels for individual programs subject to appropriations. Congress will use…

  17. An Analysis and Allocation System for Library Collections Budgets: The Comprehensive Allocation Process (CAP)

    Science.gov (United States)

    Lyons, Lucy Eleonore; Blosser, John

    2012-01-01

    The "Comprehensive Allocation Process" (CAP) is a reproducible decision-making structure for the allocation of new collections funds, for the reallocation of funds within stagnant budgets, and for budget cuts in the face of reduced funding levels. This system was designed to overcome common shortcomings of current methods. Its philosophical…

  18. A budget impact analysis of Spiromax® compared with Turbuhaler® for the treatment of moderate to severe asthma: a potential improvement in the inhalation technique to strengthen medication adherence could represent savings for the Spanish Healthcare System and five Spanish regions

    Directory of Open Access Journals (Sweden)

    Darbà J

    2016-09-01

    Full Text Available Josep Darbà,1 Gabriela Ramírez,2 Juan L García-Rivero,3 Sagrario Mayoralas-Alises,4 José Francisco Pascual,5 Albert Roger,6 Diego Vargas,7 Adi Bijedic8 1Department of Economics, Universitat de Barcelona, 2BCN Health Economics & Outcomes Research SL, 3Hospital Laredo, Cantabria, 4Hospital Ramón y Cajal, Madrid, 5Hospital General Universitario de Alicante, Alicante, 6Hospital Universitario Germans Trias i Pujol, Barcelona, 7Hospital de Alta Resolución el Toyo, Andalusia, 8Market Access and HEOR Department, TEVA Pharmaceutical, Madrid, Spain Objective: To assess the economic impact of the introduction of DuoResp® Spiromax® by focusing on a potential improvement in the inhalation technique to strengthen medication adherence for the treatment of moderate to severe asthmatics in Spain and five Spanish regions including Andalusia, Catalonia, Galicia, Madrid, and Valencia.Methods: A 4-year budget impact model was developed for the period 2015–2018 from the Spanish Healthcare System perspective. Budesonide–formoterol fixed-dose combination delivered by Turbuhaler® was considered to be the most appropriate comparator for assessing the budget impact with the introduction of DuoResp® Spiromax®. National and regional data on asthma prevalence were obtained from the literature. Input parameters on health care resources were obtained by consulting experts from different Spanish hospitals. Resources used included medical visits, emergency room visits, and hospitalizations. The average numbers of primary care and specialist visits per year were also gathered. Based on health care resource use per patient, the total treatment cost per patient was estimated.Results: The population with moderate to severe asthma treated with budesonide–formoterol fixed-dose combinations delivered by Turbuhaler® in 2015 was estimated to be 166,985 in Spain. Region-specific prevalence data resulted in 25,081, 12,392, 16,097, 17,829, and 15,148 patients in Andalusia

  19. Cost-savings for biosimilars in the United States: a theoretical framework and budget impact case study application using filgrastim.

    Science.gov (United States)

    Grewal, Simrun; Ramsey, Scott; Balu, Sanjeev; Carlson, Josh J

    2018-05-18

    Biosimilars can directly reduce the cost of treating patients for whom a reference biologic is indicated by offering a highly similar, lower priced alternative. We examine factors related to biosimilar regulatory approval, uptake, pricing, and financing and the potential impact on drug expenditures in the U.S. We developed a framework to illustrate how key factors including regulatory policies, provider and patient perception, pricing, and payer policies impact biosimilar cost-savings. Further, we developed a budget impact cost model to estimate savings from filgrastim biosimilars under various scenarios. The model uses publicly available data on disease incidence, treatment patterns, market share, and drug prices to estimate the cost-savings over a 5-year time horizon. We estimate five-year cost savings of $256 million, of which 18% ($47 million) are from reduced patient out-of-pocket costs, 34% ($86 million) are savings to commercial payers, and 48% ($123 million) are savings for Medicare. Additional scenarios demonstrate the impact of uncertain factors, including price, uptake, and financing policies. A variety or interrelated factors influence the development, uptake, and cost-savings for Biosimilars use in the U.S. The filgrastim case is a useful example that illustrates these factors and the potential magnitude of costs savings.

  20. Colorado Children's Budget 2013

    Science.gov (United States)

    Buck, Beverly; Baker, Robin

    2013-01-01

    The "Colorado Children's Budget" presents and analyzes investments and spending trends during the past five state fiscal years on services that benefit children. The "Children's Budget" focuses mainly on state investment and spending, with some analysis of federal investments and spending to provide broader context of state…

  1. The budget impact of introducing delayed-release dimethyl fumarate for treatment of relapse-remitting multiple sclerosis in Canada.

    Science.gov (United States)

    Dorman, Emily; Kansal, Anuraag R; Sarda, Sujata

    2015-01-01

    Multiple sclerosis (MS) causes significant disability globally and is especially prevalent in Canada. Delayed-release dimethyl fumarate (DMF; also known as gastro-resistant DMF) is an orally administered disease-modifying treatment (DMT) for patients with relapsing-remitting MS (RRMS) that is currently on the market in the US, Australia, Canada, and Europe. A budget impact model (BIM) was developed to assess the financial consequences of introducing DMF for treatment of RRMS in Canada. A BIM calculated the financial consequences of introducing DMF in Canada over 3 years based on RRMS prevalence, treatment market share, and clinical effects. RRMS prevalence in Canada was derived from published literature and natural relapse rates, and disease state distribution from clinical trial data. It was conservatively assumed that 100% of RRMS patients were treated with a DMT. DMF was assumed to absorb market share proportionally from the following current treatments: interferon beta-1a-IM, interferon beta-1a-SC, interferon beta-1b, and glatiramer acetate. Treatment efficacy, in terms of relapse rate reductions and treatment discontinuation rates, was determined from mixed treatment comparison. Treatment costs (including costs of acquisition, monitoring, and administration) and cost of relapse were considered. Deterministic one-way sensitivity analyses were conducted to assess the most sensitive input parameters. Over 3 years, the introduction of DMF resulted in an average annual increase of CAD417 per treated patient per year, with reductions in costs associated with relapses (CAD192/patient/year) partially offsetting increased drug acquisition costs (CAD602/patient/year). On a population level, the average annual cost increase was CAD24,654,237, a CAD 0.68 increase per population covered by the Canadian healthcare system. The main drivers of budget impact were drop-out rates, proportion of RRMS patients treated, and market share assumptions. The acquisition costs of DMF for

  2. Analysis of Budget Deficits and Macroeconomic Fundamentals: A VAR-VECM Approach

    Directory of Open Access Journals (Sweden)

    Manamba Epaphra

    2017-10-01

    Full Text Available Aim/purpose - This paper examines the relationship between budget deficits and selected macroeconomic variables in Tanzania for the period spanning from 1966 to 2015. Design/methodology/approach - The paper uses Vector autoregression (VAR - Vector Error Correction Model (VECM and variance decomposition techniques. The Johansen's test is applied to examine the long run relationship among the variables under study. Findings - The Johansen's test of cointegration indicates that the variables are cointegrated and thus have a long run relationship. The results based on the VAR-VECM estimation show that real GDP and exchange rate have a negative and significant relationship with budget deficit whereas inflation, money supply and lending interest rate have a positive one. Variance decomposition results show that variances in the budget deficits are mostly explained by the real GDP, followed by inflation and real exchange rate. Research implications/limitations - Results are very indicative, but highlight the importance of containing inflation and money supply to check their effects on budget deficits over the short run and long-run periods. Also, policy recommendation calls for fiscal authorities in Tanzania to adopt efficient and effective methods of tax collection and public sector spending. Originality/value/contribution - Tanzania has been experiencing budget deficit since the 1970s and that this budget deficit has been blamed for high indebtedness, inflation and poor investment and growth. The paper contributes to the empirical debate on the causal relationship between budget deficits and macroeconomic variables by employing VAR-VECM and variance decomposition approaches.

  3. Vegetation cover analysis using a low budget hyperspectral proximal sensing system

    Directory of Open Access Journals (Sweden)

    C. Daquino

    2006-06-01

    Full Text Available This report describes the implementation of a hyperspectral proximal sensing low-budget acquisition system and its application to the detection of terrestrian vegetation cover anomalies in sites of high environmental quality. Anomalies can be due to stress for lack of water and/or pollution phenomena and weed presence in agricultural fields. The hyperspectral cube (90-bands ranging from 450 to 900 nm was acquired from the hill near Segni (RM, approximately 500 m far from the target, by means of electronically tunable filters and 8 bit CCD cameras. Spectral libraries were built using both endmember identification method and extraction of centroids of the clusters obtained from a k-means analysis of the image itself. Two classification methods were applied on the hyperspectral cube: Spectral Angle Mapper (hard and Mixed Tuned Matching Filters (MTMF. Results show the good capability of the system in detecting areas with an arboreal, shrub or leafage cover, distinguishing between zones with different spectral response. Better results were obtained using spectral library originated by the k-means method. The detected anomalies not correlated to seasonal phenomena suggest a ground true analysis to identify their origin.

  4. Preparing the operating budget.

    Science.gov (United States)

    Williams, R B

    1983-12-01

    The process of preparing a hospital pharmacy budget is presented. The desired characteristics of a budget and the process by which it is developed and approved are described. Fixed, flexible, and zero-based budget types are explained, as are the major components of a well-developed budget: expense, workload, productivity, revenue, and capital equipment and other expenditures. Specific methods for projecting expenses and revenues, based on historical data, are presented along with a discussion of variables that must be considered in order to achieve an accurate and useful budget. The current shift in emphasis away from revenue capture toward critical analysis of pharmacy costs underscores the importance of budgetary analysis for hospital pharmacy managers.

  5. Budget impact model for oncopharmacogenetics from the perspective of mandatory basic health insurance in Switzerland using the example of breast cancer

    Directory of Open Access Journals (Sweden)

    Szucs TD

    2018-04-01

    Full Text Available Thomas D Szucs,1 Kevin P Szillat,2 Eva Blozik3 1University of Basel, Institute of Pharmaceutical Medicine (ECPM, Basel, Switzerland; 2Department of Biology, Institute of Molecular Health Sciences, ETH Zurich, Zürich, Switzerland; 3Department of Health Sciences, Helsana Group, Zürich, Switzerland Abstract: Single-nucleotide polymorphisms (SNPs can severely impact individual drug response and health outcomes in cancer patients. Genetic tests to screen for marker SNPs are available to adjust the drug dose of oncologicals to the patient’s needs. However, it is unclear whether the positive effects outbalance the increased costs or even lead to an overall cost reduction. This very pragmatic analysis used three frequently used oncologicals for the treatment of breast cancer to evaluate whether preemptive pharmacogenetic testing may have a cost-reducing impact on health care spending in the Swiss health care system. Our results indicate that oncopharmacogenetics might help to reduce health care costs (ie, by avoiding adverse drug effects and to increase efficiency of drugs in oncologic patients. Keywords: pharmacogenetics, oncology, budget impact model, Switzerland, health insurance

  6. Observations of the thermal environment on Red Sea platform reefs: a heat budget analysis

    KAUST Repository

    Davis, K. A.; Lentz, S. J.; Pineda, J.; Farrar, J. T.; Starczak, V. R.; Churchill, J. H.

    2011-01-01

    Hydrographic measurements were collected on nine offshore reef platforms in the eastern Red Sea shelf region, north of Jeddah, Saudi Arabia. The data were analyzed for spatial and temporal patterns of temperature variation, and a simple heat budget

  7. Wave energy budget analysis in the Earth’s radiation belts uncovers a missing energy

    Science.gov (United States)

    Artemyev, A.V.; Agapitov, O.V.; Mourenas, D.; Krasnoselskikh, V.V.; Mozer, F.S.

    2015-01-01

    Whistler-mode emissions are important electromagnetic waves pervasive in the Earth’s magnetosphere, where they continuously remove or energize electrons trapped by the geomagnetic field, controlling radiation hazards to satellites and astronauts and the upper-atmosphere ionization or chemical composition. Here, we report an analysis of 10-year Cluster data, statistically evaluating the full wave energy budget in the Earth’s magnetosphere, revealing that a significant fraction of the energy corresponds to hitherto generally neglected very oblique waves. Such waves, with 10 times smaller magnetic power than parallel waves, typically have similar total energy. Moreover, they carry up to 80% of the wave energy involved in wave–particle resonant interactions. It implies that electron heating and precipitation into the atmosphere may have been significantly under/over-valued in past studies considering only conventional quasi-parallel waves. Very oblique waves may turn out to be a crucial agent of energy redistribution in the Earth’s radiation belts, controlled by solar activity. PMID:25975615

  8. Estimating the impact of petroleum substances on survival in ealry life stages of cod (Gadus morhua) using the Dynamic Energy Budget theory

    NARCIS (Netherlands)

    Klok, T.C.; Nordtug, T.; Tamis, J.E.

    2014-01-01

    To estimate the impact of accidental oil-spills on cod fisheries a model framework is developed in which a Dynamic Energy Budget (DEB) model is applied to assess mortality caused by petroleum substances in early life stages. In this paper we report on a literature search and DEB analyses, aiming for

  9. Return-to-work intervention for cancer survivors: budget impact and allocation of costs and returns in the Netherlands and six major EU-countries

    NARCIS (Netherlands)

    Mewes, Janne C.; Steuten, Lotte Maria Gertruda; Groeneveld, Iris F.; Boer, Angela G.E.M.; Frings-Dresen, Monique H.W.; IJzerman, Maarten Joost; van Harten, Willem H.

    2015-01-01

    Background Return-to-work (RTW)-interventions support cancer survivors in resuming work, but come at additional healthcare costs. The objective of this study was to assess the budget impact of a RTW-intervention, consisting of counselling sessions with an occupational physician and an

  10. Dairy production systems in the United States: Nutrient budgets and environmental impacts

    Science.gov (United States)

    Across the diversity of US dairy production systems, nutrient management priorities range widely, from feeding regimes to manure handling, storage and application to crop systems. To assess nutrient management and environmental impacts of dairy production systems in the US, we evaluated nutrient bud...

  11. The Impact of Budget Cutbacks on Music Teaching Positions and District Funding in Three Midwestern States

    Science.gov (United States)

    Burrack, Frederick William; Payne, Phillip; Bazan, Dale E.; Hellman, Daniel S.

    2014-01-01

    The purpose of this study was to investigate the existence and impact of budgetary cutbacks to music teaching positions and district funding in three Midwestern states, namely Kansas, Nebraska, and Missouri. The results revealed cuts to staffing and district funding of music programs without a reduction in student enrollments in 2011-2012…

  12. Budget institutions and taxation

    DEFF Research Database (Denmark)

    Aaskoven, Lasse

    2018-01-01

    While a number of different studies have explored the effects of budgetary procedures and the centralization of the budget process on government debt, deficits and spending, few of them have explored whether such fiscal institutions matter for public revenue. This article argues that centralizing...... the budget process raises the levels of taxation by limiting the ability of individual government officials to veto tax increases in line with common-pool-problem arguments regarding public finances. Using detailed data on budgetary procedures from 15 EU countries, the empirical analysis shows that greater...... centralization of the budget process increases taxation as a share of GDP and that both the type of budget centralization and level of government fractionalization matter for the size of this effect. The results suggest that further centralizing the budget process limits government debt and deficits...

  13. 42 CFR 457.140 - Budget.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Budget. 457.140 Section 457.140 Public Health... Child Health Insurance Programs and Outreach Strategies § 457.140 Budget. The State plan, or plan amendment that has a significant impact on the approved budget, must include a budget that describes the...

  14. System Budgets

    DEFF Research Database (Denmark)

    Jeppesen, Palle

    1996-01-01

    The lecture note is aimed at introducing system budgets for optical communication systems. It treats optical fiber communication systems (six generations), system design, bandwidth effects, other system impairments and optical amplifiers.......The lecture note is aimed at introducing system budgets for optical communication systems. It treats optical fiber communication systems (six generations), system design, bandwidth effects, other system impairments and optical amplifiers....

  15. Introducing non-flooded crops in rice-dominated landscapes: Impact on carbon, nitrogen and water budgets

    Science.gov (United States)

    Jauker, Frank; Wassmann, Reiner; Amelung, Wulf; Breuer, Lutz; Butterbach-Bahl, Klaus; Conrad, Ralf; Ekschmitt, Klemens; Goldbach, Heiner; He, Yao; John, Katharina; Kiese, Ralf; Kraus, David; Reinhold-Hurek, Barbara; Siemens, Jan; Weller, Sebastian; Wolters, Volkmar

    2013-04-01

    Rice production consumes about 30% of all freshwater used worldwide and 45% in Asia. Turning away from permanently flooded rice cropping systems for mitigating future water scarcity and reducing methane emissions, however, will alter a variety of ecosystem services with potential adverse effects to both the environment and agricultural production. Moreover, implementing systems that alternate between flooded and non-flooded crops increases the risk of disruptive effects. The multi-disciplinary DFG research unit ICON aims at exploring and quantifying the ecological consequences of altered water regimes (flooded vs. non-flooded), crop diversification (irrigated rice vs. aerobic rice vs. maize), and different fertilization strategies (conventional, site-specific, and zero N fertilization). ICON particularly focuses on the biogeochemical cycling of carbon and nitrogen, green-house gas (GHG) emissions, water balance, soil biotic processes and other important ecosystem services. The overarching goal is to provide the basic process understanding that is necessary for balancing the revenues and environmental impacts of high-yield rice cropping systems while maintaining their vital ecosystem services. To this aim, a large-scale field experiment has been established at the experimental farm of the International Rice Research Institute (IRRI, Philippines). Ultimately, the experimental results are analyzed in the context of management scenarios by an integrated modeling of crop development (ORYZA), carbon and nitrogen cycling (MoBiLE-DNDC), and water fluxes (CMF), providing the basis for developing pathways to a conversion of rice-based systems towards higher yield potentials under minimized environmental impacts. In our presentation, we demonstrate the set-up of the controlled large-scale field experiment for simultaneous assessment of carbon and nitrogen fluxes and water budgets. We show and discuss first results for: - Quantification and assessment of the net-fluxes of CH4

  16. DCS Budget Tracking System

    Data.gov (United States)

    Social Security Administration — DCS Budget Tracking System database contains budget information for the Information Technology budget and the 'Other Objects' budget. This data allows for monitoring...

  17. Use of the partial farm budget technique to predict the economic impact of the flock management decision to use B-mode ultrasonographic pregnancy diagnosis.

    Science.gov (United States)

    Sprecher, D J; Ley, W B; Whittier, W D; Bowen, J M; Thatcher, C D; Pelzer, K D; Moore, J M

    1989-07-15

    A computer spreadsheet was developed to predict the economic impact of a management decision to use B-mode ultrasonographic ovine pregnancy diagnosis. The spreadsheet design and spreadsheet cell formulas are provided. The program used the partial farm budget technique to calculate net return (NR) or cash flow changes that resulted from the decision to use ultrasonography. Using the program, either simple pregnancy diagnosis or pregnancy diagnosis with the ability to determine singleton or multiple pregnancies may be compared with no flock ultrasonographic pregnancy diagnosis. A wide range of user-selected regional variables are used to calculate the cash flow changes associated with the ultrasonography decisions. A variable may be altered through a range of values to conduct a sensitivity analysis of predicted NR. Example sensitivity analyses are included for flock conception rate, veterinary ultrasound fee, and the price of corn. Variables that influence the number of cull animals and the cost of ultrasonography have the greatest impact on predicted NR. Because the determination of singleton or multiple pregnancies is more time consuming, its economic practicality in comparison with simple pregnancy diagnosis is questionable. The value of feed saved by identifying and separately feeding ewes with singleton pregnancies is not offset by the increased ultrasonography cost.

  18. Impact of short-lived non-CO2 mitigation on carbon budgets for stabilizing global warming

    International Nuclear Information System (INIS)

    Rogelj, Joeri; Riahi, Keywan; Meinshausen, Malte; Schaeffer, Michiel; Knutti, Reto

    2015-01-01

    Limiting global warming to any level requires limiting the total amount of CO 2 emissions, or staying within a CO 2 budget. Here we assess how emissions from short-lived non-CO 2 species like methane, hydrofluorocarbons (HFCs), black-carbon, and sulphates influence these CO 2 budgets. Our default case, which assumes mitigation in all sectors and of all gases, results in a CO 2 budget between 2011–2100 of 340 PgC for a >66% chance of staying below 2°C, consistent with the assessment of the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. Extreme variations of air-pollutant emissions from black-carbon and sulphates influence this budget by about ±5%. In the hypothetical case of no methane or HFCs mitigation—which is unlikely when CO 2 is stringently reduced—the budgets would be much smaller (40% or up to 60%, respectively). However, assuming very stringent CH 4 mitigation as a sensitivity case, CO 2 budgets could be 25% higher. A limit on cumulative CO 2 emissions remains critical for temperature targets. Even a 25% higher CO 2 budget still means peaking global emissions in the next two decades, and achieving net zero CO 2 emissions during the third quarter of the 21st century. The leverage we have to affect the CO 2 budget by targeting non-CO 2 diminishes strongly along with CO 2 mitigation, because these are partly linked through economic and technological factors. (letter)

  19. Do budget balance rules anchor budget balance expectations? -- Some international evidence

    OpenAIRE

    Rülke, Jan-Christoph; Frenkel, Michael; Lis, Eliza

    2013-01-01

    This is the first study that analyzes whether budget balance expectations are anchored and whether budget balance rules effectively anchor expectations. To this end, we use a unique data set which covers budget balance expectations in 17 countries that implemented a budget balance rules. While our results are mixed concerning the general impact of budget balance rules on anchoring expectations, we do find that specific features of budget balance rules are important to successfully anchor budg...

  20. ANALYSIS OF THE EVOLUTION IN DYNAMICS OF BUDGET INCOMES FROM ALBA COUNTY

    Directory of Open Access Journals (Sweden)

    CLAUDIA FLORINA RADU

    2013-03-01

    Full Text Available This paper aims to examine how the main taxes collected in Alba County have evolved over the last seven years and we put in evidence the evolution of total revenue received in Alba County budget. We point out also the taxes that hold the largest share of the total revenue collected. At the same time we observe the ranking of the main taxes in our county, compared to their ranking of the entire country. On the first place in our county we find VAT, the income tax is on the second, and corporate income tax follows. They are therefore the main source of income for the Alba budget.

  1. Cost-utility and budget impact analyses of the use of NEPA for chemotherapy-induced nausea and vomiting prophylaxis in Italy.

    Science.gov (United States)

    Restelli, Umberto; Saibene, Gabriella; Nardulli, Patrizia; Di Turi, Roberta; Bonizzoni, Erminio; Scolari, Francesca; Perrone, Tania; Croce, Davide; Celio, Luigi

    2017-08-01

    To evaluate the efficiency of resources allocation and sustainability of the use of netupitant+palonosetron (NEPA) for chemotherapy-induced nausea and vomiting (CINV) prophylaxis assuming the Italian National Health Service (NHS) perspective. A published Markov model was adapted to assess the incremental cost-utility ratio of NEPA compared with aprepitant (APR) + palonosetron (PALO), fosaprepitant (fAPR) + PALO, APR + ondansetron (ONDA), fAPR + ONDA in patients receiving a highly emetogenic chemotherapy (HEC) and with APR + PALO and fAPR + PALO in patients receiving a moderately emetogenic chemotherapy (MEC). Oncology hospital department in Italy. A Markov model was used to determine the impact of NEPA on the budget of the Italian NHS on a 5-day time horizon, corresponding to the acute and delayed CINV prophylaxis phases. Direct medical costs considered were related to antiemetic drugs, adverse events management, CINV episodes management. Clinical and quality of life data referred to previously published works. The budget impact analysis considered the aforementioned therapies plus PALO alone (for HEC and MEC) on a 5-year time horizon, comparing two scenarios: one considering the use of NEPA and one not considering its use. Incremental cost per quality adjusted life year (QALY) and differential economic impact for the Italian NHS between the two scenarios considered. NEPA is more effective and less expensive (dominant) compared with APR + PALO (for HEC and MEC), fAPR + PALO (for HEC and MEC), APR + ONDA (for HEC), fAPR + ONDA (for HEC). The use of NEPA would lead to a 5-year cost decrease of €63.7 million (€42.7 million for HEC and €20.9 million for MEC). NEPA allows an efficient allocation of resources for the Italian NHS and it is sustainable, leading to a cost decrease compared with a scenario which does not consider its use. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No

  2. Verification of uncertainty budgets

    DEFF Research Database (Denmark)

    Heydorn, Kaj; Madsen, B.S.

    2005-01-01

    , and therefore it is essential that the applicability of the overall uncertainty budget to actual measurement results be verified on the basis of current experimental data. This should be carried out by replicate analysis of samples taken in accordance with the definition of the measurand, but representing...... the full range of matrices and concentrations for which the budget is assumed to be valid. In this way the assumptions made in the uncertainty budget can be experimentally verified, both as regards sources of variability that are assumed negligible, and dominant uncertainty components. Agreement between...

  3. Cost-effectiveness and budget impact analyses of a long-term hypertension detection and control program for stroke prevention.

    Science.gov (United States)

    Yamagishi, Kazumasa; Sato, Shinichi; Kitamura, Akihiko; Kiyama, Masahiko; Okada, Takeo; Tanigawa, Takeshi; Ohira, Tetsuya; Imano, Hironori; Kondo, Masahide; Okubo, Ichiro; Ishikawa, Yoshinori; Shimamoto, Takashi; Iso, Hiroyasu

    2012-09-01

    The nation-wide, community-based intensive hypertension detection and control program, as well as universal health insurance coverage, may well be contributing factors for helping Japan rank near the top among countries with the longest life expectancy. We sought to examine the cost-effectiveness of such a community-based intervention program, as no evidence has been available for this issue. The hypertension detection and control program was initiated in 1963 in full intervention and minimal intervention communities in Akita, Japan. We performed comparative cost-effectiveness and budget-impact analyses for the period 1964-1987 of the costs of public health services and treatment of patients with hypertension and stroke on the one hand, and incidence of stroke on the other in the full intervention and minimal intervention communities. The program provided in the full intervention community was found to be cost saving 13 years after the beginning of program in addition to the fact of effectiveness that; the prevalence and incidence of stroke were consistently lower in the full intervention community than in the minimal intervention community throughout the same period. The incremental cost was minus 28,358 yen per capita over 24 years. The community-based intensive hypertension detection and control program was found to be both effective and cost saving. The national government's policy to support this program may have contributed in part to the substantial decline in stroke incidence and mortality, which was largely responsible for the increase in Japanese life expectancy.

  4. A Predictor Analysis Framework for Surface Radiation Budget Reprocessing Using Design of Experiments

    Science.gov (United States)

    Quigley, Patricia Allison

    Earth's Radiation Budget (ERB) is an accounting of all incoming energy from the sun and outgoing energy reflected and radiated to space by earth's surface and atmosphere. The National Aeronautics and Space Administration (NASA)/Global Energy and Water Cycle Experiment (GEWEX) Surface Radiation Budget (SRB) project produces and archives long-term datasets representative of this energy exchange system on a global scale. The data are comprised of the longwave and shortwave radiative components of the system and is algorithmically derived from satellite and atmospheric assimilation products, and acquired atmospheric data. It is stored as 3-hourly, daily, monthly/3-hourly, and monthly averages of 1° x 1° grid cells. Input parameters used by the algorithms are a key source of variability in the resulting output data sets. Sensitivity studies have been conducted to estimate the effects this variability has on the output data sets using linear techniques. This entails varying one input parameter at a time while keeping all others constant or by increasing all input parameters by equal random percentages, in effect changing input values for every cell for every three hour period and for every day in each month. This equates to almost 11 million independent changes without ever taking into consideration the interactions or dependencies among the input parameters. A more comprehensive method is proposed here for the evaluating the shortwave algorithm to identify both the input parameters and parameter interactions that most significantly affect the output data. This research utilized designed experiments that systematically and simultaneously varied all of the input parameters of the shortwave algorithm. A D-Optimal design of experiments (DOE) was chosen to accommodate the 14 types of atmospheric properties computed by the algorithm and to reduce the number of trials required by a full factorial study from millions to 128. A modified version of the algorithm was made

  5. Tree Species Suitability to Bioswales and Impact on the Urban Water Budget.

    Science.gov (United States)

    Scharenbroch, Bryant C; Morgenroth, Justin; Maule, Brian

    2016-01-01

    Water movement between soil and the atmosphere is restricted by hardscapes in the urban environment. Some green infrastructure is intended to increase infiltration and storage of water, thus decreasing runoff and discharge of urban stormwater. Bioswales are a critical component of a water-sensitive urban design (or a low-impact urban design), and incorporation of trees into these green infrastructural components is believed to be a novel way to return stored water to the atmosphere via transpiration. This research was conducted in The Morton Arboretum's main parking lot, which is one of the first and largest green infrastructure installations in the midwestern United States. The parking lot is constructed of permeable pavers and tree bioswales. Trees in bioswales were evaluated for growth and condition and for their effects on water cycling via transpiration. Our data indicate that trees in bioswales accounted for 46 to 72% of total water outputs via transpiration, thereby reducing runoff and discharge from the parking lot. By evaluating the stomatal conductance, diameter growth, and condition of a variety of tree species in these bioswales, we found that not all species are equally suited for bioswales and that not all are equivalent in their transpiration and growth rates, thereby contributing differentially to the functional capacity of bioswales. We conclude that species with high stomatal conductance and large mature form are likely to contribute best to bioswale function. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

  6. ANALYSIS OF THE CURRENT STATE OF THE BUDGET SYSTEM OF THE RUSSIAN FEDERATION

    Directory of Open Access Journals (Sweden)

    Vladimir V. Bandurin

    2015-01-01

    Full Text Available The article analyzes the budgetary system of the Russian Federation. The elements of the budgetary system and the types of fiscal federalism. Particular attention is paid to the problem of the audit (control budget formulation and execution, the external and internal state financial control. 

  7. Analysis of the radiation budget in regional climate simulations with COSMO-CLM for Africa

    Directory of Open Access Journals (Sweden)

    Steffen Kothe

    2014-09-01

    Full Text Available This study analysed two regional climate simulations for Africa regarding the radiation budgets with particular focus on the contribution of potentially influential parameters on uncertainties in the radiation components. The ERA-Interim driven simulations have been performed with the COSMO-CLM (grid-spacings of 0.44 ° or 0.22 °. The simulated budgets were compared to the satellite-based Global Energy and Water Cycle Experiment Surface Radiation Budget and ERA-Interim data sets. The COSMO-CLM tended to underestimate the net solar radiation and the outgoing long-wave radiation, and showed a regionally varying over- or underestimation in all budget components. An increase in horizontal resolution from 0.44 ° to 0.22 ° slightly reduced the mean errors by up to 5 %. Especially over sea regions, uncertainties in cloud fraction were the main influencing parameter on errors in the simulated radiation fluxes. Compared to former simulations the introduction of a new bare soil albedo treatment reduced the influence of uncertainties in surface albedo significantly. Over the African continent errors in aerosol optical depth and skin temperature were regionally important sources for the discrepancies within the simulated radiation. In a sensitivity test it was shown that the use of aerosol optical depth values from the MACC reanalysis product improved the simulated surface radiation substantially.

  8. Impedance budget and beam stability analysis of the Fermilab Main Injector

    International Nuclear Information System (INIS)

    Martens, M.A.; Ng, K.Y.

    1993-05-01

    The impedance budget of the Fermilab Main Injector (MI) is estimated, which includes the contributions from the resistive walls, bellows, rf cavities, steps, Lambertsons, etc. Beam stability during ramping and bunch coalescence is analyzed. The transverse resistive-wall coupled bunch growth is found to be somewhat worse than the situation in the Main Ring (MR)

  9. Budgetary cash flows in the EU and their impact on national budget liquidity: the case of Slovenia

    Directory of Open Access Journals (Sweden)

    Tanja Markovič Hribernik

    2005-12-01

    Full Text Available On May 1, 2004 ten new states joined the EU. At the same time, budgetary cash flow mechanisms between the EU budget (as the central subject and national budgets were established. Despite the fact that all the rules are clear and known in advance - stipulated by the EU directives and regulations - there are some uncertainties, which may have an important effect on the liquidity as well as on the budgetary cash flows in new member states. The greatest problem for the liquidity of new member states’ budgets is posed by the time lags between inflows and outflows of EU funds. These lags are mainly because of delayed payments from the EU budget and problems with some member state’s absorption capacity. This article deals with the dynamics and the scale of budgetary cash flows between the Slovenian budget and the EU budget until 2006. A couple of likely scenarios are presented, which could happen in case of delayed payments of European funds. Consequently, both an unexpected state budget liquidity deficit and an additional burden arising from interest on delayed payments to the Brussels are possible for Slovenia.

  10. Budget Options

    National Research Council Canada - National Science Library

    2001-01-01

    ... (including the off-budget Social Security trust funds) to $281 billion. That surplus would be the largest in history in nominal dollars and the largest since 1948 as a percentage of gross domestic product (GDP...

  11. NCTN Budget

    Science.gov (United States)

    Learn about the budget for the National Clinical Trials Network (NCTN), a National Cancer Institute program that gives funds and other support to cancer research organizations to conduct cancer clinical trials.

  12. Therapies for treatment of osteoporosis in US women: cost-effectiveness and budget impact considerations.

    Science.gov (United States)

    Tosteson, Anna N A; Burge, Russel T; Marshall, Deborah A; Lindsay, Robert

    2008-09-01

    To evaluate the cost-effectiveness of osteoporosis treatments for women at high fracture risk and estimate the population-level impact of providing bisphosphonate therapy to all eligible high-risk US women. Fractures, healthcare costs, and quality-adjusted life-years (QALYs) were estimated over 10 years using a Markov model. No therapy, risedronate, alendronate, ibandronate, and teriperatide (PTH) were compared among 4 risk groups. Sensitivity analyses examined the robustness of model results for 65-year-old women with low bone density and previous vertebral fracture. Women treated with a bisphosphonate experienced fewer fractures and more QALYs compared with no therapy or PTH. Total costs were lowest for the untreated cohort, followed by risedronate, alendronate, ibandronate, and PTH in all risk groups except women aged 75 years with previous fracture. The incremental cost-effectiveness of risedronate compared with no therapy ranged from cost saving for the base case to $66,722 per QALY for women aged 65 years with no previous fracture. Ibandronate and PTH were dominated in all risk groups. (A dominated treatment has a higher cost and poorer outcome.) Treating all eligible women with a bisphosphonate would cost an estimated additional $5563 million (21% total increase) and would result in 390,049 fewer fractures (35% decrease). In the highest risk group, the additional cost of therapy was offset by other healthcare cost savings. Osteoporosis treatment of high-risk women is cost-effective, with bisphosphonates providing the most benefit at lowest cost. For highest risk women, costs are offset by savings from fracture prevention.

  13. Impact of DRG billing system on health budget consumption in percutaneous treatment of mitral valve regurgitation in heart failure.

    Science.gov (United States)

    Palmieri, Vittorio; Baldi, Cesare; Di Blasi, Paola E; Citro, Rodolfo; Di Lorenzo, Emilio; Bellino, Elisabetta; Preziuso, Feliciano; Ranaudo, Carlo; Sauro, Rosario; Rosato, Giuseppe

    2015-02-01

    Percutaneous correction of mitral regurgitation (MR) by MitraClip (Abbot Vascular, Abbot Park, Illinois, USA) trans-catheter procedure (MTP) may represent a treatment for an unmet need in heart failure (HF), but with a largely unclear economic impact. This study estimated the economic impact of the MTP in common practice using the disease-related group (DRG) billing system, duration and average cost per day of hospitalization as main drivers. Life expectancy was estimated based on the Seattle Heart Failure Model. Quality-of-life was derived by standard questionnaires to compute quality-adjusted year-life costs. Over 5535 discharges between 2012-2013, HF as DRG 127 was the main diagnosis in 20%, yielding a reimbursement of €3052.00/case; among the DRG 127, MR by ICD-9 coding was found in 12%. Duration of hospitalization was longer for DRG 127 with than without MR (9 vs 8 days, p deficit, in particular in the presence of MR, due to the high costs of hospitalization, higher than reimbursement. MTP to treat MR allowed DRG 104-related reimbursement of €24,675.00. In a cohort of 34 HF patients treated for MR by MTP, the global budget consumption was 2-fold higher compared to that simulated for those cases medically managed at 2-year follow-up. Extrapolated cost per quality-adjusted-life-years (QALY) for MTP at year-2 follow-up was ∼ €16,300. Based on DRG and hospitalization costing estimates, MTP might be cost-effective in selected HF patients with MR suitable for such a specific treatment, granted that those patients have a clinical profile predicting high likelihood of post-procedural clinical stability in sufficiently long follow-up.

  14. European Union Budget Politics

    DEFF Research Database (Denmark)

    Citi, Manuele

    2015-01-01

    The marginal involvement of the European Union (EU) in redistributive policies and its limited fiscal resources have led to a notable lack of attention by EU scholars towards the EU budget and its dynamics. Yet the nature of the budgetary data and their high usability for statistical analysis make...... to form winning coalitions in the Council, the ideological positioning of the co-legislators and the inclusion of the cohesion countries have played a significant role in driving budget change....

  15. Using adapted budget cost variance techniques to measure the impact of Lean – based on empirical findings in Lean case studies

    DEFF Research Database (Denmark)

    Kristensen, Thomas Borup

    2015-01-01

    Lean is dominating management philosophy, but the management accounting techniques that best supports this is still not fully understood. Especially how Lean fits traditional budget variance analysis, which is a main theme of every management accounting textbook. I have studied three Scandinavian...

  16. Ontario’s Bold Move to Create Jobs and Growth: Impact of the 2009 Ontario Budget and Other Recent Tax Measures on Investment, Jobs and Incomes

    Directory of Open Access Journals (Sweden)

    Jack M. Mintz

    2009-11-01

    Full Text Available • The 2009 Ontario Budget measures, together with other recent tax changes, will have a profound impact on Ontario’s competitiveness by lowering the tax burden on new business investment. • Within ten years, Ontario will benefit from: – increased capital investment of $47 billion; – increased annual incomes of up to 8.8%, or $29.4 billion; and – an estimated 591,000 net new jobs. This paper documents the impact of the 2009 Ontario Budget and other recent tax changes on capital investment, jobs, and incomes in the province. In the March 2009 Budget, Ontario announced it will harmonize its sales tax with the federal goods and services tax (GST as well as reduce corporate and personal taxes. The Budget measures will have a profound impact on the willingness of business to invest in Ontario since corporate tax rate reductions and the adoption of the federal GST base would result in the virtual elimination of taxes on capital goods and business intermediate inputs once fully phased in. Since 1980, when I began modelling the impact of taxes on investment, this is the largest change ever seen in a single budget, leading to the sharpest reduction in the tax burden on capital investment in any one province. Coupled with federal reductions in corporate taxes and Ontario’s already legislated elimination of all remaining capital taxes,1 Ontario will see its effective tax rate on new investments by medium and large businesses plummet from 33.6% in 2009 to 23.7% in 2010 and then to 18.5% by 2018. The province will then have an effective tax rate on non-resource investments that is similar to most other provinces, including Alberta, British Columbia, and Quebec. Ontario will also improve its international competitiveness dramatically with a lower tax burden on new investment compared with the average of 20 major industrialized and emerging economies. Small businesses will also benefit substantially from the 2009 Budget. The effective tax rate on

  17. An Analysis of the Factors Generating the Variance Between the Budgeted and Actual Operating Results of the Naval Aviation Depot at North Island, California

    National Research Council Canada - National Science Library

    Curran, Thomas; Schimpff, Joshua J

    2008-01-01

    .... The variance analysis between budgeted (projected) and actual financial results was performed on financial data collected on the E-2C aircraft program from Fleet Readiness Center Southwest (FRCSW...

  18. Budget deficit remedies and their impact on the non-oil sectors of an oil-exporting country: the case of Kuwait

    International Nuclear Information System (INIS)

    Eltony, M.N.

    1998-01-01

    A model for the non-oil production side of the Kuwaiti economy was developed and estimated. The model, then, was simulated according to various scenarios designed to eliminate the budget deficit by the year 2000, in order to examine the effect on the non-oil sector of the economy. The results indicate that, in terms of its impact on non-oil GDP, the extreme case scenario is harsh, bringing down the level of non-oil GDP by more than 20% by the year 2000 from its level in 1993. The impact on the budget deficit may be very positive, but non-oil production and consumption will decline very rapidly, creating widespread hardship across all economic sectors. The results suggest a better option lies in adopting either of two intermediate case scenarios. While each of these will also cause a decline in non-oil GDP, it will not be to the extent caused by the extreme case scenario

  19. BEYOND BUDGETING

    Directory of Open Access Journals (Sweden)

    Edo Cvrkalj

    2015-12-01

    Full Text Available Traditional budgeting principles, with strictly defined business goals, have been, since 1998, slowly growing into more sophisticated and organization-adjusted alternative budgeting concepts. One of those alternative concepts is the “Beyond budgeting” model with an implemented performance effects measuring process. In order for the model to be practicable, budget planning and control has to be reoriented to the “bottom up” planning and control approach. In today’s modern business surroundings one has to take both present and future opportunities and threats into consideration, by valorizing them in a budget which would allow a company to realize a whole pallet of advantages over the traditional budgeting principles which are presented later in the article. It is essential to emphasize the importance of successfully implementing the new budgeting principles within an organization. If the implementation has been lacking and done without a higher goal in mind, it is easily possible that the process has been implemented without coordination, planning and control framework within the organization itself. Further in the article we present an overview of managerial techniques and instruments within the “Beyond budgeting” model such as balanced scorecard, rolling forecast, dashboard, KPI and other supporting instruments. Lastly we define seven steps for implementing the “Beyond budgeting” model and offer a comparison of “Beyond budgeting” model against traditional budgeting principles which lists twelve reasons why “Beyond budgeting” is better suited to modern and market-oriented organizations. Each company faces those challenges in their own characteristic way but implementing new dynamic planning models will soon become essential for surviving in the market.

  20. Power budget analysis of image-plane storage in spectral hole-burning materials

    International Nuclear Information System (INIS)

    Neifeld, M.A.; Randall Babbitt, W.; Krishna Mohan, R.; Craig, A.E.

    2004-01-01

    We analyze the power requirements of a volumetric storage system based on hole-burning materials. We consider an image-plane architecture that uses ultra-fine wavelength addressing. We perform an optimization study in which hole-depth, material thickness, and spot size are selected to minimize the system power budget. We find that a data rate of 10 Gbps and a latency of 10 μs can be achieved in a read-once system based on Eu-YSO with a total power budget of only 23 mW. The same material system designed to tolerate 1000 read cycles would require only a factor of 15 increase in power

  1. The impact of economic downturns and budget cuts on homelessness claim rates across 323 local authorities in England, 2004-12.

    OpenAIRE

    Loopstra, R; Reeves, A; Barr, B; Taylor-Robinson, D; McKee, M; Stuckler, D

    2015-01-01

    It is unclear why rates of homelessness claims in England have risen since 2010. We used variations in rates across local authorities to test the impact of economic downturns and budget cuts. Using cross-area fixed effects models of data from 323 UK local authorities between 2004 and 2012, we evaluated associations of changes in statutory homelessness rates with economic activity (Gross Value Added per capita), unemployment, and local and central government expenditure. Each 10% fall in econo...

  2. The Budgeting of Portuguese Public Museums: a dynamic panel data analysis

    OpenAIRE

    João Coelho; Carlos Santos

    2008-01-01

    In this paper, the first panel on sources of funding for Portuguese publicly owned museums is explored. There has been little work in this field worldwide, and none for Portugal. Evidence in this paper seems contrary to that relating to the UK and to the US. We find that incremental budgeting still plays a major role on the funding of Portuguese museums, allowing for inefficient management and moral hazard: the interests of museums’ management may diverge clearly from those of the authorities...

  3. Cost-effectiveness and budget impact of obesity surgery in patients with type 2 diabetes in three European countries(II).

    Science.gov (United States)

    Anselmino, Marco; Bammer, Tanja; Fernández Cebrián, José Maria; Daoud, Frederic; Romagnoli, Giuliano; Torres, Antonio

    2009-11-01

    This study aimed to establish a payer-perspective cost-effectiveness and budget impact model of adjustable gastric banding (AGB) and gastric bypass (GBP) vs. conventional treatment (CT) in patients with a body mass index (BMI) > or = 35 kg x m(-2) and type 2 diabetes mellitus (T2DM) in Austria, Italy, and Spain. A health economics model described in a previous publication was applied to resource utilization and cost data in AGB, GBP, and CT from Austria, Italy, and Spain in 2009. The base case time scope is 5 years; the annual discount rate for utilities and costs is 3.5%. In Austria and Italy, both AGB and GBP are cost-saving and are thus dominant in terms of incremental cost-effectiveness ratio compared to CT. In Spain, AGB and GBP yield a moderate cost increase but are cost-effective, assuming a willingness-to-pay threshold of 30,000 euro per quality adjusted life-year. Under worst-case analysis, AGB and GBP remain cost-saving or around breakeven in Austria and Italy and remain cost-effective in Spain. In patients with T2DM and BMI > or = 35 kg x m(-2) at 5-year follow-up vs. CT, AGB and GBP are not only clinically effective and safe but represent satisfactory value for money from a payer perspective in Austria, Italy, and Spain.

  4. Link Power Budget and Traffict QoS Performance Analysis of Gygabit Passive Optical Network

    Science.gov (United States)

    Ubaidillah, A.; Alfita, R.; Toyyibah

    2018-01-01

    Data service of telecommunication network is needed widely in the world; therefore extra wide bandwidth must be provided. For this case, PT. Telekomunikasi Tbk. applies GPON (Gigabit Passive Optical Network) as optical fibre based on telecommunication network system. GPON is a point to a multipoint technology of FTTx (Fiber to The x) that transmits information signals to the subscriber over optical fibre. In GPON trunking system, from OLT (Optical Line Terminal), the network is split to many ONT (Optical Network Terminal) of the subscribers, so it causes path loss and attenuation. In this research, the GPON performance is measured from the link power budget system and the Quality of Service (QoS) of the traffic. And the observation result shows that the link power budget system of this GPON is in good condition. The link power budget values from the mathematical calculation and direct measurement are satisfy the ITU-T G984 Class B standard, that the power level must be between -8 dBm to -27 dBm. While from the traffic performance, the observation result shows that the network resource utility of the subscribers of the observed area is not optimum. The mean of subscriber utility rate is 27.985 bps for upstream and 79.687 bps for downstream. While maximally, It should be 60.800 bps for upstream and 486.400 bps for downstream.

  5. Assessment of the GHG budget mitigation potential of intercrops: analysis on several trials and intercrops species in the Southwest of France.

    Science.gov (United States)

    Ferlicoq, M.; Ceschia, E.; Brut, A.; VandeWalle, A.

    2012-04-01

    To reduce organic carbon loss from the soil and nitrate leaching to groundwater, the European directives have promoted Good Agricultural Practices (GAP), such as the use of intercrops (IC). As shown by Béziat et al. 2009, Ceschia et al. 2010, the IC (or voluntary regrowth from the previous crop) limit net CO2 release from the ecosystem or even contribute to carbon storage during their development. However, the seeding and destruction of IC can be difficult on soil with high clay content, especially when soil is wet, and they must be destroyed early enough so that the nitrogen they contain can be released in the soil and used by the following crops. For these reasons, the Midi-Pyrenees Agriculture Department obtained a 2-year temporary derogation to test the implementation of several nitrates catch crops (mustard, diploïd oat, black oat, oat/vetch, oat/phacelia) on clay soils in order to evaluate the best management practices for growing and destroying them. Their impact on the next crop development was also analysed. In this study, the CESBIO helped the Midi-Pyrénées Agriculture Department to 1) calculate a carbon budget for the different trials and 2) to estimate GHG budgets for those trials by using a life cycle analysis (LCA) approach. Emissions associated to Field Operations (FO) were estimated based on study by Ceschia et al. (2010). During long periods of bare soil, the net CO2 flux is reduced to heterotrophic respiration. Since this component of NEE is not measured on the IC sites, it has been estimated using data from a GHG-Europe instrumented site in the same region, the same year and on similar soils (Auradé site, Gers). Heterotrophic respiration was estimated to range between 96.4 and 131 g eq-C m-2 during the IC cycle that lasted between 65 and 89 days. At the end of the IC period, biomass was (in g eq-C) 0.77, 0.18, 9.89, 0.42, 0.48 for mustard, diploïd oat, black oat, oat/vetch, oat/phacelia respectively. The low amount of biomass is explained

  6. Cost-effectiveness and budget impact of hepatitis C virus treatment with sofosbuvir and ledipasvir in the United States.

    Science.gov (United States)

    Chhatwal, Jagpreet; Kanwal, Fasiha; Roberts, Mark S; Dunn, Michael A

    2015-03-17

    Sofosbuvir and ledipasvir, which have recently been approved for treatment of chronic hepatitis C virus (HCV) infection, are more efficacious and safer than the old standard of care (oSOC) but are substantially more expensive. Whether and in which patients their improved efficacy justifies their increased cost is unclear. To evaluate the cost-effectiveness and budget impact of sofosbuvir and ledipasvir. Microsimulation model of the natural history of HCV infection. Published literature. Treatment-naive and treatment-experienced HCV population defined on the basis of HCV genotype, age, and fibrosis distribution in the United States. Lifetime. Third-party payer. Simulation of sofosbuvir-ledipasvir compared with the oSOC (interferon-based therapies). Quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and 5-year spending on antiviral drugs. Sofosbuvir-based therapies added 0.56 QALY relative to the oSOC at an ICER of $55 400 per additional QALY. The ICERs ranged from $9700 to $284 300 per QALY depending on the patient's status with respect to treatment history, HCV genotype, and presence of cirrhosis. At a willingness-to-pay threshold of $100 000 per QALY, sofosbuvir-based therapies were cost-effective in 83% of treatment-naive and 81% of treatment-experienced patients. Compared with the oSOC, treating eligible HCV-infected persons in the United States with the new drugs would cost an additional $65 billion in the next 5 years, whereas the resulting cost offsets would be $16 billion. Results were sensitive to drug price, drug efficacy, and quality of life after successful treatment. Data on real-world effectiveness of new antivirals are lacking. Treatment of HCV is cost-effective in most patients, but additional resources and value-based patient prioritization are needed to manage patients with HCV. National Institutes of Health.

  7. Isocyanic acid in a global chemistry transport model: Tropospheric distribution, budget, and identification of regions with potential health impacts

    Science.gov (United States)

    Young, Paul. J.; Emmons, Louisa K.; Roberts, James M.; Lamarque, Jean-FrançOis; Wiedinmyer, Christine; Veres, Patrick; Vandenboer, Trevor C.

    2012-05-01

    This study uses a global chemical transport model to estimate the distribution of isocyanic acid (HNCO). HNCO is toxic, and concentrations exceeding 1 ppbv have been suggested to have negative health effects. Based on fire studies, HNCO emissions were scaled to those of hydrogen cyanide (30%), resulting in yearly total emissions of 1.5 Tg for 2008, from both anthropogenic and biomass burning sources. Loss processes included heterogeneous uptake (pH dependent), dry deposition (like formic acid), and reaction with the OH radical (k = 1 × 10-15 molecule-1 cm3 s-1). Annual mean surface HNCO concentrations were highest over parts of China (maximum of 470 pptv), but episodic fire emissions gave much higher levels, exceeding 4 ppbv in tropical Africa and the Amazon, and exceeding 10 ppbv in Southeast Asia and Siberia. This suggests that large biomass burning events could result in deleterious health effects for populations in these regions. For the tropospheric budget, using the model-calculated pH the HNCO lifetime was 37 days, with the split between dry deposition and heterogeneous loss being 95%:5%. Fixing the heterogeneous loss rate at pH = 7 meant that this process dominated, accounting for ˜70% of the total loss, giving a lifetime of 6 days, and resulting in upper tropospheric concentrations that were essentially zero. However, changing the pH does not notably impact the high concentrations found in biomass burning regions. More observational data is needed to evaluate the model, as well as a better representation of the likely underestimated biofuel emissions, which could mean more populations exposed to elevated HNCO concentrations.

  8. Impact of the snow cover scheme on snow distribution and energy budget modeling over the Tibetan Plateau

    Science.gov (United States)

    Xie, Zhipeng; Hu, Zeyong; Xie, Zhenghui; Jia, Binghao; Sun, Genhou; Du, Yizhen; Song, Haiqing

    2018-02-01

    This paper presents the impact of two snow cover schemes (NY07 and SL12) in the Community Land Model version 4.5 (CLM4.5) on the snow distribution and surface energy budget over the Tibetan Plateau. The simulated snow cover fraction (SCF), snow depth, and snow cover days were evaluated against in situ snow depth observations and a satellite-based snow cover product and snow depth dataset. The results show that the SL12 scheme, which considers snow accumulation and snowmelt processes separately, has a higher overall accuracy (81.8%) than the NY07 (75.8%). The newer scheme performs better in the prediction of overall accuracy compared with the NY07; however, SL12 yields a 15.1% underestimation rate while NY07 overestimated the SCF with a 15.2% overestimation rate. Both two schemes capture the distribution of the maximum snow depth well but show large positive biases in the average value through all periods (3.37, 3.15, and 1.48 cm for NY07; 3.91, 3.52, and 1.17 cm for SL12) and overestimate snow cover days compared with the satellite-based product and in situ observations. Higher altitudes show larger root-mean-square errors (RMSEs) in the simulations of snow depth and snow cover days during the snow-free period. Moreover, the surface energy flux estimations from the SL12 scheme are generally superior to the simulation from NY07 when evaluated against ground-based observations, in particular for net radiation and sensible heat flux. This study has great implications for further improvement of the subgrid-scale snow variations over the Tibetan Plateau.

  9. Assessing the impact of budget controls on the prescribing behaviours of physicians treating dialysis-dependent patients.

    Science.gov (United States)

    Chang, Ray-E; Tsai, Ya-Hsing; Myrtle, Robert C

    2015-11-01

    This study examined whether outpatient haemodialysis providers changed their treatment practices with the establishment of an outpatient dialysis global budget (ODGB) through analysing the outpatient visits and medication received by those patients. A sample of 4668 observations (patient year) of 1350 haemodialysis with hypertension (HH) patients and 4668 observations of 1436 non-HH (NHH) patients were drawn from the National Health Insurance Research Database over the years from 1999 to 2005. The impact of ODGB on hypertension-related outpatient utilization of HH was estimated using the difference in difference (DID) method and examined in three stages: (1) the fee for service stage, the pre-ODGB (2000), (2) the phase-in stage (2001-2002) and (3) the post-ODGB stage (2003-2005). ODGB implementation did not affect the number of dialysis visits for HH patients. However, it did lead to a reduction in fees for antihypertension drugs used by haemodialysis facilities. There was an increase of 4.06 visits per patient per year (P < 0.001) in the number of non-dialysis outpatient with antihypertensive drugs visits for HH patients compared with the control group. The total fees for antihypertensive drugs for HH patients increased by New Taiwan Dollars (NT$)13 008 (P < 0.001) per patient per year relative to the control group after the implementation of ODGB. As ODGB was implemented, HH patients received fewer antihypertensive drugs during their dialysis visit. In addition, there was an increase in the number of non-dialysis outpatient visits by HH patients as well as increased payment in the drugs associated with their non-dialysis outpatient visits compared with the control group. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

  10. The Budget Impact of Including Necitumumab on the Formulary for First-Line Treatment of Metastatic Squamous Non-Small Cell Lung Cancer: U.S. Commercial Payer and Medicare Perspectives.

    Science.gov (United States)

    Bly, Christopher A; Molife, Cliff; Brown, Jacqueline; Tawney, Mahesh K; Carter, Gebra Cuyun; Cinfio, Frank N; Klein, Robert W

    2018-06-01

    ,812 (13.5%), and disease costs increased by $7,951 (0.4%), whereas adverse event costs decreased by $1,368 (0.5%) in year 1. From the Medicare perspective, the overall year 1 incremental budget impact was $438,056 ($0.037 PMPM, $3,112 PPPY), representing a 3.0% cost increase. The higher incremental budget in Medicare, compared with commercial plans, was due to higher msqNSCLC incidence in the older Medicare patients (154 vs. 30 patients, respectively). Results were most sensitive to Neci drug costs. Based on projected market shares, coverage for first-line therapy with Neci + GCis appeared to modestly affect overall U.S. health care budgets for msqNSCLC-related care. Given the small eligible patient population, the PMPM budgetary impact on a commercial health plan of reimbursing Neci + GCis in the first year was less than $0.01, rising with increased use of Neci + GCis to $0.025 in the third year. The real-world effect of Neci + GCis needs to be evaluated to validate this analysis; however, these findings may help policymakers in making coverage decisions for Neci + GCis. This study was funded by Eli Lilly and Company. Molife, Brown, Tawney, and Cuyun Carter are equity holders and employees of Eli Lilly and Company. Bly, Cinfio, and Klein are employees of Medical Decision Modeling, which received funding from Eli Lilly and Company to conduct this research and prepare this manuscript.

  11. The budget impact and cost-effectiveness of defibrotide for treatment of veno-occlusive disease with multi-organ dysfunction in patients post-hematopoietic stem cell transplant.

    Science.gov (United States)

    Veenstra, David L; Guzauskas, Gregory F; Villa, Kathleen F; Boudreau, Denise M

    2017-05-01

    A Phase-3 study of defibrotide compared with historical controls demonstrated a 23% improvement in 100-day survival post-hematopoietic stem cell transplantation (HSCT) among patients with veno-occlusive disease with multi-organ dysfunction (VOD with MOD). To estimate the budget impact and cost-effectiveness of introducing defibrotide to a transplant center. The authors developed a budget impact model from the perspective of a bone-marrow transplant center. It was estimated that 2.3% of adults and 4.2% of children would develop VOD with MOD following HSCT based on a retrospective hospital database analysis and the effect that treating patients with defibrotide would have on costs for adult and pediatric centers was estimated. A cost-utility analysis (CUA) was also developed to capture the long-term cost-effectiveness of defibrotide. Projected life expectancies in the two groups were estimated based on trial data, transplant registry data, studies of long-term survival among HSCT patients, and US population life-tables. There was an estimated 3% increase ($330,706) per year in total adult transplantation center costs associated with adopting defibrotide, and a incremental cost-effectiveness ratio (ICER) was $47,736 per QALY gained; 88% probability defibrotide was cost-effective at a $100,000/QALY threshold. The budget impact of defibrotide for a transplant center is relatively modest compared to the overall cost of transplantation. Defibrotide provides an important survival advantage for VOD with MOD patients, and the life years gained lead to defibrotide being highly cost-effective.

  12. Experimental and modeling study of the impact of vertical transport processes from the boundary-layer on the variability and the budget of tropospheric ozone; Etude experimentale et numerique de l'influence des processus de transport depuis la couche-limite sur la variabilite et le bilan d'ozone tropospherique

    Energy Technology Data Exchange (ETDEWEB)

    Colette, A

    2005-12-15

    Closing the tropospheric ozone budget requires a better understanding of the role of transport processes from the major reservoirs: the planetary boundary layer and the stratosphere. Case studies lead to the identification of mechanisms involved as well as their efficiency. However, their global impact on the budget must be addressed on a climatological basis. This manuscript is thus divided in two parts. First, we present case studies based on ozone LIDAR measurements performed during the ESCOMPTE campaign. This work consists in a data analysis investigation by means of a hybrid - Lagrangian study involving: global meteorological analyses, Lagrangian particle dispersion computation, and mesoscale, chemistry - transport, and Lagrangian photochemistry modeling. Our aim is to document the amount of observed ozone variability related to transport processes and, when appropriate, to infer the role of tropospheric photochemical production. Second, we propose a climatological analysis of the respective impact of transport from the boundary-layer and from the tropopause region on the tropospheric ozone budget. A multivariate analysis is presented and compared to a trajectography approach. Once validated, this algorithm is applied to the whole database of ozone profiles collected above Europe during the past 30 years in order to discuss the seasonal, geographical and temporal variability of transport processes as well as their impact on the tropospheric ozone budget. The variability of turbulent mixing and its impact on the persistence of tropospheric layers will also be discussed. (author)

  13. Experimental and modeling study of the impact of vertical transport processes from the boundary-layer on the variability and the budget of tropospheric ozone; Etude experimentale et numerique de l'influence des processus de transport depuis la couche-limite sur la variabilite et le bilan d'ozone tropospherique

    Energy Technology Data Exchange (ETDEWEB)

    Colette, A

    2005-12-15

    Closing the tropospheric ozone budget requires a better understanding of the role of transport processes from the major reservoirs: the planetary boundary layer and the stratosphere. Case studies lead to the identification of mechanisms involved as well as their efficiency. However, their global impact on the budget must be addressed on a climatological basis. This manuscript is thus divided in two parts. First, we present case studies based on ozone LIDAR measurements performed during the ESCOMPTE campaign. This work consists in a data analysis investigation by means of a hybrid - Lagrangian study involving: global meteorological analyses, Lagrangian particle dispersion computation, and mesoscale, chemistry - transport, and Lagrangian photochemistry modeling. Our aim is to document the amount of observed ozone variability related to transport processes and, when appropriate, to infer the role of tropospheric photochemical production. Second, we propose a climatological analysis of the respective impact of transport from the boundary-layer and from the tropopause region on the tropospheric ozone budget. A multivariate analysis is presented and compared to a trajectography approach. Once validated, this algorithm is applied to the whole database of ozone profiles collected above Europe during the past 30 years in order to discuss the seasonal, geographical and temporal variability of transport processes as well as their impact on the tropospheric ozone budget. The variability of turbulent mixing and its impact on the persistence of tropospheric layers will also be discussed. (author)

  14. Detailed budget analysis of HONO in central London reveals a missing daytime source

    Directory of Open Access Journals (Sweden)

    J. D. Lee

    2016-03-01

    Full Text Available Measurements of HONO were carried out at an urban background site near central London as part of the Clean air for London (ClearfLo project in summer 2012. Data were collected from 22 July to 18 August 2014, with peak values of up to 1.8 ppbV at night and non-zero values of between 0.2 and 0.6 ppbV seen during the day. A wide range of other gas phase, aerosol, radiation, and meteorological measurements were made concurrently at the same site, allowing a detailed analysis of the chemistry to be carried out. The peak HONO/NOx ratio of 0.04 is seen at  ∼  02:00 UTC, with the presence of a second, daytime, peak in HONO/NOx of similar magnitude to the night-time peak, suggesting a significant secondary daytime HONO source. A photostationary state calculation of HONO involving formation from the reaction of OH and NO and loss from photolysis, reaction with OH, and dry deposition shows a significant underestimation during the day, with calculated values being close to 0, compared to the measurement average of 0.4 ppbV at midday. The addition of further HONO sources from the literature, including dark conversion of NO2 on surfaces, direct emission, photolysis of ortho-substituted nitrophenols, the postulated formation from the reaction of HO2 ×  H2O with NO2, photolysis of adsorbed HNO3 on ground and aerosols, and HONO produced by photosensitized conversion of NO2 on the surface increases the daytime modelled HONO to 0.1 ppbV, still leaving a significant missing daytime source. The missing HONO is plotted against a series of parameters including NO2 and OH reactivity (used as a proxy for organic material, with little correlation seen. Much better correlation is observed with the product of these species with j(NO2, in particular NO2 and the product of NO2 with OH reactivity. This suggests the missing HONO source is in some way related to NO2 and also requires sunlight. Increasing the photosensitized surface conversion rate of NO2 by a

  15. BUDGET AND PUBLIC DEBT

    Directory of Open Access Journals (Sweden)

    Morar Ioan Dan

    2014-12-01

    Full Text Available The issue of public budgeting is an important issue for public policy of the state, for the simple reason that no money from the state budget can not promote public policy. Budgetary policy is official government Doctrine vision mirror and also represents a starting point for other public policies, which in turn are financed by the public budget. Fiscal policy instruments at its disposal handles the public sector in its structure, and the private sector. Tools such as grant, budgetary allocation, tax, welfare under various forms, direct investments and not least the state aid is used by the state through their budgetary policies to directly and indirectly infuence sector, and the private. Fiscal policies can be grouped according to the structure of the public sector in these components, namely fiscal policy, budgeting and resource allocation policies for financing the budget deficit. An important issue is the financing of the budget deficit budgetary policies. There are two funding possibilities, namely, the higher taxes or more axles site and enter the second call to public loans. Both options involve extra effort from taxpayers in the current fiscal year when they pay higher taxes or a future period when public loans will be repaid. We know that by virtue of "fiscal pact" structural deficits of the member countries of the EU are limited by the European Commission, according to the macro structural stability and budget of each Member State. This problem tempers to some extent the governments of the Member States budgetary appetite, but does not solve the problem of chronic budget deficits. Another issue addressed in this paper is related to the public debt, the absolute amount of its relative level of public datoriri, about the size of GDP, public debt financing and its repayment sources. Sources of public debt issuance and monetary impact on the budget and monetary stability are variables that must underpin the justification of budgetary

  16. Budget impact model of Mydrane®, a new intracameral injectable used for intra-operative mydriasis, from a UK hospital perspective.

    Science.gov (United States)

    Davey, Keith; Chang, Bernard; Purslow, Christine; Clay, Emilie; Vataire, Anne-Lise

    2018-04-19

    During cataract surgery, maintaining an adequate degree of mydriasis throughout the entire operation is critical to allow for visualisation of the capsulorhexis and the crystalline lens. Good anaesthesia is also essential for safe intraocular surgery. Mydrane® is a new injectable intracameral solution containing two mydriatics (tropicamide 0.02% and phenylephrine 0.31%) and one anaesthetic (lidocaine 1%) that was developed as an alternative to the conventional topical pre-operative mydriatics used in cataract surgery. This study aimed to estimate the budget impact across a one year time frame using Mydrane® instead of topical dilating eye drops, for a UK hospital performing 3,000 cataract operations a year. A budget impact model (BIM) was developed to compare the economic outcomes associated with the use of Mydrane® versus topical drops (tropicamide 0.5% and phenylephrine 10%) in patients undergoing cataract surgery in a UK hospital. The outcomes of interest included costs and resource use (e.g. clinician time, mydriasis failures, operating room time, number of patients per vial of therapy etc.) associated with management of mydriasis in patients undergoing cataract surgery. All model inputs considered the UK hospital perspective without social or geographical variables. Deterministic sensitivity analyses were also performed to assess the model uncertainty. Introduction of Mydrane® is associated with a cost saving of £6,251 over 3,000 cataract surgeries in one year. The acquisition costs of the Mydrane® (£18,000 by year vs. £3,330 for eye drops) were balanced by substantial reductions in mainly nurses' costs and time, plus a smaller contribution from savings in surgeons' costs (£20,511) and lower costs associated with auxiliary dilation (£410 due to avoidance of additional dilation methods). Results of the sensitivity analyses confirmed the robustness of the model to the variation of inputs. Except for the duration of one session of eye drop instillation

  17. Cost-effectiveness and budget impact of Empirical vitamin D therapy on unintentional falls in older adults in the UK.

    Science.gov (United States)

    Poole, C D; Smith, J; Davies, J S

    2015-09-29

    To evaluate the health outcomes and economics associated with the current guidance relating to the prevention of falls in the elderly through vitamin D supplementation. UK. UK population aged 60 years and above. A Markov health state transition model simulated patient transitions between key fall-related outcomes using a 5-year horizon and annual cycles to assess the costs and benefits of empirical treatment with colecalciferol 800 iu daily. Costs and health outcomes attributable to fall prevention following vitamin D supplementation. Our model shows that treating the UK population aged 60 years and above with 800 iu colecalciferol would, over a 5-year period: (1) prevent in excess of 430,000 minor falls; (2) avoid 190,000 major falls; (3) prevent 1579 acute deaths; (4) avoid 84,000 person-years of long-term care and (5) prevent 8300 deaths associated with increased mortality in long-term care. The greatest gains are seen among those 75 years and older. Based on reduction in falls alone, the intervention in all adults aged 65+ is cost-saving and leads to increased quality adjusted life years. Treating all adults aged 60+ incurs an intervention cost of £2.70bn over 5 years, yet produces a -£3.12bn reduction in fall-related costs; a net saving of £420M. Increasing the lower bound age limit by 5-year increments increases budget impact to -£1.17bn, -£1.75bn, and -£2.06bn for adults 65+, 70+ and 75+, respectively. This study shows that treatment of the elderly UK population with colecalciferol 800 iu daily would be associated with reductions in mortality and substantial cost-savings through fall prevention. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  18. Cost-effectiveness analysis and efficient use of the pharmaceutical budget: the key role of clinical pharmacologists.

    Science.gov (United States)

    Edlin, Richard; Round, Jeff; Hulme, Claire; McCabe, Christopher

    2010-09-01

    The purpose of this paper is to provide information about cost-effectiveness analysis and the roles of clinical pharmacologists generally in providing efficient health care. The paper highlights the potential consequences of 'off-label prescribing' and 'indication creep' behaviour given slower growth (or potential cuts) in the NHS budget. This paper highlights the key roles of clinical pharmacologists in delivering an efficient health care system when resources are allocated using cost-effectiveness analyses. It describes what cost-effectiveness analysis (CEA) is and how incremental cost-effectiveness ratios (ICERs) are used to identify efficient options. After outlining the theoretical framework within which using CEA can promote the efficient allocation of the health care budget, it considers the place of disinvestment within achieving efficient resource allocation. Clinical pharmacologists are argued to be critical to providing improved population health under CEA-based resource allocation processes because of their roles in implementation and disinvestment. Given that the challenges facing the United Kingdom National Health Service (NHS) are likely to increase, this paper sets out the stark choices facing clinical pharmacologists.

  19. Large-scale dynamical influence of a gravity wave generated over the Antarctic Peninsula – regional modelling and budget analysis

    Directory of Open Access Journals (Sweden)

    JOEL Arnault

    2013-03-01

    Full Text Available The case study of a mountain wave triggered by the Antarctic Peninsula on 6 October 2005, which has already been documented in the literature, is chosen here to quantify the associated gravity wave forcing on the large-scale flow, with a budget analysis of the horizontal wind components and horizontal kinetic energy. In particular, a numerical simulation using the Weather Research and Forecasting (WRF model is compared to a control simulation with flat orography to separate the contribution of the mountain wave from that of other synoptic processes of non-orographic origin. The so-called differential budgets of horizontal wind components and horizontal kinetic energy (after subtracting the results from the simulation without orography are then averaged horizontally and vertically in the inner domain of the simulation to quantify the mountain wave dynamical influence at this scale. This allows for a quantitative analysis of the simulated mountain wave's dynamical influence, including the orographically induced pressure drag, the counterbalancing wave-induced vertical transport of momentum from the flow aloft, the momentum and energy exchanges with the outer flow at the lateral and upper boundaries, the effect of turbulent mixing, the dynamics associated with geostrophic re-adjustment of the inner flow, the deceleration of the inner flow, the secondary generation of an inertia–gravity wave and the so-called baroclinic conversion of energy between potential energy and kinetic energy.

  20. Future Costs, Fixed Healthcare Budgets, and the Decision Rules of Cost-Effectiveness Analysis.

    Science.gov (United States)

    van Baal, Pieter; Meltzer, David; Brouwer, Werner

    2016-02-01

    Life-saving medical technologies result in additional demand for health care due to increased life expectancy. However, most economic evaluations do not include all medical costs that may result from this additional demand in health care and include only future costs of related illnesses. Although there has been much debate regarding the question to which extent future costs should be included from a societal perspective, the appropriate role of future medical costs in the widely adopted but more narrow healthcare perspective has been neglected. Using a theoretical model, we demonstrate that optimal decision rules for cost-effectiveness analyses assuming fixed healthcare budgets dictate that future costs of both related and unrelated medical care should be included. Practical relevance of including the costs of future unrelated medical care is illustrated using the example of transcatheter aortic valve implantation. Our findings suggest that guidelines should prescribe inclusion of these costs. Copyright © 2014 John Wiley & Sons, Ltd.

  1. Analysis of Changes in the Lorenz Energy Budget of the Atmosphere

    Science.gov (United States)

    Ellis, T. D.

    2009-12-01

    Several recent papers have addressed the topic of changes in global precipitation rates related to changes in Earth's global energy balance. Less studied are the processes that may be governing the large-scale regional distribution of precipitation around the globe. This study uses the energy budget partition paradigm first put forth by Lorenz (1955) and follows the methodology of Arpé et al. (1986) and Oriol (1982) to identify latitude bands where the partition of energy amongst zonal and eddy kinetic and potential energy bins may account for the spatial patterns of precipitation change predicted by many IPCC AR4 models. In doing so, this study may help to identify whether or not the climate change predicted by these models is indeed creating enhanced baroclinic storms in the mid-latitudes or if there are other mechanisms at work producing the patterns of precipitation change.

  2. Environmental budget and policy goal

    Energy Technology Data Exchange (ETDEWEB)

    Noh, Sang Hwan [Korea Environment Institute, Seoul (Korea)

    1998-12-01

    The assigned budget for environmental sector is quite insufficient to meet enormous environmental demand. Under this circumstance, there is only one way to solve environmental problems efficiently, i.e. to use a given budget efficiently. Therefore, the study on efficient utilization of a given environmental invested finance is needed by customizing a diagnosis of present condition on the operation of environmental budget and environmental investment analysis. In this respect, an entire national budget of 1999 and environmental budget were analyzed in this study. By analyzing economic efficiency of sewage disposal program, integrated septic tank system, VOC regulation, incinerator construction program, food waste disposal program, and recycling program, an efficient budget policy was presented. 19 refs., 18 figs., 169 tabs.

  3. ANALYSIS OF THE INFLUENCE OF THROMBOEMBOLIC COMPLICATIONS PREVENTION WITH ORAL ANTICOAGULANTS ON BUDGET IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION

    Directory of Open Access Journals (Sweden)

    A. V. Rudakova

    2015-09-01

    drug is included in the essential drugs list, subject to 10% VAT and 10% wholesale mark. The cost of complications treatment corresponded to the rate of compulsory health insurance for the city of St. Petersburg for 2015.Results. The estimated number of patients with non-valvular AF who require anticoagulation therapy in the RF is 1,196,600 people according to the epidemiological data. Treatment with apixaban significantly reduces the incidence of cardiovascular events as compared with warfarin and rivaroxaban. The results of the budget impact analysis, taking into account the price obtained at auction from 01.04.14 through 01.04.15, show a decrease in the load on the budget when the apixaban is included in the therapy regimen of non-valvular atrial fibrillation. Potential savings of resources of the health care system reached 10.9 billion rubles as compared with dabigatran and 39.2 billion rubles as compared with rivaroxaban. This advantage can be explained by both the lower cost of apixaban in comparison with reference drugs, and a reduction of the in-hospital expenses on complications treatment. Switching from warfarin to apixaban increases the budget load in 2.81 times. However, previous data demonstrate the economic feasibility of the additional costs of apixaban, that help to achieve significant advantages from a clinical point of view. The results obtained on the basis of prices, intended to include apixaban in the list of essential drugs, showed that in this case the savings of the budget of the health care system will reach 127-129 bln. rubles for 5 years (average 26% as compared with dabigatran and rivaroxaban. The comparison of apixaban with warfarin showed an increase in total costs of therapy in 2.72 times.Conclusion. The inclusion of apixaban in the therapy regimen of non-valvular atrial fibrillation can significantly reduce the burden on the budget of the health care system as compared with dabigatran and rivaroxaban, as well as reduce the incidence of

  4. [Budget impact of the incorporation of GeneXpert MTB/RIF for diagnosis of pulmonary tuberculosis from the perspective of the Brazilian Unified National Health System, Brazil, 2013-2017].

    Science.gov (United States)

    Pinto, Márcia Ferreira Teixeira; Steffen, Ricardo; Entringer, Aline; Costa, Ana Carolina Carioca da; Trajman, Anete

    2017-10-09

    The study aimed to estimate the budget impact of GeneXpert MTB/RIF for diagnosis of tuberculosis from the perspective of the Brazilian National Program for Tuberculosis Control, drawing on a static model using the epidemiological method, from 2013 to 2017. GeneXpert MTB/RIF was compared with two diagnostic sputum smear tests. The study used epidemiological, population, and cost data, exchange rates, and databases from the Brazilian Unified National Health System. Sensitivity analysis of scenarios was performed. Incorporation of GeneXpert MTB/RIF would cost BRL 147 million (roughly USD 45 million) in five years and would have an impact of 23 to 26% in the first two years and some 11% between 2015 and 2017. The results can support Brazilian and other Latin American health administrators in planning and managing the decision on incorporating the technology.

  5. An analysis of budgetary goals impacting organizational performance

    Directory of Open Access Journals (Sweden)

    Cheok MUI YEE

    2016-05-01

    Full Text Available This study proposes a conceptual review of how budgetary goals impact organizational performance. The aim of this study is to get a better understanding of the direct and indirect relationship between the organization’s decision-making process and operational performances. Setting the budget particularly influences subordinates’ budget goal levels and motivations (i.e., budget goal acceptance and budget goal commitment, which ultimately enhances the organization’s performance. To test these relationships, data were collected using the three perspectives approach: budgetary goal, budgetary participation and budgetary evaluation. The study provided evidence that perception of fairness mediates the relation between the levels of budget participation and goal commitment, whereas goal commitment mediates the relation between fairness perceptions and performance. At the end of the article, there are some implications for SMEs industries and some suggestions for future studies.

  6. Home - House Budget Committee

    Science.gov (United States)

    Initiatives Hearings Full Menu About Toggle Links Members History Staff Rules & Budget Law News Toggle Links Press Releases Budget Digests HBC Publications Op-Eds Speeches & Statements Budgets Toggle Links FY 2018 Budget FY 2017 Budget FY 2017 Reconciliation FY 2016 Budget FY 2016 Reconciliation FY 2015

  7. A transitioning Arctic surface energy budget: the impacts of solar zenith angle, surface albedo and cloud radiative forcing

    Energy Technology Data Exchange (ETDEWEB)

    Sedlar, Joseph; Tjernstroem, Michael; Leck, Caroline [Stockholm University, Department of Meteorology, Stockholm (Sweden); Mauritsen, Thorsten [Max-Planck-Institute for Meteorology, Hamburg (Germany); Shupe, Matthew D.; Persson, P.O.G. [University of Colorado, NOAA-ESRL-PSD, Boulder, CO (United States); Brooks, Ian M.; Birch, Cathryn E. [University of Leeds, School of Earth and Environment, Leeds (United Kingdom); Sirevaag, Anders [University of Bergen, Bjerknes Center for Climate Research, Bergen (Norway); Nicolaus, Marcel [Norwegian Polar Institute, Tromsoe (Norway); Alfred Wegener Institute for Polar and Marine Research, Bremerhaven (Germany)

    2011-10-15

    Snow surface and sea-ice energy budgets were measured near 87.5 N during the Arctic Summer Cloud Ocean Study (ASCOS), from August to early September 2008. Surface temperature indicated four distinct temperature regimes, characterized by varying cloud, thermodynamic and solar properties. An initial warm, melt-season regime was interrupted by a 3-day cold regime where temperatures dropped from near zero to -7 C. Subsequently mean energy budget residuals remained small and near zero for 1 week until once again temperatures dropped rapidly and the energy budget residuals became negative. Energy budget transitions were dominated by the net radiative fluxes, largely controlled by the cloudiness. Variable heat, moisture and cloud distributions were associated with changing air-masses. Surface cloud radiative forcing, the net radiative effect of clouds on the surface relative to clear skies, is estimated. Shortwave cloud forcing ranged between -50 W m{sup -2} and zero and varied significantly with surface albedo, solar zenith angle and cloud liquid water. Longwave cloud forcing was larger and generally ranged between 65 and 85 W m{sup -2}, except when the cloud fraction was tenuous or contained little liquid water; thus the net effect of the clouds was to warm the surface. Both cold periods occurred under tenuous, or altogether absent, low-level clouds containing little liquid water, effectively reducing the cloud greenhouse effect. Freeze-up progression was enhanced by a combination of increasing solar zenith angles and surface albedo, while inhibited by a large, positive surface cloud forcing until a new air-mass with considerably less cloudiness advected over the experiment area. (orig.)

  8. Impact analysis of shipping casks

    International Nuclear Information System (INIS)

    Pfeiffer, P.A.; Kennedy, J.M.

    1989-01-01

    Shipping casks are being used in the United States Department of Energy to transport irradiated experiments, reactor fuel, radioactive waste, etc. One of the critical requirements in shipping cask analysis is the necessity to withstand severe impact environments. It is still conventional to develop the design and to verify the design requirements by hand calculations. Full three dimensional computations of impact scenarios have been performed but they are too expensive and time consuming for design purposes. Typically, on the order of more than an hour of CRAY time is required for a detailed, three dimensional analysis. The paper describes how simpler two- and three-dimensional models can be used to provide an intermediate level of detail between full three dimensional finite element calculations and hand calculations. The regulation that is examined here is: 10 CFR-71.73 hypothetical accident conditions, free drop. Free drop for an accident condition of a Class I package (approximate weight of 22,000 lb) is defined as a 30 foot drop onto a flat, essentially unyielding, horizontal surface, striking the surface in a position for which maximum damage is expected. Three free drop scenarios are analyzed to assess the integrity of the cask when subjected to large bending and axial stresses. These three drop scenarios are: (1) a thirty foot axial drop on either end, (2) a thirty foot oblique angle drop with the cask having several different orientations from the vertical with impact on the top end cask corner, and (3) a thirty foot side drop with simultaneous impact on the strength of the various components that comprise the cask. The predicted levels of deformation and stresses in the cask will be used to assess the potential damage level. 5 refs., 5 figs., 1 tab

  9. Sediment Budget Analysis and Hazard Assessment in the Peynin, a Small Alpine Catchment (Upper Guil River, Southern Alps, France)

    Science.gov (United States)

    Carlier, Benoit; Arnaud-Fassetta, Gilles; Fort, Monique; Bouccara, Fanny; Sourdot, Grégoire; Tassel, Adrien; Lissak, Candide; Betard, François; Cossart, Etienne; Madelin, Malika; Viel, Vincent; Charnay, Bérengère; Bletterie, Xavier

    2014-05-01

    The upper Guil catchment (Southern Alps) is prone to hydro-geomorphic hazards. Major hazards are related to catastrophic floods, with an amplification of their impacts due to strong hillslope-channel connectivity as observed in 1957 and 2000. In both cases, the rainfall intensity, aggravated by the pre-existing saturated soils, explained the instantaneous response of the fluvial system, such as destabilisation of slopes, high sediment discharge, and subsequent damages to exposed structures and settlements present in the floodplain and at confluence sites. The Peynin junction with the Guil River is one of these sites, where significant land-use change during the last decades in relation to the development of handicraft and tourism economy has increased debris flow threat to population. Here, we adopt a sediment budget analysis aimed at better understanding the functioning of this small subcatchment. This latter offers a combination of factors that favour torrential and gravitational activity. It receives abundant and intense rainfall during "Lombarde" events (moist air mass from Mediterranean Sea). Its elongated shape and small surface area (15 km²) together with asymmetric slopes (counter dip slope on the left bank) accelerate runoff on a short response time. In addition highly tectonised shaly schists supply a large volume of debris (mostly platy clasts and fine, micaceous sediment). The objectives of this study, carried out in the frame of SAMCO (ANR) project, are threefold: Identify the different sediment storages; Characterise the processes that put sediment into motion; Quantify volumes of sediment storages. We produced a geomorphic map using topographic surveys and aerial photos in order to locate the different sediment storage types and associated processes. This analysis was made with respect to geomorphic coupling and sediment flux activity. In terms of surface area, the dominant landforms in the valley were found to be mass wasting, talus slopes and

  10. Current and Future Carbon Budgets of Tropical Rain Forest: A Cross Scale Analysis. Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Oberbauer, S. F.

    2004-01-16

    The goal of this project was to make a first assessment of the major carbon stocks and fluxes and their climatic determinants in a lowland neotropical rain forest, the La Selva Biological Station, Costa Rica. Our research design was based on the concurrent use of several of the best available approaches, so that data could be cross-validated. A major focus of our effort was to combine meteorological studies of whole-forest carbon exchange (eddy flux), with parallel independent measurements of key components of the forest carbon budget. The eddy flux system operated from February 1998 to February 2001. To obtain field data that could be scaled up to the landscape level, we monitored carbon stocks, net primary productivity components including tree growth and mortality, litterfall, woody debris production, root biomass, and soil respiration in a series of replicated plots stratified across the major environmental gradients of the forest. A second major focus of this project was on the stocks and changes of carbon in the soil. We used isotope studies and intensive monitoring to investigate soil organic stocks and the climate-driven variation of soil respiration down the soil profile, in a set of six 4m deep soil shafts stratified across the landscape. We measured short term tree growth, climate responses of sap flow, and phenology in a suite of ten canopy trees to develop individual models of tree growth to daytime weather variables.

  11. The impact of municipal budgets and land-use management on the hazardous waste production of Malaga municipalities

    International Nuclear Information System (INIS)

    Soler, Ismael P.; Gemar, German; Jimenez-Madrid, Alberto

    2017-01-01

    Economic development and the search for competitiveness have become key issues in regions' economic success. However, despite the direct relationship between economic and environmental management, few land-use plans consider the latter aspect, and city managers delegate the responsibility for environmental impacts to state legislation and private initiatives. This myopic search for competitiveness has meant that a holistic view of environmental issues is often not integrated into municipal decision-making processes. Therefore, this study's objective was to determine the relevant direct and indirect relationships of land management and budgetary procedures of municipalities with overall production levels of hazardous waste. To this end, a primary tourist region, Málaga, was examined in terms of how this waste's environmental impacts can affect the region's vital tourism sector. This research used principal component analysis, regression by ordinary least squares, cluster analysis in two stages and a means test to compare the data for the Province of Malaga's subregions. The results confirm a positive relationship between municipal expenditure and waste production and highlight the environmental benefits of land use involving environmentally non-aggressive crops. The results also reveal a negative relationship between waste production and financial assets and a direct relationship between unproductive land and the production of hazardous waste. The findings also highlight the necessity of raising awareness about the need for collaboration between different agents, especially in the development of inter-municipal strategies.

  12. Naval Reserve Force: Cost and Benefit Analysis of Reducing the Number of Naval Surface Reserve Force Operating Budget Holders

    National Research Council Canada - National Science Library

    Young, Eric

    1997-01-01

    .... This thesis examines one of Commander Naval Surface Reserve Force's initiatives for reducing the current number of Operating Budget holder's Comptroller Departments without sacrificing efficiency...

  13. A modelling study of the impact of cirrus clouds on the moisture budget of the upper troposphere

    Directory of Open Access Journals (Sweden)

    S. Fueglistaler

    2006-01-01

    Full Text Available We present a modelling study of the effect of cirrus clouds on the moisture budget of the layer wherein the cloud formed. Our framework simplifies many aspects of cloud microphysics and collapses the problem of sedimentation onto a 0-dimensional box model, but retains essential feedbacks between saturation mixing ratio, particle growth, and water removal through particle sedimentation. The water budget is described by two coupled first-order differential equations for dimensionless particle number density and saturation point temperature, where the parameters defining the system (layer depth, reference temperature, amplitude and time scale of temperature perturbation and inital particle number density, which may or may not be a function of reference temperature and cooling rate are encapsulated in a single coefficient. This allows us to scale the results to a broad range of atmospheric conditions, and to test sensitivities. Results of the moisture budget calculations are presented for a range of atmospheric conditions (T: 238–205 K; p: 325–180 hPa and a range of time scales τT of the temperature perturbation that induces the cloud formation. The cirrus clouds are found to efficiently remove water for τT longer than a few hours, with longer perturbations (τT≳10 h required at lower temperatures (T≲210 K. Conversely, we find that temperature perturbations of duration order 1 h and less (a typical timescale for e.g., gravity waves do not efficiently dehydrate over most of the upper troposphere. A consequence is that (for particle densities typical of current cirrus clouds the assumption of complete dehydration to the saturation mixing ratio may yield valid predictions for upper tropospheric moisture distributions if it is based on the large scale temperature field, but this assumption is not necessarily valid if it is based on smaller scale temperature fields.

  14. [Outpatient management of patients with deep vein thrombosis and cancer: a study of safety, cost and budget impact].

    Science.gov (United States)

    Jara Palomares, Luis; Caballero Eraso, Candela; Elías Hernández, Teresa; Ferrer Galván, Marta; Márquez Peláez, Sergio; Cayuela, Aurelio; Alfaro, María José; Barrot Cortés, Emilia; Otero Candelera, Remedios

    2012-04-07

    This is a safety and cost comparison study with an analysis of budgetary impact of ambulatory management of patients with cancer and deep vein thrombosis (DVT) compared with hospital management. Prospective observational study of patients with known malignancy and diagnosed with DVT from 2003 to 2007. The outcome variables were mortality, relapse and bleeding in one month. We conducted an economic analysis to evaluate the comparative cost of ambulatory patients. Three hundred and seventeen patients, 55 (17%) had cancer. The mean age of patients was 63 ± 11 years. There were 2 hemorrhagic events, 2 recurrences and 6 deaths in one month of follow-up. Of all patients, only 7 (13,7%) required hospitalization. All but one deaths were due to progression of the underlying disease. Economic analysis concluded that outpatient management is 6 times less expensive than hospital management, which would imply a cost reduction of 85%. Specialized outpatient treatment of cancer patients with DVT is safe and could save significant financial resources. Copyright © 2011 Elsevier España, S.L. All rights reserved.

  15. BUDGET PLANNING IN FINANCIAL MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Nataliya Melnichuk

    2015-11-01

    Full Text Available The purpose of the paper is to determine the nature, targets, functions, principles and methods of budget planning and development of classifications due to its types. The essence of budget planning presented by various authors, is own interpretation (the process of developing a plan of formation, distribution and redistribution of financial funds according to budget system units during the reporting period based on budgetary purposes and targets defined by socio-economic development strategy is proposed. Methodology. The following methods such as cognition, induction, deduction, analysis and synthesis have been used in the process of survey. Results of the survey proves that budget planning plays an essential role in the financial management. On condition business environment changing even the best management system can become obsolete. The immediate reaction to the new trends in the financial system as a whole, in the industry is possible with budget planning as well. It also allows to make appropriate adjustments to the plans. Adjustment of long-term, medium-term and short-term plans makes it possible, without changing goals, to change ways of their achievement and thus to raise the level of efficiency of budget funds formation and use. It is necessary to revise the whole system plans, including their mission and goals in the case of global changes in the external and internal environment. Practical implications. The proposed approach to the classification of budget planning types allows to cope with the shortcomings of modern planning in the public sector (the development of the targets according to the state budget expenditures in Ukraine remains a formality and it rarely complies with realities. Value/originality is specified in the proposed interpretation which differs from existing ones that provides clarification of budget planning purpose in financial management; classification of budget planning principles, which differs from previous

  16. Economic impact of new active substance status on EU payers' budgets: example of dimethyl fumarate (Tecfidera(®)) for multiple sclerosis.

    Science.gov (United States)

    Toumi, Mondher; Jadot, Guy

    2014-01-01

    Recently, collaboration between regulators and payers was set up and was mainly focused on evidence generation along product clinical development. However, neither the regulatory path nor the new active substance status (NASs) was considered. Granting NASs will provide the product with 8 years of data protection and 2 years of market exclusivity during which no generic could enter the market. To review the economic impact (for payers) of NASs granted by the European Medicines Agency (EMA) for dimethyl fumarate (DMF), developed by Biogen and approved for multiple sclerosis (MS) as Tecfidera(®) on 3 February 2014. We reviewed the available DMF-containing products and identified their indication and price through relevant databases and official Web sites. The economic impact of Tecfidera(®) on payers' budgets was calculated assuming NASs was or was not granted. The forecast was identified in Datamonitor. Results identified four products already containing DMF as the main or unique active substance. This would have potentially prevented Tecfidera(®) from being granted NASs. The EMA Committee for Medicinal Products for Human Use (CHMP) denied Tecfidera(®) NASs and, following a company appeal, reversed its position opening as polemic. The impact of that decision has been evaluated at €7 to €10 billion over a 10-year period. NASs is a critical decision because it does have a major budget impact for payers, and it prevents generic competition. Current European Union (EU) regulations on that topic are unclear and open up too many interpretations thus distorting fair trade and affecting payers' bills. Greater clarity and more stringent rules are required to prevent mistrust of this EMA decision.

  17. Budget Deficits Effects on Economic Growth

    Directory of Open Access Journals (Sweden)

    L.C.Risti

    2013-06-01

    Full Text Available The budget deficit can not be analyzed autarchically, as it affects all the macroeconomic processes and, is itself influenced by all other macroeconomic indicators. Most analyses and studies on public finance and budget balance measure the impact that budgetary deficits accumulation has on economy. Therefore, the present paper aims at following and analyzing the mutual impact between budget deficit and another economic macro indicator, namely the economic growth.

  18. Projected Impact of Climate Change on the Water and Salt Budgets of the Arctic Ocean by a Global Climate Model

    Science.gov (United States)

    Miller, James R.; Russell, Gary L.

    1996-01-01

    The annual flux of freshwater into the Arctic Ocean by the atmosphere and rivers is balanced by the export of sea ice and oceanic freshwater. Two 150-year simulations of a global climate model are used to examine how this balance might change if atmospheric greenhouse gases (GHGs) increase. Relative to the control, the last 50-year period of the GHG experiment indicates that the total inflow of water from the atmosphere and rivers increases by 10% primarily due to an increase in river discharge, the annual sea-ice export decreases by about half, the oceanic liquid water export increases, salinity decreases, sea-ice cover decreases, and the total mass and sea-surface height of the Arctic Ocean increase. The closed, compact, and multi-phased nature of the hydrologic cycle in the Arctic Ocean makes it an ideal test of water budgets that could be included in model intercomparisons.

  19. The impact of poplar tree plantations for biomass production on the aquifer water budget and base flow in a Mediterranean basin

    Energy Technology Data Exchange (ETDEWEB)

    Folch, Albert, E-mail: folch.hydro@gmail.com [Hydrogeology Group (UPC-CSIC), Department of Geotechnical Engineering and Geo-sciences, Universitat Politècnica de Catalunya-BarcelonaTech, Barcelona (Spain); Institut de Ciència i Tecnologia Ambientals, Universitat Autònoma de Barcelona, Bellaterra (Spain); Ferrer, Núria [Hydrogeology Group (UPC-CSIC), Department of Geotechnical Engineering and Geo-sciences, Universitat Politècnica de Catalunya-BarcelonaTech, Barcelona (Spain)

    2015-08-15

    Poplar plantations are used for biomass production in many countries. These plantations are often located in areas where the tree roots can reach the water table of shallow aquifers to reduce irrigation costs and increase evapotranspiration, mainly during the summer. This study aims to assess the effects of these plantations on an aquifer water budget and on the stream flow of a Mediterranean basin (Santa Coloma River, 321.3 km{sup 2} NE Spain). A numerical flow model was constructed to simulate shallow aquifers and to simulate the stream–aquifer interaction for a period of 9 years. Once the model was calibrated, different land use scenarios, such as deciduous forests, dry farming and irrigated farming, were simulated for comparison. The mass balance shows that poplar extracts an average of 2.40 hm{sup 3} from the aquifer, i.e., approximately 18% of the average recharge of the modelled area. This effect reduces the groundwater flow to the main stream and increases the infiltration from the stream to the aquifer. As a result, there is an average reduction in the main stream flow by 46% during the summer, when the lowest flow occurs and when the river is most sensitive. The results indicate that these impacts should be considered in basin management plans and in evaluating the benefits of this type of biomass production. - Highlights: • Poplar plantations can evapotranspirate aquifer groundwater in semiarid areas • A groundwater flow model is presented to quantify poplars’ impact on the water budget • 20% of the aquifer recharge is consumed by poplars • The main stream flow is reduced up to 46% during summer due to plantations uptake • Biomass production impacts must be considered for evaluating water resources planning.

  20. Atmospheric deposition impacts on nutrients and biological budgets of the Mediterranean Sea, results from the high resolution coupled model NEMOMED12/PISCES

    Science.gov (United States)

    Richon, Camille; Dutay, Jean-Claude; Dulac, François; Desboeufs, Karine; Nabat, Pierre; Guieu, Cécile; Aumont, Olivier; Palmieri, Julien

    2016-04-01

    Atmospheric deposition is at present not included in regional oceanic biogeochemical models of the Mediterranean Sea, whereas, along with river inputs, it represents a significant source of nutrients at the basin scale, especially through intense desert dust events. Moreover, observations (e.g. DUNE campaign, Guieu et al. 2010) show that these events significantly modify the biogeochemistry of the oligotrophic Mediterranean Sea. We use a high resolution (1/12°) version of the 3D coupled model NEMOMED12/PISCES to investigate the effects of high resolution atmospheric dust deposition forcings on the biogeochemistry of the Mediterranean basin. The biogeochemical model PISCES represents the evolution of 24 prognostic tracers including five nutrients (nitrate, ammonium, phosphate, silicate and iron) and two phytoplankton and zooplanktons groups (Palmiéri, 2014). From decadal simulations (1982-2012) we evaluate the influence of natural dust and anthropogenic nitrogen deposition on the budget of nutrients in the basin and its impact on the biogeochemistry (primary production, plankton distributions...). Our results show that natural dust deposition accounts for 15% of global PO4 budget and that it influences primarily the southern part of the basin. Anthropogenic nitrogen accounts for 50% of bioavailable N supply for the northern part. Deposition events significantly affect biological production; primary productivity enhancement can be as high as 30% in the areas of high deposition, especially during the stratified period. Further developments of the model will include 0D and 1D modeling of bacteria in the frame of the PEACETIME project.

  1. Scientific and theoretical principles of personnel costs’ budgeting

    Directory of Open Access Journals (Sweden)

    O.P. Gutsal

    2015-06-01

    Full Text Available The object of this article is to determine the main purpose of company’s budgeting, to study its functions in terms of personnel management, to identify the main advantages and disadvantages of budgeting and to determine the stages of realization budgeting in the company. There have been considered the purpose and aim of budgeting. The main functions of budgeting, which include such ones as: planning, forecasting, information and analysis function, motivational, coordinative, control and involvement function have been identified (determined. In terms of defined functions of budgeting their essence in budgeting personnel costs has been outlined. The main advantages and disadvantages of budgeting have been found. There has been determined the implementing and realization company’s budgeting. The process of budgeting is realized according to the following consecutive stages: preparatory and analytical stage; definition of budget constraints; drafting up the budget; discussion and adjustment of budget indicators; adoption of budget; analysis and control of the budget. There also has been considered budget organization structure which includes budget committee, budget planning and analysis department, financial responsibility center.

  2. Impact of the Application Technique on Nitrogen Gas Emissions and Nitrogen Budgets in Case of Energy Maize Fertilized with Biogas Residues

    Science.gov (United States)

    Andres, Monique; Fränzke, Manuel; Schuster, Carola; Kreuter, Thomas; Augustin, Jürgen

    2014-05-01

    Despite an increasing cultivation of energy maize fertilized with ammonia-rich biogas residues (BR), little is known about the impact of the application technique on gaseous nitrogen (N) losses as well as N budgets, indicative of N use efficiency. To contribute to closing this knowledge gap we conducted a field experiment supplemented by a laboratory incubation study. The field experiment was carried out in Dedelow, located in the Northeastern German Lowlands and characterized by well-drained loamy sand (haplic luvisol). Two treatments with different application technique for BR fertilization - i) trail hoses and ii) injection - were compared to an unfertilized control (0% N). Seventy percent of the applied N-BR was assumed to be plant-available. In 2013, biweekly nitrous oxide (N2O) measurements were conducted during the time period between BR application and maize harvest (18.04.-11.09.2013; 147 days) using non-flow-through non-steady-state chamber measurements. To quantify soil Nmin status, soil samples were taken from 0-30 cm soil depth in the spring (before fertilization) and autumn (after maize harvest). Immediately after BR application, ammonia (NH3) volatilization was measured intensively using the open dynamic chamber Dräger-Tube method. Export of N due to harvest was determined via plant N content (Nharvest). Based on the measured N gas fluxes, N soil and plant parameters, soil N budgets were calculated using a simple difference approach. Values of N output (Nharvest, NN2O_cum and NNH3_cum) are subtracted from N input values (Nfertilizer and Nmin_autumnminus Nmin_spring). In order to correctly interpret N budgets, other N fluxes must be integrated into the budget calculation. Apart from soil-based mobilization and immobilization turnover processes and nitrate leaching, this applies specifically to N2 losses due to denitrification. Therefore, we measured the N2 emissions from laboratory-incubated undisturbed soil cores (250 cm3) by means of the helium

  3. Use of programme budgeting and marginal analysis as a framework for resource reallocation in respiratory care in North Wales, UK.

    Science.gov (United States)

    Charles, J M; Brown, G; Thomas, K; Johnstone, F; Vandenblink, V; Pethers, B; Jones, A; Edwards, R T

    2016-09-01

    Since the global financial crisis, UK NHS spending has reduced considerably. Respiratory care is a large cost driver for Betsi Cadwaladr University Health Board, the largest health board in Wales. Under the remit of 'prudent healthcare' championed by the Welsh Health Minister, a Programme Budgeting Marginal Analysis (PBMA) of the North Wales respiratory care pathway was conducted. A PBMA panel of directors of medicines management, therapies finance, planning, public health and healthcare professionals used electronic voting to establish criteria for decision-making and vote on candidate interventions in which to disinvest and invest. A sum of £86.9 million was spent on respiratory care in 2012-13. Following extensive discussion of 13 proposed candidate interventions facilitated by a chairperson, 4 candidates received recommendations to disinvest, 7 to invest and 2 to maintain current activity. Marginal analysis prioritized mucolytics and high antibiotic prescribing as areas for disinvestment, and medicines waste management and pulmonary rehabilitation for investment. This exercise demonstrates the potential for health boards to use evidence-based approaches to reach potentially controversial disinvestment and investment decisions. Initial progress has begun with communication from the Medical Director in relation to the disinvestment in mucolytics prescribing and possible redirection of funding options being explored. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health.

  4. Automated Budget System -

    Data.gov (United States)

    Department of Transportation — The Automated Budget System (ABS) automates management and planning of the Mike Monroney Aeronautical Center (MMAC) budget by providing enhanced capability to plan,...

  5. Budget impact of continuous subcutaneous insulin infusion therapy in patients with type 1 diabetes who experience severe recurrent hypoglycemic episodes in Spain.

    Science.gov (United States)

    Giménez, Marga; Elías, Isabel; Álvarez, María; Quirós, Carmen; Conget, Ignacio

    Hypoglycemia is one of the most common complications to achieve a good metabolic control, and has been listed by several scientific associations as a common indication to start treatment with continuous subcutaneous insulin infusion (CSII). Use of CSII is still residual in Spain as compared to neighbouring countries, and cost of acquisition cost is one of the main reasons. This study estimates the budget impact of treatment with CSII, as compared to multiple daily insulin injections, of patients with type 1 diabetes mellitus who experience recurrent severe hypoglycemia episodes from the National Healthcare System perspective. Budget impact was based on a retrospective, observational study evaluating the efficacy of CSII in patients with type 1 diabetes mellitus conducted at Hospital Clínic i Universitari in Barcelona, where one of the main indications for switching to CSII were recurrent severe hypoglycemia episodes. The mean number of annual episodes was 1.33 in the two years prior to CSII start and 0.08 in the last two years of follow up (p=0.003). Costs of treatment and major hypoglycemic events over a four-year period were considered. Costs were taken from different Spanish data sources and expressed in € of 2016. Treatment with CSII increased costs by €9,509 per patient as compared to multiple daily insulin injections (€11,902-€2,393). Cost associated to severe hypoglycemic events decreased by €19,330 per patient treated with CSIII (€1,371-€20,701). Results suggest mean total savings of €9,821 per patient during the four-year study period. The higher costs associated to CSII therapy may be totally offset by the severe hypoglycemic events prevented. Copyright © 2017 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. France, Germany, Greece and the United Kingdom an analysis and comparison of budget deficits and defense spending

    OpenAIRE

    Schoettelndreyer, Friedrich.

    2011-01-01

    Approved for public release; distribution is unlimited. This thesis documents findings on the relationship of government budget deficits and defense spending for France, Germany, Greece, and the United Kingdom in detail and for NATO and OECD country collectives. The thesis topic is relevant, as many European countries are justifying their recent cuts in defense spending with high government budget deficits. The author looked at different data sources and metrics to graphically analyze the ...

  7. DOE FY 2010 Budget Request and Recovery Act Funding for Energy Research, Development, Demonstration, and Deployment: Analysis and Recommendations

    Energy Technology Data Exchange (ETDEWEB)

    Anadon, Laura Diaz; Gallagher, Kelly Sims; Bunn, Matthew

    2009-06-01

    The combination of the FY 2010 budget request for the Department of Energy (DOE) and the portion of the American Recovery and Reinvestment Act of 2009 (ARRA) funds likely to be available in 2010 would (assuming that they would be split evenly between FY 2010 and FY 2011) result in a doubling in funding available for energy research, development, and deployment (ERD and D) from $3.6 billion in FY 2009 to $7.2 billion in FY 2010. Without the stimulus funds, DOE ERD and D investments in FY 2010 would decrease very slightly when compared to FY 2009. Excluding the $7.5 billion for the Advanced Technology Vehicles Manufacturing Loans in FY 2009, the FY 2010 budget request for deployment represents a 33 percent decrease from the FY 2009 levels from $520 million to $350 million. This decrease is largely due to the large amounts of funds appropriated in ARRA for DOE deployment programs, or $23.6 billion, which are three times greater than those appropriated in the FY 2009 budget. These very substantial funding amounts, coupled with the broad range of institutional innovations the administration is putting in place and movement toward putting a price on carbon emissions, will help accelerate innovation for a broad range of energy technologies. DOE's Advanced Research Projects Agency-Energy (ARPA-E) and the Energy Innovation Hubs are important initiatives that could contribute to two weak points of the government's energy innovation effort, namely funding high-risk projects in transformational technologies and in companies that have not traditionally worked with the government and strengthening the integration of basic and applied research in priority areas. Increasing the funding for different types of energy storage research, providing some support for exploring opportunities in coal-to-liquids with carbon capture and storage (CCS) and coal-and-biomass-to-liquids with CCS, and reducing funding for fission RD and D are other actions that Congress could take in the

  8. Oviposition by Female Plodia interpunctella (Lepidoptera: Pyralidae: Description and Time Budget Analysis of Behaviors in Laboratory Studies

    Directory of Open Access Journals (Sweden)

    Kishan R. Sambaraju

    2016-01-01

    Full Text Available The oviposition behavior of the Indian meal moth, Plodia interpunctella (Hübner (Lepidoptera: Pyralidae, a major insect pest of durable stored foods, was studied in small experimental arenas under laboratory conditions using videography, and a time budget analysis of its behaviors was documented. Resting gravid females typically became active shortly after the start of the scotophase. The characteristic behaviors exhibited by mated females prior to oviposition included antennal movement, grooming of antennae and mouth parts using the forelegs, walking or flying, and abdomen bending and dragging. Pre-oviposition behaviors such as antennal grooming and walking or flying were observed to alternate several times before females commenced the abdominal dragging behavior that preceded egg laying. Eggs were laid singly or sometimes in groups, either freely or stuck to food material. Gravid females showed little or no movement during the photophase; however, they actively flew and oviposited during the scotophase. Females allocated only a small portion of their time to oviposition while the rest of the time was spent away from food. Females oviposited on food material by making repeated visits, predominantly during the first four hours of the scotophase. Visits and time spent on food declined as the scotophase advanced.

  9. Oviposition by Female Plodia interpunctella (Lepidoptera: Pyralidae): Description and Time Budget Analysis of Behaviors in Laboratory Studies.

    Science.gov (United States)

    Sambaraju, Kishan R; Donelson, Sarah L; Bozic, Janko; Phillips, Thomas W

    2016-01-22

    The oviposition behavior of the Indian meal moth, Plodia interpunctella (Hübner) (Lepidoptera: Pyralidae), a major insect pest of durable stored foods, was studied in small experimental arenas under laboratory conditions using videography, and a time budget analysis of its behaviors was documented. Resting gravid females typically became active shortly after the start of the scotophase. The characteristic behaviors exhibited by mated females prior to oviposition included antennal movement, grooming of antennae and mouth parts using the forelegs, walking or flying, and abdomen bending and dragging. Pre-oviposition behaviors such as antennal grooming and walking or flying were observed to alternate several times before females commenced the abdominal dragging behavior that preceded egg laying. Eggs were laid singly or sometimes in groups, either freely or stuck to food material. Gravid females showed little or no movement during the photophase; however, they actively flew and oviposited during the scotophase. Females allocated only a small portion of their time to oviposition while the rest of the time was spent away from food. Females oviposited on food material by making repeated visits, predominantly during the first four hours of the scotophase. Visits and time spent on food declined as the scotophase advanced.

  10. Estimating the Economic Impact of Adding Panobinostat to a U.S. Formulary for Relapsed and/or Refractory Multiple Myeloma: A Budget Impact and Cost-Benefit Model.

    Science.gov (United States)

    Bloudek, Lisa; Roy, Anuja; Kish, Jonathan K; Siegel, David S; Jagannath, Sundar; Globe, Denise; Orloski, Laurie; Kuriakose, Emil T

    2016-08-01

    Multiple myeloma is an incurable B-cell malignancy with a natural history that involves alternating periods of remission and subsequent relapse. For relapsed and/or refractory multiple myeloma (RRMM), the typical patient currently receives more lines of therapy than has been feasible in the past, translating into longer progression-free survival (PFS). Consequently, cost issues have become more prominent because patients may be offered newer and more expensive therapies during a more prolonged overall treatment course. To estimate the economic impact of adding panobinostat to a U.S. health plan formulary as a treatment option with bortezomib and dexamethasone for patients with RRMM previously treated with a proteasome inhibitor (PI) and immunomodulatory drug (IMiD), using a budget impact and cost-benefit model. Total costs of commonly used salvage therapy regimens were combined with market share data and population prevalence estimates of RRMM to yield the total cost of treatment, from the perspective of a U.S. third-party payer (commercial or Medicare) with a time horizon of 1 year. Comparator treatment regimens included bortezomib-dexamethasone, lenalidomide-dexamethasone, lenalidomide-bortezomib-dexamethasone, carfilzomib monotherapy, carfilzomib-lenalidomide-dexamethasone, and pomalidomide-dexamethasone. Costs (2015 U.S. dollars) included drug costs for oral oncology agents, medical and administration costs for injectable oncology agents, costs of adverse event (AE) prophylaxis and monitoring, and costs of grade 3/4 AEs. In a hypothetical health plan with 1 million members, the annual number of RRMM patients with previous PI and IMiD treatments was estimated at 16 and 118 for a commercial and Medicare plan, respectively. Introduction of panobinostat as part of the panobinostat-bortezomib-dexamethasone regimen was not expected to result in a substantial budget impact to either commercial or Medicare plans, with an incremental cost money. Funding for this study

  11. Budget Elements of Economic Security: Specifics of Classification

    Directory of Open Access Journals (Sweden)

    О. S.

    2017-02-01

    Full Text Available Theoretical aspects of economic security in conjunction with budget components such as “budget interests” and “budget necessities” are analyzed. Key positions of the categories “budget interests” and “budget necessities” in the theory of economic security in the budgetary area are substantiated given their priority role in setting up its implementation strategy. The category “budget interests” is defined as the system of budget necessities of the interest holders, implemented through budget activities of entities and aimed at seeking benefits through the budget, in order to guarantee functioning and development of the society, the state, legal entities and physical persons. “Budget necessities” are defined as the need in budget funds to achieve and sustain, at a certain level, life activities of individuals, social groups, society, state and legal entities. Classification of budget interests by various criteria is made in the context of their impact on the economic security of the state. It is demonstrated that the four-tier classification of the budget interests by interest holder is essential to guaranteeing economic security in the budgetary area: budget interests of the state: the interests held by central and local power offices; budget interests of legal entities: the interests of profit and non-profit (public, budgetary, party and other organizations; budget interests of individuals: basic necessities of individuals, met by budget transfers, which stand out of the array of public necessities by their individual character.

  12. Impact analysis of composite aircraft structures

    Science.gov (United States)

    Pifko, Allan B.; Kushner, Alan S.

    1993-01-01

    The impact analysis of composite aircraft structures is discussed. Topics discussed include: background remarks on aircraft crashworthiness; comments on modeling strategies for crashworthiness simulation; initial study of simulation of progressive failure of an aircraft component constructed of composite material; and research direction in composite characterization for impact analysis.

  13. California Budget Simulation

    Science.gov (United States)

    Mallinson, Daniel J.

    2018-01-01

    The California Budget Challenge produced by Next10 provides a useful and intuitive tool for instructors to introduce students to public budgeting. Students will reason through a series of budgeting decisions using information provided on the fiscal and practical implications of their choices. The Challenge is updated with each budget cycle, so it…

  14. Plan Your Advertising Budget.

    Science.gov (United States)

    Britt, Steuart-Henderson

    1979-01-01

    Methods for establishing an advertising budget are reviewed. They include methods based on percentage of sales or profits, unit of sales, and objective and task. Also discussed are ways to allocate a promotional budget. The most common breakdowns are: departmental budgets, total budget, calendar periods, media, and sales area. (JMD)

  15. A Lagrangian analysis of the moisture budget over the Fertile Crescent during two intense drought episodes

    Science.gov (United States)

    Salah, Zeinab; Nieto, Raquel; Drumond, Anita; Gimeno, Luis; Vicente-Serrano, Sergio M.

    2018-05-01

    The Fertile Crescent (FC) region comprises the east coast of the Mediterranean Sea and the northern part of the Arabian Peninsula. The FC suffered two severe drought episodes separated by a 7-year period, in 1998-2000 and 2007-2009, which are considered the most severe episodes to hit the region in the last 50 years. A Lagrangian model (FLEXPART) and ERA-Interim data (with a 1° × 1° lat-long resolution) were used to identify for the first time the climatological sources of moisture for the FC and their characteristics. Variability and the source-receptor relationships, concerning their contribution to the precipitation, and the implications regarding the transport of moisture changes over the FC, during the wet season (October-May) from 1980 to 2014 were analysed. The main climatological moisture sources during this period were determined to be the FC itself, the eastern Mediterranean Sea, the Red Sea, the Persian Gulf, the Arabian Sea, the Caspian and Black Seas, and the central and western parts of the Mediterranean Sea. The analysis showed higher anomalous conditions in the moisture transport from some moisture sources during the two outstanding drought episodes. The key feature of the wet seasons during these episodes was a deficit in the moisture losses over the studied area related to the FC itself, the Red and Arabian Seas sources, followed and to a lesser extent by the eastern Mediterranean Sea over the northern part of the FC region. Nevertheless, the moisture supply deficit from the sources was much greater during the 2007-2009 drought event. The SPEI index at large scales (24 months) showed that the 2007-2009 episode was part of longer-term drought conditions that had been developing over the previous months, reinforcing the drought severity given recycling processes attributed to the FC. During the two extreme drought episodes, the mountainous terrain over the northern and eastern FC suffered the highest precipitation deficits, and these areas are

  16. Towards a Comparative Analysis of Democratic Innovations. Lessons from a small-N fsQCA of Participatory Budgeting

    Directory of Open Access Journals (Sweden)

    Ryan, Matt

    2012-12-01

    Full Text Available While there has been a proliferation of academic interest in ‘democratic innovations’, most empirical analysis tends to rely on single case studies. Very little attention has been given to the comparative analysis of innovations, in particular the conditions under which they emerge and are sustained. Recent studies of participatory budgeting (PB have begun to utilise cross-case analysis in an attempt to explain divergent outcomes. This paper argues that the comparative analysis of democratic innovations could be enhanced significantly through the application of the relatively novel technique of fuzzy-set qualitative comparative analysis (fsQCA. A small- N study of PBs is offered to identify the potential (and pitfalls of using fsQCA to evaluate the conditions under which such an innovation is institutionalised effectively.

    Aunque el interés académico por las “innovaciones democráticas” ha proliferado, la mayoría de los análisis empíricos se apoyan en un solo caso de estudio. Se ha prestado poca atención al análisis comparativo de las innovaciones, en concreto de las condiciones en que emergen y se mantienen. Algunos estudios recientes sobre presupuestos participativos (PP han comenzado a emplear análisis de casos cruzados en un intento por explicar los resultados divergentes. En este artículo se sostiene que el análisis comparado de las innovaciones podría mejorar significativamente mediante la aplicación de una técnica relativamente nueva, el análisis cualitativo comparado de conjuntos difusos (fsQCA. Aquí se ofrece un estudio de N pequeña sobre PP para identificar el potencial (y las dificultades que entraña el empleo de fsQCA para evaluar las condiciones en las que tal innovación se institucionaliza de forma efectiva.

  17. Cross-impacts analysis development and energy policy analysis applications

    Energy Technology Data Exchange (ETDEWEB)

    Roop, J.M.; Scheer, R.M.; Stacey, G.S.

    1986-12-01

    Purpose of this report is to describe the cross-impact analysis process and microcomputer software developed for the Office of Policy, Planning, and Analysis (PPA) of DOE. First introduced in 1968, cross-impact analysis is a technique that produces scenarios of future conditions and possibilities. Cross-impact analysis has several unique attributes that make it a tool worth examining, especially in the current climate when the outlook for the economy and several of the key energy markets is uncertain. Cross-impact analysis complements the econometric, engineering, systems dynamics, or trend approaches already in use at DOE. Cross-impact analysis produces self-consistent scenarios in the broadest sense and can include interaction between the economy, technology, society and the environment. Energy policy analyses that couple broad scenarios of the future with detailed forecasting can produce more powerful results than scenario analysis or forecasts can produce alone.

  18. FY 1996 Congressional budget request: Budget highlights

    Energy Technology Data Exchange (ETDEWEB)

    1995-02-01

    The FY 1996 budget presentation is organized by the Department`s major business lines. An accompanying chart displays the request for new budget authority. The report compares the budget request for FY 1996 with the appropriated FY 1995 funding levels displayed on a comparable basis. The FY 1996 budget represents the first year of a five year plan in which the Department will reduce its spending by $15.8 billion in budget authority and by $14.1 billion in outlays. FY 1996 is a transition year as the Department embarks on its multiyear effort to do more with less. The Budget Highlights are presented by business line; however, the fifth business line, Economic Productivity, which is described in the Policy Overview section, cuts across multiple organizational missions, funding levels and activities and is therefore included in the discussion of the other four business lines.

  19. Value-impact analysis. Final report

    International Nuclear Information System (INIS)

    Cohn, M.; Dracup, J.A.; Erdmann, R.C.; Hughes, E.; vonHerrmann, J.

    1979-11-01

    This document represents a first step in the process of developing comprehensive value-impact methodology for the nuclear industry. It describes the development of the methodology and includes a discussion of the uses of cost-benefit or value-impact by other industries. This background is provided as a guide to the development of the methodology for the specific problems confronted by the nuclear industry. The use of benefit-cost analysis, or value-impact analysis, within the nuclear power industry has grown in recent years and is relied upon by both the regulatory community and the regulated industry. This report summarizes the state of the art of value-impact analysis as it affects these users. Relevant past experience in such fields as water resource development, transportation, environmental concerns, and health and medicine is reviewed. A critique of the applicability of existing value-impact analysis methods to nuclear safety decision problems is presented

  20. Universal Coverage on a Budget: Impacts on Health Care Utilization and Out-Of-Pocket Expenditures in Thailand

    NARCIS (Netherlands)

    S. Limwattananon (Supon); S. Neelsen (Sven); O.A. O'Donnell (Owen); P. Prakongsai (Phusit); V. Tangcharoensathien (Viroj); E.K.A. van Doorslaer (Eddy)

    2013-01-01

    textabstractWe estimate the impact on health care utilization and out-of-pocket (OOP) expenditures of a major reform in Thailand that extended health insurance to one-quarter of the population to achieve universal coverage while keeping health spending below 4% of GDP. Identification is through

  1. Impact analysis of a water storage tank

    International Nuclear Information System (INIS)

    Jhung, Myung Jo; Jo, Jong Chull; Jeong, Sang Jin

    2006-01-01

    This study investigates the dynamic response characteristics of a structure impacted by a high speed projectile. The impact of a 300 kg projectile on a water storage tank is simulated by the general purpose computer codes ANSYS and LS-DYNA. Several methods to simulate the impact are considered and their results are compared. Based upon this, an alternative impact analysis method that equivalent to an explicit dynamic analysis is proposed. The effect of fluid on the responses of the tank is also addressed

  2. Projected Impact of Climate Change on the Energy Budget of the Arctic Ocean by a Global Climate Model

    Science.gov (United States)

    Miller, James R.; Russell, Gary L.; Hansen, James E. (Technical Monitor)

    2001-01-01

    The annual energy budget of the Arctic Ocean is characterized by a net heat loss at the air-sea interface that is balanced by oceanic heat transport into the Arctic. The energy loss at the air-sea interface is due to the combined effects of radiative, sensible, and latent heat fluxes. The inflow of heat by the ocean can be divided into two components: the transport of water masses of different temperatures between the Arctic and the Atlantic and Pacific Oceans and the export of sea ice, primarily through Fram Strait. Two 150-year simulations (1950-2099) of a global climate model are used to examine how this balance might change if atmospheric greenhouse gases (GHGs) increase. One is a control simulation for the present climate with constant 1950 atmospheric composition, and the other is a transient experiment with observed GHGs from 1950 to 1990 and 0.5% annual compounded increases of CO2 after 1990. For the present climate the model agrees well with observations of radiative fluxes at the top of the atmosphere, atmospheric advective energy transport into the Arctic, and surface air temperature. It also simulates the seasonal cycle and summer increase of cloud cover and the seasonal cycle of sea-ice cover. In addition, the changes in high-latitude surface air temperature and sea-ice cover in the GHG experiment are consistent with observed changes during the last 40 and 20 years, respectively. Relative to the control, the last 50-year period of the GHG experiment indicates that even though the net annual incident solar radiation at the surface decreases by 4.6 W(per square meters) (because of greater cloud cover and increased cloud optical depth), the absorbed solar radiation increases by 2.8 W(per square meters) (because of less sea ice). Increased cloud cover and warmer air also cause increased downward thermal radiation at the surface so that the net radiation into the ocean increases by 5.0 Wm-2. The annual increase in radiation into the ocean, however, is

  3. Impact analysis of shipping casks

    International Nuclear Information System (INIS)

    Pfeiffer, P.A.; Kennedy, J.M.

    1989-01-01

    This paper describes how simpler two- and three-dimensional models can be used to provide an intermediate level of detail between full three dimensional finite element calculations and hand calculation. Three free drop scenarios are analyzed to assess the integrity of the cask when subjected to large bending and axial stresses. These three drop scenarios are: a thirty foot axial drop on either end, a thirty foot oblique angel drop with the cask having several different orientations from the vertical with impact on the top end cask corner, and a thirty foot side drop with simultaneous impact on one of the lifting trunnions and the bottom end. Prevention of damage hinges on the strength of the various components that comprises the cask. The predicted levels of deformation and stresses in the cask are used to assess the potential damage level

  4. Next-generation sequencing in NSCLC and melanoma patients : A cost and budget impact analysis

    NARCIS (Netherlands)

    Van Amerongen, Rosa A.; Retèl, Valesca P.; Coupé, Veerle M.H.; Nederlof, Petra M.; Vogel, Maartje J.; Van Harten, Wim H.

    2016-01-01

    Next-generation sequencing (NGS) has reached the molecular diagnostic laboratories. Although the NGS technology aims to improve the effectiveness of therapies by selecting the most promising therapy, concerns are that NGS testing is expensive and that the 'benefits' are not yet in relation to these

  5. Fiscal Year 2015 Budget

    Data.gov (United States)

    Montgomery County of Maryland — This dataset includes the Fiscal Year 2015 Council-approved operating budget for Montgomery County. The dataset does not include revenues and detailed agency budget...

  6. The impact of economic downturns and budget cuts on homelessness claim rates across 323 local authorities in England, 2004-12.

    Science.gov (United States)

    Loopstra, Rachel; Reeves, Aaron; Barr, Ben; Taylor-Robinson, David; McKee, Martin; Stuckler, David

    2016-09-01

    It is unclear why rates of homelessness claims in England have risen since 2010. We used variations in rates across local authorities to test the impact of economic downturns and budget cuts. Using cross-area fixed effects models of data from 323 UK local authorities between 2004 and 2012, we evaluated associations of changes in statutory homelessness rates with economic activity (Gross Value Added per capita), unemployment, and local and central government expenditure. Each 10% fall in economic activity was associated with an increase of 0.45 homelessness claims per 1000 households (95% CI: 0.10-0.80). Increasing rates of homelessness were also strongly linked with government reductions in welfare spending. Disaggregating types of welfare expenditure, we found that strongest associations with reduced homelessness claims were spending on social care, housing services, discretionary housing payments and income support for older persons. Recession and austerity measures are associated with significant increases in rates of homelessness assistance. These findings likely understate the full burden of homelessness as they only capture those who seek aid. Future research is needed to investigate what is happening to vulnerable groups who may not obtain assistance, including those with mental health problems and rough sleepers. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health.

  7. The atmospheric impacts of monoterpene ozonolysis on global stabilised Criegee intermediate budgets and SO2 oxidation: experiment, theory and modelling

    Directory of Open Access Journals (Sweden)

    M. J. Newland

    2018-05-01

    Full Text Available The gas-phase reaction of alkenes with ozone is known to produce stabilised Criegee intermediates (SCIs. These biradical/zwitterionic species have the potential to act as atmospheric oxidants for trace pollutants such as SO2, enhancing the formation of sulfate aerosol with impacts on air quality and health, radiative transfer and climate. However, the importance of this chemistry is uncertain as a consequence of limited understanding of the abundance and atmospheric fate of SCIs. In this work we apply experimental, theoretical and numerical modelling methods to quantify the atmospheric impacts, abundance and fate of the structurally diverse SCIs derived from the ozonolysis of monoterpenes, the second most abundant group of unsaturated hydrocarbons in the atmosphere. We have investigated the removal of SO2 by SCIs formed from the ozonolysis of three atmospherically important monoterpenes (α-pinene, β-pinene and limonene in the presence of varying amounts of water vapour in large-scale simulation chamber experiments that are representative of boundary layer conditions. The SO2 removal displays a clear dependence on water vapour concentration, but this dependence is not linear across the range of [H2O] explored. At low [H2O] a strong dependence of SO2 removal on [H2O] is observed, while at higher [H2O] this dependence becomes much weaker. This is interpreted as being caused by the production of a variety of structurally (and hence chemically different SCIs in each of the systems studied, which displayed different rates of reaction with water and of unimolecular rearrangement or decomposition. The determined rate constants, k(SCI+H2O, for those SCIs that react primarily with H2O range from 4 to 310  ×  10−15 cm3 s−1. For those SCIs that predominantly react unimolecularly, determined rates range from 130 to 240 s−1. These values are in line with previous results for the (analogous stereo-specific SCI system of syn-/anti-CH3

  8. The atmospheric impacts of monoterpene ozonolysis on global stabilised Criegee intermediate budgets and SO2 oxidation: experiment, theory and modelling

    Science.gov (United States)

    Newland, Mike J.; Rickard, Andrew R.; Sherwen, Tomás; Evans, Mathew J.; Vereecken, Luc; Muñoz, Amalia; Ródenas, Milagros; Bloss, William J.

    2018-05-01

    The gas-phase reaction of alkenes with ozone is known to produce stabilised Criegee intermediates (SCIs). These biradical/zwitterionic species have the potential to act as atmospheric oxidants for trace pollutants such as SO2, enhancing the formation of sulfate aerosol with impacts on air quality and health, radiative transfer and climate. However, the importance of this chemistry is uncertain as a consequence of limited understanding of the abundance and atmospheric fate of SCIs. In this work we apply experimental, theoretical and numerical modelling methods to quantify the atmospheric impacts, abundance and fate of the structurally diverse SCIs derived from the ozonolysis of monoterpenes, the second most abundant group of unsaturated hydrocarbons in the atmosphere. We have investigated the removal of SO2 by SCIs formed from the ozonolysis of three atmospherically important monoterpenes (α-pinene, β-pinene and limonene) in the presence of varying amounts of water vapour in large-scale simulation chamber experiments that are representative of boundary layer conditions. The SO2 removal displays a clear dependence on water vapour concentration, but this dependence is not linear across the range of [H2O] explored. At low [H2O] a strong dependence of SO2 removal on [H2O] is observed, while at higher [H2O] this dependence becomes much weaker. This is interpreted as being caused by the production of a variety of structurally (and hence chemically) different SCIs in each of the systems studied, which displayed different rates of reaction with water and of unimolecular rearrangement or decomposition. The determined rate constants, k(SCI+H2O), for those SCIs that react primarily with H2O range from 4 to 310 × 10-15 cm3 s-1. For those SCIs that predominantly react unimolecularly, determined rates range from 130 to 240 s-1. These values are in line with previous results for the (analogous) stereo-specific SCI system of syn-/anti-CH3CHOO. The experimental results are

  9. The New Russian Budget System; A Critical Assessment and Future Reform Agenda

    OpenAIRE

    Jack Diamond

    2002-01-01

    This paper documents the main elements of the new budget system established in the Russian Federation through its revised budget system law, or the Budget Code, of 2000. It critically examines the budget preparation, budget approval, and budget execution processes, as well as the financial management and planning procedures that underlie the Budget Code. Based on this analysis, recent developments are discussed and a future reform agenda is indicated.

  10. Budgeting and Beyond

    DEFF Research Database (Denmark)

    Rohde, Carsten

    Budgets and budget control has been known since the early 19th century1. However the use of budget control was until the beginning of the 1920ies in US primarily related to governmental units and states and to a minor extent to business units in practice. At that time James McKinsey describes...

  11. Between Bedside and Budget

    NARCIS (Netherlands)

    J.L.T. Blank; E. Eggink

    1998-01-01

    Original title: Tussen bed en budget. The report Between bedside and budget (Tussen bed en budget) describes an extensive empirical study of the efficiency of general and university hospitals in the Netherlands. A policy summary recaps the main findings of the study. Those findings

  12. Library Budget Primer.

    Science.gov (United States)

    Warner, Alice Sizer

    1993-01-01

    Discusses the advantages and disadvantages of six types of budgets commonly used by many different kinds of libraries. The budget types covered are lump-sum; formula; line or line-item; program; performance or function; and zero-based. Accompanying figures demonstrate the differences between four of the budget types. (three references) (KRN)

  13. The impact of cloud inhomogeneities on the Earth radiation budget: the 14 October 1989 I.C.E. convective cloud case study

    Directory of Open Access Journals (Sweden)

    F. Parol

    1994-01-01

    Full Text Available Through their multiple interactions with radiation, clouds have an important impact on the climate. Nonetheless, the simulation of clouds in climate models is still coarse. The present evolution of modeling tends to a more realistic representation of the liquid water content; thus the problem of its subgrid scale distribution is crucial. For a convective cloud field observed during ICE 89, Landsat TM data (resolution: 30m have been analyzed in order to quantify the respective influences of both the horizontal distribution of liquid water content and cloud shape on the Earth radiation budget. The cloud field was found to be rather well-represented by a stochastic distribution of hemi-ellipsoidal clouds whose horizontal aspect ratio is close to 2 and whose vertical aspect ratio decreases as the cloud cell area increases. For that particular cloud field, neglecting the influence of the cloud shape leads to an over-estimate of the outgoing longwave flux; in the shortwave, it leads to an over-estimate of the reflected flux for high solar elevations but strongly depends on cloud cell orientations for low elevations. On the other hand, neglecting the influence of cloud size distribution leads to systematic over-estimate of their impact on the shortwave radiation whereas the effect is close to zero in the thermal range. The overall effect of the heterogeneities is estimated to be of the order of 10 W m-2 for the conditions of that Landsat picture (solar zenith angle 65°, cloud cover 70%; it might reach 40 W m-2 for an overhead sun and overcast cloud conditions.

  14. The impact of cloud inhomogeneities on the Earth radiation budget: the 14 October 1989 I.C.E. convective cloud case study

    Directory of Open Access Journals (Sweden)

    F. Parol

    Full Text Available Through their multiple interactions with radiation, clouds have an important impact on the climate. Nonetheless, the simulation of clouds in climate models is still coarse. The present evolution of modeling tends to a more realistic representation of the liquid water content; thus the problem of its subgrid scale distribution is crucial. For a convective cloud field observed during ICE 89, Landsat TM data (resolution: 30m have been analyzed in order to quantify the respective influences of both the horizontal distribution of liquid water content and cloud shape on the Earth radiation budget. The cloud field was found to be rather well-represented by a stochastic distribution of hemi-ellipsoidal clouds whose horizontal aspect ratio is close to 2 and whose vertical aspect ratio decreases as the cloud cell area increases. For that particular cloud field, neglecting the influence of the cloud shape leads to an over-estimate of the outgoing longwave flux; in the shortwave, it leads to an over-estimate of the reflected flux for high solar elevations but strongly depends on cloud cell orientations for low elevations. On the other hand, neglecting the influence of cloud size distribution leads to systematic over-estimate of their impact on the shortwave radiation whereas the effect is close to zero in the thermal range. The overall effect of the heterogeneities is estimated to be of the order of 10 W m-2 for the conditions of that Landsat picture (solar zenith angle 65°, cloud cover 70%; it might reach 40 W m-2 for an overhead sun and overcast cloud conditions.

  15. Impact of the heatwave in 2003 on the summer CH4 and N2O budget of a spruce forest ecosystem: A four-year comparison

    Science.gov (United States)

    Lamers, M.; Fiedler, S.; Jungkunst, H. F.; Stahr, K.; Streck, T.

    2009-04-01

    Both CH4 and N2O reduction and oxidation are highly sensitive to variation in soil moisture. Significant changes of net CH4 and total N2O fluxes from soils can therefore be expected to accompany redistribution for precipitation in the course of climate change where more extreme events are predicted for the future. The extreme summer drought in 2003 offered the unique opportunity to study the impact of such events on the emission of greenhouse gases, such as methane or nitrous oxide, under field conditions. The main objective of the present study was to evaluate the impact of the summer drought in 2003 on the net methane and nitrous oxide budget of a spruce forest ecosystem (South-West Germany) with large variation in soil drainage. During the summers of 2000-2004 we measured net CH4 and N2O fluxes (bi)-weekly using the closed-chamber technique for six different soil types ranging from well-aerated Cambisols to poorly drained Gleysols and a wet Histosol. With regard to CH4 the extreme summer draught (1) did not elevate net CH4-sink function of soils, but (2) highly reduced net CH4-source strength and (3) reversed the net CH4 source of the investigated catchment into a sink. In all four summers investigated, net ecosystem exchange of CH4 was found only in the hydromorphic soils but not in the dominant well-aerated soils. This highlighted the key role of hydromorphic soils for the investigated pedodiverse system. With regard to N2O the summer draught in 2003 significantly reduced N2O emissions at least for the Humic Gleysol and the Sapric Histosol and hence markedly reduced the net N2O source strength of the investigated ecosystem.

  16. 7 CFR 3402.14 - Budget and budget narrative.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Budget and budget narrative. 3402.14 Section 3402.14... GRADUATE AND POSTGRADUATE FELLOWSHIP GRANTS PROGRAM Preparation of an Application § 3402.14 Budget and budget narrative. Applicants must prepare the Budget, Form CSREES-2004, and a budget narrative...

  17. Budget Brief: 2015 Proposed Budget Milwaukee Public Schools

    Science.gov (United States)

    Allen, Vanessa; Chapman, Anne; Henken, Rob

    2014-01-01

    In this report, the authors provide a detailed analysis of the major changes in revenue and expenditures in the Milwaukee Public Schools (MPS) 2015 proposed budget, and the manner in which MPS has responded to recent legislative changes and turbulent workforce challenges. The objective is to provide an independent assessment of the district's…

  18. Global carbon budget 2013

    International Nuclear Information System (INIS)

    Le Quere, C.; Moriarty, R.; Jones, S.D.; Boden, T.A.; Peters, G.P.; Andrew, R.M.; Andres, R.J.; Ciais, P.; Bopp, L.; Maignan, F.; Viovy, N.

    2014-01-01

    .1 GtC yr -1 , SOCEAN 2.5±0.5 GtC yr -1 , and SLAND 2.8±0.8 GtC yr -1 . For year 2012 alone, EFF grew to 9.7±0.5 GtC yr -1 , 2.2% above 2011, reflecting a continued growing trend in these emissions, GATM was 5.1±0.2 GtC yr -1 , SOCEAN was 2.9±0.5 GtC yr -1 , and assuming an ELUC of 1.0±0.5 GtC yr -1 (based on the 2001-2010 average), SLAND was 2.7±0.9 GtC yr -1 . GATM was high in 2012 compared to the 2003-2012 average, almost entirely reflecting the high EFF. The global atmospheric CO 2 concentration reached 392.520.10 ppm averaged over 2012. We estimate that EFF will increase by 2.1% (1.1- 3.1 %) to ±9.9±0.5 GtC in 2013, 61% above emissions in 1990, based on projections of world gross domestic product and recent changes in the carbon intensity of the economy. With this projection, cumulative emissions of CO 2 will reach about 535±55 GtC for 1870-2013, about 70% from EFF (390±20 GtC) and 30% from ELUC (145±50 GtC). This paper also documents any changes in the methods and data sets used in this new carbon budget from previous budgets (Le Quere et al., 2013). All observations presented here can be downloaded from the Carbon Dioxide Information Analysis Center (doi:10.3334/CDIAC/GCP 2 013 V 2.3). (authors)

  19. Elastic analysis of beam support impact

    International Nuclear Information System (INIS)

    Salmon, M.A.; Verma, V.K.; Youtsos, T.G.

    1982-01-01

    The effect of gaps present in the seismic supports of nuclear piping systems has been studied with the use of such large general purpose analysis codes as ANSYS. Exact analytical solutions to two simple beam impact problems are obtained to serve as benchmarks for the evaluation of the ability of such codes to model impact between beam elements and their supports. Bernoulli-Euler beam theory and modal analysis are used to obtain analytical solutions for the motion of simply supported and fixed ended beams after impact with a spring support at midspan. The solutions are valid up to the time the beam loses contact with the spring support. Numerical results are obtained which show that convergence for both contact force and bending moment at the point of impact is slower as spring stiffness is increased. Finite element solutions obtained with ANSYS are compared to analytical results and good agreement is obtained

  20. Impact Analysis for Risks in Informatics Systems

    OpenAIRE

    Baicu, Floarea; Baches, Maria Alexandra

    2013-01-01

    In this paper are presented methods of impact analysis on informatics system security accidents, qualitative and quantitative methods, starting with risk and informational system security definitions. It is presented the relationship between the risks of exploiting vulnerabilities of security system, security level of these informatics systems, probability of exploiting the weak points subject to financial losses of a company, respectively impact of a security accident on the company. Herewit...

  1. Update of Part 61 impacts analysis methodology

    International Nuclear Information System (INIS)

    Oztunali, O.I.; Roles, G.W.

    1986-01-01

    The US Nuclear Regulatory Commission is expanding the impacts analysis methodology used during the development of the 10 CFR Part 61 rule to allow improved consideration of costs and impacts of disposal of waste that exceeds Class C concentrations. The project includes updating the computer codes that comprise the methodology, reviewing and updating data assumptions on waste streams and disposal technologies, and calculation of costs for small as well as large disposal facilities. This paper outlines work done to date on this project

  2. Update of Part 61 impacts analysis methodology

    International Nuclear Information System (INIS)

    Oztunali, O.I.; Roles, G.W.; US Nuclear Regulatory Commission, Washington, DC 20555)

    1985-01-01

    The US Nuclear Regulatory Commission is expanding the impacts analysis methodology used during the development of the 10 CFR Part 61 regulation to allow improved consideration of costs and impacts of disposal of waste that exceeds Class C concentrations. The project includes updating the computer codes that comprise the methodology, reviewing and updating data assumptions on waste streams and disposal technologies, and calculation of costs for small as well as large disposal facilities. This paper outlines work done to date on this project

  3. Budget-impact model for colonoscopy cost calculation and comparison between 2 litre PEG+ASC and sodium picosulphate with magnesium citrate or sodium phosphate oral bowel cleansing agents.

    Science.gov (United States)

    Gruss, H-J; Cockett, A; Leicester, R J

    2012-01-01

    With the availability of several bowel cleansing agents, physicians and hospitals performing colonoscopies will often base their choice of cleansing agent purely on acquisition cost. Therefore, an easy to use budget impact model has been developed and established as a tool to compare total colon preparation costs between different established bowel cleansing agents. The model was programmed in Excel and designed as a questionnaire evaluating information on treatment costs for a range of established bowel cleansing products. The sum of costs is based on National Health Service reference costs for bowel cleansing products. Estimations are made for savings achievable when using a 2-litre polyethylene glycol with ascorbate components solution (PEG+ASC) in place of other bowel cleansing solutions. Test data were entered into the model to confirm validity and sensitivity. The model was then applied to a set of audit cost data from a major hospital colonoscopy unit in the UK. Descriptive analysis of the test data showed that the main cost drivers in the colonoscopy process are the procedure costs and costs for bed days rather than drug acquisition costs, irrespective of the cleansing agent. Audit data from a colonoscopy unit in the UK confirmed the finding with a saving of £107,000 per year in favour of PEG+ASC when compared to sodium picosulphate with magnesium citrate solution (NaPic+MgCit). For every patient group the model calculated overall cost savings. This was irrespective of the higher drug expenditure associated with the use of PEG+ASC for bowel preparation. Savings were mainly realized through reduced costs for repeat colonoscopy procedures and associated costs, such as inpatient length of stay. The budget impact model demonstrated that the primary cost driver was the procedure cost for colonoscopy. Savings can be realized through the use of PEG+ASC despite higher drug acquisition costs relative to the comparator products. From a global hospital funding

  4. Impact parameter analysis and soft QCD dynamics

    International Nuclear Information System (INIS)

    Carvalho, P.A.S.; Martini, A.F.; Menon, M.J.

    2002-01-01

    In a recent paper, based on the hypothesis of light-cone dipole representation for gluon Bremsstrahlung, Kopeliovich et al. developed a dynamical model for the elastic hadronic amplitude. The model has been applied to pp and p (bar) p scattering and the effects of unitarity and peripheral interactions have been investigated in the impact parameter representation. In this communication, making use of a model independent extraction of the scattering amplitude in the impact parameter space (early developed), we represent a comparative study between the predictions from the dynamical model and the impact parameter analysis. (author)

  5. A Budget Impact Model of Hemophilia Bypassing Agent Prophylaxis Relative to Recombinant Factor VIIa On-Demand.

    Science.gov (United States)

    Mehta, Darshan A; Oladapo, Abiola O; Epstein, Joshua D; Novack, Aaron R; Neufeld, Ellis J; Hay, Joel W

    2016-02-01

    Hemophilia patients use factor-clotting concentrates (factor VIII for hemophilia A and factor IX for hemophilia B) for improved blood clotting. These products are used to prevent or stop bleeding episodes. However, some hemophilia patients develop inhibitors (i.e., the patient's immune system develops antibodies against these factor concentrates). Hence, these patients do not respond well to the factor concentrates. A majority of hemophilia patients with inhibitors are managed on-demand with the following bypassing agents: recombinant factor VIIa (rFVIIa) and activated prothrombin complex concentrate (aPCC). The recently published U.S. registries Dosing Observational Study in Hemophilia (DOSE) and Hemostasis and Thrombosis Research Society (HTRS) reported higher rFVIIa on-demand use for bleed management than previously described. To estimate aPCC and rFVIIa prophylaxis costs relative to rFVIIa on-demand treatment cost based on rFVIIa doses reported in U.S. registries. A literature-based cost model was developed assuming a base case on-demand annual bleed rate (ABR) of 28.7 per inhibitor patient, which was taken from a randomized phase 3 clinical trial. The doses for rFVIIa on-demand were taken from the median dose per bleed reported by the DOSE and HTRS registries. Model inputs for aPCC and rFVIIa prophylaxis (i.e., dosing and efficacy) were derived from respective randomized clinical trials. Cost analysis was from the U.S. payer perspective, and only direct drug costs were considered. The drug cost was based on the Medicare Part B 2014 average sale price (ASP). Two-way sensitivity and threshold analyses were performed by simultaneously varying on-demand ABR, prophylaxis efficacy, and unit drug cost. In addition to studying relative costs associated with on-demand and prophylaxis treatments, relative cost per bleeding episode avoided were also calculated for aPCC and rFVIIa prophylaxis treatments. The prophylaxis efficacy reported in the trials were used to

  6. Size, Stability and Incremental Budgeting Outcomes in Public Universities.

    Science.gov (United States)

    Schick, Allen G.; Hills, Frederick S.

    1982-01-01

    Examined the influence of relative size in the analysis of total dollar and workforce budgets, and changes in total dollar and workforce budgets when correlational/regression methods are used. Data suggested that size dominates the analysis of total budgets, and is not a factor when discretionary dollar increments are analyzed. (JAC)

  7. The Budget Impact of Increased Use of Febuxostat in the Management of Gout: A US Health Plan Managed Care Pharmacy and Medical Costs Perspective.

    Science.gov (United States)

    Smolen, Lee J; Gahn, James C; Mitri, Ghaith; Shiozawa, Aki

    2016-07-01

    Gout is a chronic disease characterized by the deposition of urate crystals in the joints and throughout the body, caused by an excess burden of serum uric acid (sUA). The study estimates pharmacy and medical cost budgetary impacts of wider adoption by US payers of febuxostat, a urate-lowering therapy (ULT) for the treatment of gout. A US payer-perspective budget impact model followed ULT patients from a 1,000,000-member plan over 3 years. The current market share scenario, febuxostat (6%) and ULT allopurinol (94%), was compared with an 18% febuxostat market share. Data were implemented from randomized controlled trials, census and epidemiologic studies, and real-world database analyses. An innovation was the inclusion of gout-related chronic kidney disease costs. Cost results were estimated as annual and cumulative incremental costs, expressed as total costs, cost per member per month, and cost per treated member per month. Clinical results were also estimated. Increasing the febuxostat market share resulted in a 6.3% increase in patients achieving the sUA target level of <6.0 mg/dL and a 1.4% reduction in gout flares during the 3-year period. Total cost increased 1.4%, with a 49.9% increase in ULT costs, a 1.4% reduction in flare costs, a 1.2% reduction in chronic kidney disease costs, and a 2.8% reduction in gout care costs. The cumulative incremental costs were $1,307,425 in the first year, $1,939,016 through the second year, and $2,092,744 through the third year. By the third year, savings in medical costs offset most of the increase in treatment costs. Impacts on cumulative cost per member per month and cumulative cost per treated member per month followed the same pattern, with the highest impact in the first year and cumulative impacts declining during the 3-year period. The cumulative cost per member per month impact was estimated as $0.109, $0.081, and $0.058 and the cumulative cost per treated member per month impact was estimated as $12.416, $9.207, and

  8. Planning-Programming-Budgeting Systems.

    Science.gov (United States)

    Tudor, Dean

    Planning Programming and Budgeting Systems (PPBS) have been considered as either synonymous with abstract, advanced, mathematical systems analysis or as an advanced accounting and control system. If PPBS is to perform a useful function, both viewpoints must be combined such that a number of standardized procedures and reports are required and…

  9. Early retirement and the influence on healthcare budgets and insurance premiums in a diabetes population.

    Science.gov (United States)

    Walzer, Stefan

    2007-01-01

    To contribute to current discussions about budget impact modeling, two different approaches for the impact of a new pharmaceutical product were analyzed: firstly considering the impact on annual healthcare expenditures only, and secondly additional inclusion of lost insurance premiums due to possible early retirement in patients with chronic diseases. The dynamic model calculates the budget impact from two different perspectives: (a) the impact on healthcare expenditures and (b) on expenditures as well as on health insurance revenues due to premiums. The latter approach could especially be useful for patients with chronic diseases who have higher probabilities of early retirement. Early retirement rates and indirect costs were derived from published data. Healthcare premiums were calculated based on an average premium and a mean income. Epidemiological input data were obtained from the literature. Time horizon was 10 years. Results in terms of reimbursement decisions of the budget impact analysis varied depending on the assumptions made for the insurance premiums, costs, and early retirement rate. Sensitivity analyses revealed that in extreme cases the decision for accepting a new pharmaceutical product would probably be negative using approach (a), but positive using approach (b). Depending on the disease and population of interest in a budget impact analysis, not only the healthcare expenditures for a health insurance have to be considered but also the revenue side for an insurance due to retirement should be included.

  10. Understanding the Budget Process

    Directory of Open Access Journals (Sweden)

    Mesut Yalvaç

    2000-03-01

    Full Text Available Many different budgeting techniques can be used in libraries, and some combination of these will be appropriate for almost any individual situation. Li-ne-item, program, performance, formula, variable, and zero-base budgets all have features that may prove beneficial in the preparation of a budget. Budgets also serve a variety of functions, providing for short-term and long-term financial planning as well as for cash management over a period of time. Short-term plans are reflected in the operating budget, while long-term plans are reflected in the capital budget. Since the time when cash is available to an organization does not usually coincide with the time that disbursements must be made, it is also important to carefully plan for the inflow and outflow of funds by means of a cash budget.      During the budget process an organization selects its programs and activities by providing the necessary funding; the library, along with others in the organization, must justify its requests. Because of the cyclical nature of the budget process, it is possible continually to gather information and evaluate alternatives for the next budget period so that the library may achieve its maximum potential for service to its patrons.

  11. STATE BUDGET APPROPRIATION MANAGERS AS THE SUBJECTS OF BUDGET PLANNING IN THE REPUBLIC OF LITHUANIA

    Directory of Open Access Journals (Sweden)

    Bronius Sudavicius

    2017-01-01

    Full Text Available The subject. The article deals with the problem of legal status of the state budget appropriation managers in the process of budget planning in the Republic of Lithuania.The purpose of the article is evaluation of state budget appropriation managers’ role in the process of budget planning in the Republic of Lithuania.The methodology of research is the analysis of the budgetary legislation of the Republic of Lithuania and the scientific literature, using the methods of logical and systematic analysis and other methods of scientific researchMain results, and scope of it’s application. The legal definition and the system of state budget appropriation managers is analyzed in the article. Particular attention is given to the question of role of state budget appropriation managers in the process of budget framework. The role of the Government and Parliament, as well as a special body of management of public finances (in the Republic of Lithuania, the Ministry of Finance – legislative and executive authorities – is emphasized in the scientific literature. But it is often not mentioned what an important place in this process other participants of budgetary relations – state budget appropriation managers – takes. The main participation of state budget appropriation managers in the budget planning process related to the planning of the budget expenditures.Preparation of strategic plans and programmes of budgetary funds by state budget appropriation managers can be considered part of governance activities in general. For budget planning drawn up draft budgets of the programs by state budget appropriation managers is particularly important.Conclusions. The efficiency of the use of state funds depends on the spending of funds, the quality and validity of the developed programmes of activities led by their agencies. State budget appropriation managers are involved, along with other entities, on each stage of the budget planning. They provide the

  12. STUDY CONCERNING THE EXECUTION OF LOCAL BUDGETS REVENUES

    Directory of Open Access Journals (Sweden)

    Cristinel ICHIM

    2013-12-01

    Full Text Available Implementation of local budget revenues is a very important sub-phase of the local budgetary process its correct accomplishment ensures regularity and efficiency in revenue collection, which will cover the local budget expenditures. Through this scientific approach we intended to achieve an analysis of the implementation of revenues mobilized to the local budgets in Romania. The study started with fixing the concept of execution of budget revenues and defining its phases, and followed with the analysis of the implementation of local budget revenues in three levels, namely: the overall local budgets in Romania, at the city level and at the community level. We have to mention that the analysis of the execution of local budgets was done in 2011, based on existing data in the last occurrence of the Romanian Statistical Yearbook for 2012. The paper concluded with some considerations regarding the execution of local budgets revenues and some proposals for improving the collection of local income.

  13. Budget impact model in moderate-to-severe psoriasis vulgaris assessing effects of calcipotriene and betamethasone dipropionate foam on per-patient standard of care costs.

    Science.gov (United States)

    Asche, Carl V; Kim, Minchul; Feldman, Steven R; Zografos, Panagiotis; Lu, Minyi

    2017-09-01

    To develop a budget impact model (BIM) for estimating the financial impact of formulary adoption and uptake of calcipotriene and betamethasone dipropionate (C/BD) foam (0.005%/0.064%) on the costs of biologics for treating moderate-to-severe psoriasis vulgaris in a hypothetical US healthcare plan with 1 million members. This BIM incorporated epidemiologic data, market uptake assumptions, and drug utilization costs, simulating the treatment mix for patients who are candidates for biologics before (Scenario #1) and after (Scenario #2) the introduction of C/BD foam. Predicted outcomes were expressed in terms of the annual cost of treatment (COT) and the COT per member per month (PMPM). At year 1, C/BD foam had the lowest per-patient cost ($9,913) necessary to achieve a Psoriasis Area and Severity Index (PASI)-75 response compared with etanercept ($73,773), adalimumab ($92,871), infliximab ($34,048), ustekinumab ($83,975), secukinumab ($113,858), apremilast ($47,960), and ixekizumab ($62,707). Following addition of C/BD foam to the formulary, the annual COT for moderate-to-severe psoriasis would decrease by $36,112,572 (17.91%, from $201,621,219 to $165,508,647). The COT PMPM is expected to decrease by $3.00 (17.86%, from $16.80 to $13.80). Drug costs were based on Medi-Span reference pricing (January 21, 2016); differences in treatment costs for drug administration, laboratory monitoring, or adverse events were not accounted for. Potentially confounding were the definition of "moderate-to-severe" and the heterogeneous efficacy data. The per-patient cost for PASI-75 response at year 1 was estimated from short-term efficacy data for C/BD foam and apremilast only. The introduction of C/BD foam is expected to decrease the annual COT for moderate-to-severe psoriasis treatable with biologics by $36,112,572 for a hypothetical US healthcare plan with 1 million plan members, and to lower the COT PMPM by $3.00.

  14. An evaluation paradigm for cumulative impact analysis

    Science.gov (United States)

    Stakhiv, Eugene Z.

    1988-09-01

    Cumulative impact analysis is examined from a conceptual decision-making perspective, focusing on its implicit and explicit purposes as suggested within the policy and procedures for environmental impact analysis of the National Environmental Policy Act of 1969 (NEPA) and its implementing regulations. In this article it is also linked to different evaluation and decision-making conventions, contrasting a regulatory context with a comprehensive planning framework. The specific problems that make the application of cumulative impact analysis a virtually intractable evaluation requirement are discussed in connection with the federal regulation of wetlands uses. The relatively familiar US Army Corps of Engineers' (the Corps) permit program, in conjunction with the Environmental Protection Agency's (EPA) responsibilities in managing its share of the Section 404 regulatory program requirements, is used throughout as the realistic context for highlighting certain pragmatic evaluation aspects of cumulative impact assessment. To understand the purposes of cumulative impact analysis (CIA), a key distinction must be made between the implied comprehensive and multiobjective evaluation purposes of CIA, promoted through the principles and policies contained in NEPA, and the more commonly conducted and limited assessment of cumulative effects (ACE), which focuses largely on the ecological effects of human actions. Based on current evaluation practices within the Corps' and EPA's permit programs, it is shown that the commonly used screening approach to regulating wetlands uses is not compatible with the purposes of CIA, nor is the environmental impact statement (EIS) an appropriate vehicle for evaluating the variety of objectives and trade-offs needed as part of CIA. A heuristic model that incorporates the basic elements of CIA is developed, including the idea of trade-offs among social, economic, and environmental protection goals carried out within the context of environmental

  15. Understanding the Budget Process

    OpenAIRE

    Mesut Yalvaç

    2000-01-01

    Many different budgeting techniques can be used in libraries, and some combination of these will be appropriate for almost any individual situation. Li-ne-item, program, performance, formula, variable, and zero-base budgets all have features that may prove beneficial in the preparation of a budget. Budgets also serve a variety of functions, providing for short-term and long-term financial planning as well as for cash management over a period of time. Short-term plans are reflected in the oper...

  16. Zero-based budgeting: Pathway to sustainable budget implementation in Nigeria

    OpenAIRE

    Udeh Francis Nnoli; Sopekan Sam Adeyemi; Oraka Azubuike Onuora

    2017-01-01

    This paper investigates the application of Zero-Based Budgeting (ZBB) system to budget implementation by the Federal Government of Nigeria by ascertaining among others, the relationship between ZBB approach and budget performance indices in Nigeria. To achieve the above, primary data were obtained through questionnaires that were specifically designed for this study. The data obtained were analysed with the SPSS version 21. The statistical tools employed were Analysis of Variance (ANOVA) and ...

  17. Dynamical influence of gravity waves generated by the Vestfjella Mountains in Antarctica: radar observations, fine-scale modelling and kinetic energy budget analysis

    Directory of Open Access Journals (Sweden)

    Joel Arnault

    2012-02-01

    Full Text Available Gravity waves generated by the Vestfjella Mountains (in western Droning Maud Land, Antarctica, southwest of the Finnish/Swedish Aboa/Wasa station have been observed with the Moveable atmospheric radar for Antarctica (MARA during the SWEDish Antarctic Research Programme (SWEDARP in December 2007/January 2008. These radar observations are compared with a 2-month Weather Research Forecast (WRF model experiment operated at 2 km horizontal resolution. A control simulation without orography is also operated in order to separate unambiguously the contribution of the mountain waves on the simulated atmospheric flow. This contribution is then quantified with a kinetic energy budget analysis computed in the two simulations. The results of this study confirm that mountain waves reaching lower-stratospheric heights break through convective overturning and generate inertia gravity waves with a smaller vertical wavelength, in association with a brief depletion of kinetic energy through frictional dissipation and negative vertical advection. The kinetic energy budget also shows that gravity waves have a strong influence on the other terms of the budget, i.e. horizontal advection and horizontal work of pressure forces, so evaluating the influence of gravity waves on the mean-flow with the vertical advection term alone is not sufficient, at least in this case. We finally obtain that gravity waves generated by the Vestfjella Mountains reaching lower stratospheric heights generally deplete (create kinetic energy in the lower troposphere (upper troposphere–lower stratosphere, in contradiction with the usual decelerating effect attributed to gravity waves on the zonal circulation in the upper troposphere–lower stratosphere.

  18. Analysis of aircraft impact to concrete structures

    International Nuclear Information System (INIS)

    Arros, Jorma; Doumbalski, Nikolay

    2007-01-01

    Analysis of aircraft impact to nuclear power plant structures is discussed utilizing a simplified model of a 'fictitious nuclear building' to perform analyses using LS-DYNA software, representing the loading: (i) by the Riera force history method and (ii) by modeling the crash by impacting a model of a plane similar to Boeing 747-400 to the structure (i.e., 'missile-target interaction method'). Points discussed include: (1) comparison of shock loading within the building as obtained from the Riera force history analysis versus from the missile-target interaction analysis, (2) sensitivity of the results on the assumed Riera force loading area, (3) linear versus nonlinear modeling and (4) on failure criteria

  19. The Budget-Related Antecedents of Job Performance

    Directory of Open Access Journals (Sweden)

    Emine Yilmaz Karakoc

    2016-04-01

    Full Text Available This study aims to investigate budget related antecedents of job performance of managers. For this purpose, relationships among budgetary participation, budget goal commitment, information sharing, and job performance of managers were examined. The sample consists of managers who are responsible from the budgets of their units in different private enterprises located in Turkey. Survey data was analyzed with confirmatory factor analyses and Structural Equation Modeling. Results indicate that budgetary participation has statistically significant and positive impact on job performance. It also positively affects budget goal commitment and information sharing. Budget goal commitment and information sharing have significant and positive impact on job performance. In addition, budget goal commitment positively affects information sharing of managers. Analyses also revealed that budget goal commitment and information sharing have partial mediation effect on the relationship between budgetary participation and job performance.

  20. Development of a survey tool to assess and monitor the influence of food budget restraint on healthy eating, food related climate impact and quality of life

    DEFF Research Database (Denmark)

    Nielsen, Annemette Ljungdalh; Holm, Lotte; Lund, Thomas Bøker

    This documentation describes the development of a survey tool designed to: 1) measure how different levels of constraints on food budgets are associated to outcomes of healthy eating, environmental sustainability and life quality for individuals in Denmark, and 2) explore how these different...... outcomes are related to strategies people employ to cope with restricted food budgets. The resulting survey consists of a total of 63 question items. The paper lays out the various steps involved in the process of developing the survey tool, presents the final survey items included in the tool...

  1. Budgeting Approaches in Community Colleges

    Science.gov (United States)

    Palmer, James C.

    2014-01-01

    Several budgeting approaches have been initiated as alternatives to the traditional, incremental process. These include formula budgeting; zero-base budgeting; planning, programming, and budgeting systems; and responsibility center budgeting. Each is premised on assumptions about how organizations might best make resource allocation decisions.…

  2. CEA budget in 1982

    Energy Technology Data Exchange (ETDEWEB)

    1981-12-01

    In 1982, the amount of the CEA budget will be 13.4 billions French Francs. The main characteristics are the priority for employment and investments. In this budget programs are adapted to fit R and D to the government policy: innovation, industrial valorization and fundamental research especially thermonuclear fusion and in the electronuclear field to safety, reprocessing and radioactive waste management.

  3. Budgeting in Nonprofit Organizations.

    Science.gov (United States)

    Kelly, Lauren

    1985-01-01

    This description of the role of budgets in nonprofit organizations uses libraries as an example. Four types of budgets--legislative, management, cash, and capital--are critiqued in terms of cost effectiveness, implementation, and facilitation of organizational control and objectives. (CLB)

  4. Colorado Children's Budget 2010

    Science.gov (United States)

    Colorado Children's Campaign, 2010

    2010-01-01

    The "Children's Budget 2010" is intended to be a resource guide for policymakers and advocates who are interested in better understanding how Colorado funds children's programs and services. It attempts to clarify often confusing budget information and describe where the state's investment trends are and where those trends will lead the…

  5. The Agency's budget

    International Nuclear Information System (INIS)

    1964-01-01

    A total Agency Budget of $10 406 000 for 1965 was approved by the General Conference at its session of September 1964; the Budget for the year 1964 amounted to $9 812 000. The consolidated Budget figures are shown in the table at the end of this article. The Budget falls into two parts - the Regular Budget and the Operational Budget. The Regular Budget provides for the ordinary administrative expenses of the Agency, and for expert panels, special missions, symposia and conferences, distribution of information, and scientific and technical services. In conformity with the Agency's Statute, these expenses are met by contributions made according to Voluntary contributions are paid initially into a General Fund established for this purpose, and money for operations is transferred to the respective Operating Funds as appropriate, and as approved by the Board of Governors. The scale of assessments for 1965 is based on the United Nations scale for 1964. The assessments are estimated to yield $7 713 000 - an increase of 6.8 per cent; however, more than three quarters of this increase will be offset by credits which Member States will receive as a result of a cash surplus brought forward. The Operational Budget is financed by voluntary contributions and is divided into two parts - Operating Fund I, devoted to certain laboratory and research projects, and Operating Fund II, for technical assistance, training and research contracts.

  6. Impact analysis on a massively parallel computer

    International Nuclear Information System (INIS)

    Zacharia, T.; Aramayo, G.A.

    1994-01-01

    Advanced mathematical techniques and computer simulation play a major role in evaluating and enhancing the design of beverage cans, industrial, and transportation containers for improved performance. Numerical models are used to evaluate the impact requirements of containers used by the Department of Energy (DOE) for transporting radioactive materials. Many of these models are highly compute-intensive. An analysis may require several hours of computational time on current supercomputers despite the simplicity of the models being studied. As computer simulations and materials databases grow in complexity, massively parallel computers have become important tools. Massively parallel computational research at the Oak Ridge National Laboratory (ORNL) and its application to the impact analysis of shipping containers is briefly described in this paper

  7. Budget impact of switching from an immediate-release to a prolonged-release formulation of tacrolimus in renal transplant recipients in the UK based on differences in adherence

    Directory of Open Access Journals (Sweden)

    Muduma G

    2014-03-01

    Full Text Available Gorden Muduma,1 Isaac Odeyemi,1 Jayne Smith-Palmer,2 Richard F Pollock21Astellas Pharma Europe, Chertsey, UK; 2Ossian Health Economics and Communications, Basel, SwitzerlandBackground and aims: Advagraf is a once-daily prolonged-release formulation of tacrolimus with proven noninferiority to Prograf, a twice-daily immediate-release formulation of tacrolimus, in biopsy-proven acute rejection, graft survival and patient survival in renal transplant recipients. Advagraf is associated with improved adherence compared with Prograf, which may ultimately improve long-term outcomes. The present study assessed the budget impact of switching patients from Prograf to Advagraf in the UK.Materials and methods: A budget-impact model was constructed based on published data on acute rejection, graft failure, and mortality in the UK setting. Patients were assumed to convert from Prograf to Advagraf on a 1:1 milligram:milligram basis. In a study comparing the adherence rates between once-daily versus twice-daily formulations of tacrolimus, the proportion of patients taking the prescribed number of daily doses was 88.2% in Advagraf patients and 78.8% in Prograf patients. The model applied a relative risk of graft failure of 3.47 to nonadherent patients based on data from a 2004 meta-analysis (based on graft-failure rates of 1.3%–40.0% in adherent patients, compared with 6.1%–100% in nonadherent patients. Cost data were taken from the March 2013 British National Formulary and 2012–2013 National Health Service tariff information. The analysis was performed over a 5-year time horizon and future costs were not discounted, in line with International Society for Pharmacoeconomics and Outcomes Research guidelines.Results: Over a 5-year time horizon, the mean cost per patient (including tacrolimus, concomitant immunosuppressive medications, dialysis after graft failure, and treatment for acute rejection was £29,328 (standard deviation [SD] £2,844 for Advagraf

  8. Zero-based budgeting: Pathway to sustainable budget implementation in Nigeria

    Directory of Open Access Journals (Sweden)

    Udeh Francis Nnoli

    2017-10-01

    Full Text Available This paper investigates the application of Zero-Based Budgeting (ZBB system to budget implementation by the Federal Government of Nigeria by ascertaining among others, the relationship between ZBB approach and budget performance indices in Nigeria. To achieve the above, primary data were obtained through questionnaires that were specifically designed for this study. The data obtained were analysed with the SPSS version 21. The statistical tools employed were Analysis of Variance (ANOVA and Pearson Correlation Coefficiant (PCC. The Cronbach’s Alpha reliability test was used to test the internal consistency/reliability of the instrument used for the study. On the basis of the analysis, we found that there is significant difference in the effectiveness of ZBB in terms of budget implementation compared to the Traditional Budgeting System (TBS. It was also found that the application of ZBB tend to be performance-driven and is able to detect the redundant programmes/projects and staff, thereby recommending either realignment, discharge, transfer or redeployment of projects or resources. The study therefore, recommends among others that ZBB should be encouraged as a good means of budget implementation and also close monitoring of budget execution should be enshrined in work ethics at every stage of budget preparation and implementation in the country. This is believed would go a long way to strengthen measures aimed at mitigating poor budget implementation in the country.

  9. Reliability analysis of pipe whip impacts

    International Nuclear Information System (INIS)

    Alzbutas, R.; Dundulis, G.; Kulak, R.F.; Marchertas, P.V.

    2003-01-01

    A probabilistic analysis of a group distribution header (GDH) guillotine break and the damage resulting from the failed GDH impacting against a neighbouring wall was carried out for the Ignalita RBMK-1500 reactor. The NEPTUNE software system was used for the deterministic transient analysis of a GDH guillotine break. Many deterministic analyses were performed using different values of the random variables that were specified by ProFES software. All the deterministic results were transferred to the ProFES system, which then performed probabilistic analyses of piping failure and wall damage. The Monte Carlo Simulation (MCS) method was used to study the sensitivity of the response variables and the effect of uncertainties of material properties and geometry parameters to the probability of limit states. The First Order Reliability Method (FORM) was used to study the probability of failure of the impacted-wall and the support-wall. The Response Surface (RS/MCS) method was used in order to express failure probability as function and to investigate the dependence between impact load and failure probability. The results of the probability analyses for a whipping GDH impacting onto an adjacent wall show that: (i) there is a 0.982 probability that after a GDH guillotine break contact between GDH and wall will occur; (ii) there is a probability of 0.013 that the ultimate tensile strength of concrete at the impact location will be reached, and a through-crack may open; (iii) there is a probability of 0.0126 that the ultimate compressive strength of concrete at the GDH support location will be reached, and the concrete may fail; (iv) at the impact location in the adjacent wall, there is a probability of 0.327 that the ultimate tensile strength of the rebars in the first layer will be reached and the rebars will fail; (v) at the GDH support location, there is a probability of 0.11 that the ultimate stress of the rebars in the first layer will be reached and the rebars will fail

  10. Government programs for climate change mitigation in Japan. An analysis based on public budget documents and Government Project Review Sheets

    International Nuclear Information System (INIS)

    Kimura, Osamu

    2016-01-01

    The Japanese government has been spending huge public budgets for various programs to mitigate climate change, such as subsidy programs for energy efficient and renewable technologies, and R and D programs to develop innovative low carbon technologies. This report makes a comprehensive review of government projects and expenditure related to climate change mitigation in order to grasp their total expenditure and to analyze portfolio of supported technology and activity types, outcome, and the cost-effectiveness. It is estimated that the total expenditure for climate change mitigation excluding nuclear energy and forest sink projects amounts to 4.8 trillion JPY (approximately 40 billion USD) in the period of 2008 to 2014. 40% of the total expenditure went to only three largest programs, namely the Eco Car Subsidy, the Eco Point Programs for Appliances and Houses, all of which have gone through virtually no or only poor evaluations by the implementing ministries. While some programs had decent cost-effectiveness of reducing carbon dioxide emission at below 10,000 JPY/t-CO 2 (approximately 90 USD), there are also programs with very low cost-effectiveness at more than 100,000 JPY/t-CO 2 . Moreover, all of the evaluation was based on 'gross' reduction, not on 'net' of freeriders, rebound and other factors, which may lead to overestimation of performances. The result shows the need for a much larger resource for evaluation activities by the government. (author)

  11. Mask characterization for CDU budget breakdown in advanced EUV lithography

    Science.gov (United States)

    Nikolsky, Peter; Strolenberg, Chris; Nielsen, Rasmus; Nooitgedacht, Tjitte; Davydova, Natalia; Yang, Greg; Lee, Shawn; Park, Chang-Min; Kim, Insung; Yeo, Jeong-Ho

    2012-11-01

    As the ITRS Critical Dimension Uniformity (CDU) specification shrinks, semiconductor companies need to maintain a high yield of good wafers per day and a high performance (and hence market value) of finished products. This cannot be achieved without continuous analysis and improvement of on-product CDU as one of the main drivers for process control and optimization with better understanding of main contributors from the litho cluster: mask, process, metrology and scanner. In this paper we will demonstrate a study of mask CDU characterization and its impact on CDU Budget Breakdown (CDU BB) performed for an advanced EUV lithography with 1D and 2D feature cases. We will show that this CDU contributor is one of the main differentiators between well-known ArFi and new EUV CDU budgeting principles. We found that reticle contribution to intrafield CDU should be characterized in a specific way: mask absorber thickness fingerprints play a role comparable with reticle CDU in the total reticle part of the CDU budget. Wafer CD fingerprints, introduced by this contributor, may or may not compensate variations of mask CD's and hence influence on total mask impact on intrafield CDU at the wafer level. This will be shown on 1D and 2D feature examples in this paper. Also mask stack reflectivity variations should be taken into account: these fingerprints have visible impact on intrafield CDs at the wafer level and should be considered as another contributor to the reticle part of EUV CDU budget. We observed also MEEF-through-field fingerprints in the studied EUV cases. Variations of MEEF may also play a role for the total intrafield CDU and may be taken into account for EUV Lithography. We characterized MEEF-through-field for the reviewed features, the results to be discussed in our paper, but further analysis of this phenomenon is required. This comprehensive approach to characterization of the mask part of EUV CDU characterization delivers an accurate and integral CDU Budget

  12. THE POSITION BUDGETS OF ADMINISTRATIVE AND TERRITORIAL UNITS IN GENERAL CONSOLIDATED BUDGET

    Directory of Open Access Journals (Sweden)

    CHIRCULESCU MARIA FELICIA

    2017-12-01

    Full Text Available The budget is a tool of territorial administrative units of financial and budgetary policy in which the state intervenes in the economy at the local level, having a major impact on general government.Through the decentralization processes that are increasingly debated and applied, the paper aims to highlight the importance of the territorial administrative unit budgets in the consolidated budget in Romania.Thus, the work comprises both theoretical notions concerning the presentation of the consolidated state budget and the budget of the territorial administrative units. The relevance of the work lies in the importance of general government in the regulation of macroeconomic balances by sizing or macroeconomic imbalances, with modern methods that analyze the possibilities and effects of new types of deficits or surpluses in the public sector.

  13. Flow-thermal analysis of power plant with budget dry pocket filter type TTFP 6/220 in foundry AD Kikinda

    Directory of Open Access Journals (Sweden)

    Salemović Duško R.

    2014-01-01

    Full Text Available In this paper, the power budget is given in the application of contemporary and modern methods in the treatment of air from the production facility in which the electric arc furnace. For this calculation, for existing construction and known dimensions dusters calculate flow rates and temperatures at various points of the complete piping systems for waste gases. The analysis contributes maximum energy utilization, significant financial savings and increase in energy and environmental efficiency. Engineering supervision and active computer control of a computer in pieces of PLC are supported. The possible errors are diagnosed and their causes are explained and the procedures to be followed when it comes to them. Also, the paper gives the guidelines for the maintenance and servicing of equipment for proper operation of the filter plant. The tables presented in the plant control activities to be conducted at periodic intervals.

  14. FY 1997 congressional budget request: Budget highlights

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-03-01

    This is an overview of the 1997 budget request for the US DOE. The topics of the overview include a policy overview, the budget by business line, business lines by organization, crosswalk from business line to appropriation, summary by appropriation, energy supply research and development, uranium supply and enrichment activities, uranium enrichment decontamination and decommissioning fund, general science and research, weapons activities, defense environmental restoration and waste management, defense nuclear waste disposal, departmental administration, Office of the Inspector General, power marketing administrations, Federal Energy Regulatory commission, nuclear waste disposal fund, fossil energy research and development, naval petroleum and oil shale reserves, energy conservation, economic regulation, strategic petroleum reserve, energy information administration, clean coal technology and a Department of Energy Field Facilities map.

  15. Budget institutions and fiscal performance of the Brazilian Federal Government

    Directory of Open Access Journals (Sweden)

    Ana Carolina Giuberti

    2015-05-01

    Full Text Available This article aims to assess the impact of federal budget institutions on the primary deficit of the Brazilian Federal Government from 1985 to 2009, a period marked by important changes in these institutions. Based on the methodology established in the literature on political economy that is linked to the macroeconomic mainstream, three sets of budget indices and their respective sub-indices are constructed, and their behaviour over the period of analysis indicate that the changes made have resulted in institutions that induce greater fiscal discipline. Regarding the effect of these institutions on the fiscal performance, the results allow us to conclude that the institutional changes have contributed to a lower government deficit.

  16. The Budget Deficit in the System of the Financial and Credit Development of Economy

    Directory of Open Access Journals (Sweden)

    Kucher Galyna V.

    2017-11-01

    Full Text Available Scientific approaches to the role, influence and peculiarities of usage of budget deficit as an instrument for ensuring social development both in Ukraine and in the EU countries have been disclosed. Influence of certain types of budget deficit on the economic system has been explained and expediency of considering the fluctuations of exchange rate, along with conditions of attraction of credit resources for definition of the operational budget deficit, has been substantiated. The practical results include the analysis of budget deficit indicators in Ukraine and in the EU countries, as well as the factors that determined their change. Both the national and the international experience, cyclical economic development, crisis events in the economy have demonstrated that the budget deficit is an important instrument of financial policy. Its usage helps to reduce the negative impact and to ensure a way out of the economic crisis. The budget deficit is an effective lever for macroeconomic management, which should be actively used to accelerate economic growth in the developing countries in the context of globalization.

  17. Economic impact analysis of load forecasting

    International Nuclear Information System (INIS)

    Ranaweera, D.K.; Karady, G.G.; Farmer, R.G.

    1997-01-01

    Short term load forecasting is an essential function in electric power system operations and planning. Forecasts are needed for a variety of utility activities such as generation scheduling, scheduling of fuel purchases, maintenance scheduling and security analysis. Depending on power system characteristics, significant forecasting errors can lead to either excessively conservative scheduling or very marginal scheduling. Either can induce heavy economic penalties. This paper examines the economic impact of inaccurate load forecasts. Monte Carlo simulations were used to study the effect of different load forecasting accuracy. Investigations into the effect of improving the daily peak load forecasts, effect of different seasons of the year and effect of utilization factors are presented

  18. Budget Automation System

    Data.gov (United States)

    U.S. Environmental Protection Agency — BAS is the central Agency system used to integrate strategic planning, annual planning, budgeting and financial management. BAS contains resource (dollars and FTE),...

  19. Water Budget Tool

    Science.gov (United States)

    If you're designing a new landscape or rethinking your current one, the WaterSense Water Budget Tool will tell you if you have designed a landscape that will use an appropriate amount of water for your climate.

  20. Global Carbon Budget 2017

    NARCIS (Netherlands)

    Le Quere, Corinne; Andrew, Robbie M.; Friedlingstein, Pierre; Sitch, Stephen; Pongratz, Julia; Manning, Andrew C.; Korsbakken, Jan Ivar; Peters, Glen P.; Canadell, Josep G.; Jackson, Robert B.; Boden, Thomas A.; Tans, Pieter P.; Andrews, Oliver D.; Arora, Vivek K.; Bakker, Dorothee C. E.; Barbero, Leticia; Becker, Meike; Betts, Richard A.; Bopp, Laurent; Chevallier, Frederic; Chini, Louise P.; Ciais, Philippe; Cosca, Catherine E.; Cross, Jessica; Currie, Kim; Gasser, Thomas; Harris, Ian; Hauck, Judith; Haverd, Vanessa; Houghton, Richard A.; Hunt, Christopher W.; Hurtt, George; Ilyina, Tatiana; Jain, Atul K.; Kato, Etsushi; Kautz, Markus; Keeling, Ralph F.; Goldewijk, Kees Klein; Koertzinger, Arne; Landschuetzer, Peter; Lefevre, Nathalie; Lenton, Andrew; Lienert, Sebastian; Lima, Ivan; Lombardozzi, Danica; Metzl, Nicolas; Millero, Frank; Monteiro, Pedro M. S.; Munro, David R.; Nabel, Julia E. M. S.; Nakaoka, Shin-ichiro; Nojiri, Yukihiro; Padin, X. Antonio; Peregon, Anna; Pfeil, Benjamin; Pierrot, Denis; Poulter, Benjamin; Rehder, Gregor; Reimer, Janet; Roedenbeck, Christian; Schwinger, Jorg; Seferian, Roland; Skjelvan, Ingunn; Stocker, Benjamin D.; Tian, Hanqin; Tilbrook, Bronte; Tubiello, Francesco N.; van der Laan-Luijkx, Ingrid T.; van der Werf, Guido R.; van Heuven, Steven; Viovy, Nicolas; Vuichard, Nicolas; Walker, Anthony P.; Watson, Andrew J.; Wiltshire, Andrew J.; Zaehle, Soenke; Zhu, Dan

    2018-01-01

    Accurate assessment of anthropogenic carbon dioxide (CO2) emissions and their redistribution among the atmosphere, ocean, and terrestrial biosphere - the "global carbon budget" - is important to better understand the global carbon cycle, support the development of climate policies, and project

  1. Jackson Revenue Budget

    Data.gov (United States)

    City of Jackson, Mississippi — This dataset shows the City of Jackson's FY2017 revenue budget, revenue collected to date, and the balance remaining to be collected. The data can be broken down by...

  2. Budget and Actuals

    Data.gov (United States)

    Town of Chapel Hill, North Carolina — This dataset contains the Town's Year-to-Date Budget and Actuals for Fiscal Years 2016, 2017, and 2018. Fiscal years run from July 1 to June 30. The data comes from...

  3. Under Secretary of Defense (Comptroller) > Budget Materials > Budget1998

    Science.gov (United States)

    functionalStatements OUSD(C) History FMR Budget Materials Budget Execution Financial Management Improving Financial Performance Reports Regulations banner DoD Budget Request 2019 | 2018 | 2017 |2016 | 2015 | 2014 | 2013 | 2012 President's Budget request for the Department of Defense sustains the President's commitment to invest in

  4. A New Approach in Public Budgeting: Citizens' Budget

    Science.gov (United States)

    Bilge, Semih

    2015-01-01

    Change and transformation in the understanding and definition of citizenship has led to the emergence of citizen-oriented public service approach. This approach also raised a new term and concept in the field of public budgeting because of the transformation in the processes of public budgeting: citizens' budget. The citizens' budget which seeks…

  5. The Budget as a Management Tool: Zero Base Budgeting, Panacea ...

    African Journals Online (AJOL)

    Nigeria has been experiencing difficulties in Budget implementation. The objective of this article is to present alternative forms of budgeting and after exposition on them, to recommend one that could mitigate budget implementation problem for Nigeria. Two types of budgeting addressed are incremental and zero-base.

  6. Global Carbon Budget 2016

    Science.gov (United States)

    Le Quéré, Corinne; Andrew, Robbie M.; Canadell, Josep G.; Sitch, Stephen; Korsbakken, Jan Ivar; Peters, Glen P.; Manning, Andrew C.; Boden, Thomas A.; Tans, Pieter P.; Houghton, Richard A.; Keeling, Ralph F.; Alin, Simone; Andrews, Oliver D.; Anthoni, Peter; Barbero, Leticia; Bopp, Laurent; Chevallier, Frédéric; Chini, Louise P.; Ciais, Philippe; Currie, Kim; Delire, Christine; Doney, Scott C.; Friedlingstein, Pierre; Gkritzalis, Thanos; Harris, Ian; Hauck, Judith; Haverd, Vanessa; Hoppema, Mario; Klein Goldewijk, Kees; Jain, Atul K.; Kato, Etsushi; Körtzinger, Arne; Landschützer, Peter; Lefèvre, Nathalie; Lenton, Andrew; Lienert, Sebastian; Lombardozzi, Danica; Melton, Joe R.; Metzl, Nicolas; Millero, Frank; Monteiro, Pedro M. S.; Munro, David R.; Nabel, Julia E. M. S.; Nakaoka, Shin-ichiro; O'Brien, Kevin; Olsen, Are; Omar, Abdirahman M.; Ono, Tsuneo; Pierrot, Denis; Poulter, Benjamin; Rödenbeck, Christian; Salisbury, Joe; Schuster, Ute; Schwinger, Jörg; Séférian, Roland; Skjelvan, Ingunn; Stocker, Benjamin D.; Sutton, Adrienne J.; Takahashi, Taro; Tian, Hanqin; Tilbrook, Bronte; van der Laan-Luijkx, Ingrid T.; van der Werf, Guido R.; Viovy, Nicolas; Walker, Anthony P.; Wiltshire, Andrew J.; Zaehle, Sönke

    2016-11-01

    .3 ± 0.5 GtC yr-1, ELUC 1.0 ± 0.5 GtC yr-1, GATM 4.5 ± 0.1 GtC yr-1, SOCEAN 2.6 ± 0.5 GtC yr-1, and SLAND 3.1 ± 0.9 GtC yr-1. For year 2015 alone, the growth in EFF was approximately zero and emissions remained at 9.9 ± 0.5 GtC yr-1, showing a slowdown in growth of these emissions compared to the average growth of 1.8 % yr-1 that took place during 2006-2015. Also, for 2015, ELUC was 1.3 ± 0.5 GtC yr-1, GATM was 6.3 ± 0.2 GtC yr-1, SOCEAN was 3.0 ± 0.5 GtC yr-1, and SLAND was 1.9 ± 0.9 GtC yr-1. GATM was higher in 2015 compared to the past decade (2006-2015), reflecting a smaller SLAND for that year. The global atmospheric CO2 concentration reached 399.4 ± 0.1 ppm averaged over 2015. For 2016, preliminary data indicate the continuation of low growth in EFF with +0.2 % (range of -1.0 to +1.8 %) based on national emissions projections for China and USA, and projections of gross domestic product corrected for recent changes in the carbon intensity of the economy for the rest of the world. In spite of the low growth of EFF in 2016, the growth rate in atmospheric CO2 concentration is expected to be relatively high because of the persistence of the smaller residual terrestrial sink (SLAND) in response to El Niño conditions of 2015-2016. From this projection of EFF and assumed constant ELUC for 2016, cumulative emissions of CO2 will reach 565 ± 55 GtC (2075 ± 205 GtCO2) for 1870-2016, about 75 % from EFF and 25 % from ELUC. This living data update documents changes in the methods and data sets used in this new carbon budget compared with previous publications of this data set (Le Quéré et al., 2015b, a, 2014, 2013). All observations presented here can be downloaded from the Carbon Dioxide Information Analysis Center (doi:10.3334/CDIAC/GCP_2016).

  7. [Research progress on phosphorus budgets and regulations in reservoirs].

    Science.gov (United States)

    Shen, Xiao; Li, Xu; Zhang, Wang-shou

    2014-12-01

    Phosphorus is an important limiting factor of water eutrophication. A clear understanding of its budget and regulated method is fundamental for reservoir ecological health. In order to pro- mote systematic research further and improve phosphorus regulation system, the budget balance of reservoir phosphorus and its influencing factors were concluded, as well as conventional regulation and control measures. In general, the main phosphorus sources of reservoirs include upstream input, overland runoff, industrial and domestic wastewater, aquaculture, atmospheric deposition and sediment release. Upstream input is the largest phosphorus source among them. The principal output path of phosphorus is the flood discharge, the emission load of which is mainly influenced by drainage patterns. In addition, biological harvest also can export a fraction of phosphorus. There are some factors affecting the reservoir phosphorus balance, including reservoirs' function, hydrological conditions, physical and chemical properties of water, etc. Therefore, the phosphorus budgets of different reservoirs vary greatly, according to different seasons and regions. In order to reduce the phosphorus loading in reservoirs, some methods are carried out, including constructed wetlands, prefix reservoir, sediment dredging, biomanipulation, etc. Different methods need to be chosen and combined according to different reservoirs' characteristics and water quality management goals. Thus, in the future research, it is reasonable to highlight reservoir ecological characteristics and proceed to a complete and systematic analysis of the inherent complexity of phosphorus budget and its impact factors for the reservoirs' management. Besides, the interaction between phosphorus budget and other nutrients in reservoirs also needs to be conducted. It is fundamental to reduce the reservoirs' phosphorus loading to establish a scientific and improved management system based on those researches.

  8. Analysis of flexible structures under lateral impact

    International Nuclear Information System (INIS)

    Ramirez, D. F.; Razavi, H.

    2012-01-01

    Three methods for analysis of flexible structures under lateral impact are presented. The first proposed method (Method A) consists of: (1) modifying an available deceleration on a rigid target with conservation principles to account for structural flexibility; and (2) transient nonlinear analysis of the structure with the corrected forcing function. The second proposed method (Method B) is similar to Method A in obtaining the forcing function but it solves the equations of motion of an idealized two-degree-of-freedom system instead of directly using conservation principles. The last method simply provides the maximum force in the structure using the conservation of energy and linear momentum. A coupled simulation is also performed in LS-DYNA and compared against the proposed methods. A case study is presented to illustrate the applicability of all three methods and the LS-DYNA simulation. (authors)

  9. Global atmospheric budget of acetaldehyde: 3-D model analysis and constraints from in-situ and satellite observations

    Directory of Open Access Journals (Sweden)

    D. B. Millet

    2010-04-01

    Full Text Available We construct a global atmospheric budget for acetaldehyde using a 3-D model of atmospheric chemistry (GEOS-Chem, and use an ensemble of observations to evaluate present understanding of its sources and sinks. Hydrocarbon oxidation provides the largest acetaldehyde source in the model (128 Tg a−1, a factor of 4 greater than the previous estimate, with alkanes, alkenes, and ethanol the main precursors. There is also a minor source from isoprene oxidation. We use an updated chemical mechanism for GEOS-Chem, and photochemical acetaldehyde yields are consistent with the Master Chemical Mechanism. We present a new approach to quantifying the acetaldehyde air-sea flux based on the global distribution of light absorption due to colored dissolved organic matter (CDOM derived from satellite ocean color observations. The resulting net ocean emission is 57 Tg a−1, the second largest global source of acetaldehyde. A key uncertainty is the acetaldehyde turnover time in the ocean mixed layer, with quantitative model evaluation over the ocean complicated by known measurement artifacts in clean air. Simulated concentrations in surface air over the ocean generally agree well with aircraft measurements, though the model tends to overestimate the vertical gradient. PAN:NOx ratios are well-simulated in the marine boundary layer, providing some support for the modeled ocean source. We introduce the Model of Emissions of Gases and Aerosols from Nature (MEGANv2.1 for acetaldehyde and ethanol and use it to quantify their net flux from living terrestrial plants. Including emissions from decaying plants the total direct acetaldehyde source from the land biosphere is 23 Tg a−1. Other terrestrial acetaldehyde sources include biomass burning (3 Tg a−1 and anthropogenic emissions (2 Tg a−1. Simulated concentrations in the continental boundary layer are generally unbiased and capture the spatial

  10. Hydrogeologic setting, water budget, and preliminary analysis of ground-water exchange at Lake Starr, a seepage lake in Polk County, Florida

    Science.gov (United States)

    Swancar, Amy; Lee, T.M.; O'Hare, T. M.

    2000-01-01

    Lake Starr, a 134-acre seepage lake of multiple-sinkhole origin on the Lake Wales Ridge of central Florida, was the subject of a detailed water-budget study from August 1996 through July 1998. The study monitored the effects of hydrogeologic setting, climate, and ground-water pumping on the water budget and lake stage. The hydrogeologic setting of the Lake Starr basin differs markedly on the two sides of the lake. Ground water from the surficial aquifer system flows into the lake from the northwest side of the basin, and lake water leaks out to the surficial aquifer system on the southeast side of the basin. Lake Starr and the surrounding surficial aquifer system recharge the underlying Upper Floridan aquifer. The rate of recharge to the Upper Floridan aquifer is determined by the integrity of the intermediate confining unit and by the downward head gradient between the two aquifers. On the inflow side of the lake, the intermediate confining unit is more continuous, allowing ground water from the surficial aquifer system to flow laterally into the lake. Beneath the lake and on the southeast side of the basin, breaches in the intermediate confining unit enhance downward flow to the Upper Floridan aquifer, so that water flows both downward and laterally away from the lake through the ground-water flow system in these areas. An accurate water budget, including evaporation measured by the energy-budget method, was used to calculate net ground-water flow to the lake, and to do a preliminary analysis of the relation of net ground-water fluxes to other variables. Water budgets constructed over different timeframes provided insight on processes that affect ground-water interactions with Lake Starr. Weekly estimates of net ground-water flow provided evidence for the occurrence of transient inflows from the nearshore basin, as well as the short-term effects of head in the Upper Floridan aquifer on ground-water exchange with the lake. Monthly water budgets showed the effects

  11. Medical impact analysis for the space station.

    Science.gov (United States)

    Nelson, B D; Gardner, R M; Ostler, D V; Schulz, J M; Logan, J S

    1990-02-01

    Since the Space Station Health Maintenance Facility can house only a relatively limited quantity of supplies and equipment, the decisions about what should be included must be based on documented research. In this study, Space Station medical care priorities were determined by a medical impact analysis of two analog populations, U.S. Army and U.S. Navy personnel. Diseases and injuries in the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) were ranked, using a Medical Impact Score (MIS) combining modified incidence rate and a function of disease outcome. The validity of the analysis method was tested by measuring rank order correlation between the two analog populations. Despite virtually identical age and sex distributions, Army and Navy incidence rates differed significantly for half of the ICD-9-CM categories, p less than 0.05. Disability rates differed for 76%, p less than 0.05. Nevertheless, Army and Navy MIS rank orders for categories and sections were not significantly different, p less than 0.001. In critical ways, the Space Station will be a safer environment than Earth. Cardiac events, musculoskeletal injuries, affective psychoses, and renal calculi were among the highest scoring categories.

  12. Research on budget management under IT environment

    Directory of Open Access Journals (Sweden)

    Wenchang Li

    2017-03-01

    Full Text Available IT technology has become a key element of core competitiveness of enterprises, and also the basis for its daily operation. The budget is a management process of forecasting and planning of the future operation and financial activities under the guidance of the strategic objectives, and completion of the strategic objectives to a maximum extent. Whether both of them can be effectively combined with is the key to effective implementation of the budget. Through analysis of the existing problems of the traditional budget of the enterprise and the budget under the information technology environment, analysis of the internal and external influencing factors of the budget management of the large and medium sized enterprises under the current environment with SWOT, factor quantization and weight with AHP, development of the strategic program according to the priority of weight, and finally verification with a case, this paper concludes that, the budget management work can be more strategic and forward-looking through combination with AHP and SWOT analysis.

  13. EVOLUTION OF ECONOMY AND ITS IMPACT ON INSURANCE MARKET – A STATISTICAL ANALYSIS

    Directory of Open Access Journals (Sweden)

    Sandra TEODORESCU

    2015-07-01

    Full Text Available The economic context has a strong impact on the insurance sector. On the one hand, the decisions related to sector regulation could influence the life of the insurance companies. On the other hand, taxes and other measures that may affect purchasing power, economic instability represent a threat. It is a fact that insurances are products that customers and companies access them when economic conditions are predictable and budgets could be accurately predicted. The paper mainly analyzes in terms of indicators, the impact of the economy on the insurance sector. We are talking about the interrelationships between Gross Written Premiums (the insurance "Budget" and some macroeconomic indicators characterizing the Romanian economy, such as Gross Domestic Product, net average earnings, the average number of employees etc. Statistical analysis is performed for a 12-year period during 2002-2013. This analysis is based on official statistics published by the National Institute of Statistics, the National Forecasting Commission and the National Bank of Romania. The methodology consists of correlation and regression analysis. Of the variables used in the study we mention: Gross Domestic Product, the number of employees, employment, net average earnings, the activity rate of the working age population (15-64 years, non-governmental domestic credit. The analysis of correlation between the studied variables reveals that is a strong correlation between Gross Written Premiums and GDP, the number of employees, average earnings and non-government domestic credit.. Thus, economic growth, rising incomes, the increasing number of employees and facilitating credit conditions could be some elements that would lead to sustainable growth of the insurance market.

  14. Radiation budget measurement/model interface

    Science.gov (United States)

    Vonderhaar, T. H.; Ciesielski, P.; Randel, D.; Stevens, D.

    1983-01-01

    This final report includes research results from the period February, 1981 through November, 1982. Two new results combine to form the final portion of this work. They are the work by Hanna (1982) and Stevens to successfully test and demonstrate a low-order spectral climate model and the work by Ciesielski et al. (1983) to combine and test the new radiation budget results from NIMBUS-7 with earlier satellite measurements. Together, the two related activities set the stage for future research on radiation budget measurement/model interfacing. Such combination of results will lead to new applications of satellite data to climate problems. The objectives of this research under the present contract are therefore satisfied. Additional research reported herein includes the compilation and documentation of the radiation budget data set a Colorado State University and the definition of climate-related experiments suggested after lengthy analysis of the satellite radiation budget experiments.

  15. Historical analysis and modeling of the forest carbon dynamics using the Carbon Budget Model: an example for the Trento Province (NE, Italy

    Directory of Open Access Journals (Sweden)

    Pilli R

    2014-02-01

    Full Text Available Historical analysis and modeling of the forest carbon dynamics using the Carbon Budget Model: an example for the Trento Province (NE, Italy. The Carbon Budget Model (CBM-CFS3 developed by the Canadian Forest Service was applied to data collected by the last Italian National Forest Inventory (INFC for the Trento Province (NE, Italy. CBM was modified and adapted to the different management types (i.e., even-aged high forests, uneven-aged high forests and coppices and silvicultural systems (including clear cuts, single tree selection systems and thinning applied in this province. The aim of this study was to provide an example of down-scaling of this model from a national to a regional scale, providing (i an historical analysis, from 1995 to 2011, and (ii a projection, from 2012 to 2020, of the forest biomass and the carbon stock evolution. The analysis was based on the harvest rate reported by the Italian National Institute of Statistics (from 1995 to 2011, corrected according to the last INFC data and distinguished between timber and fuel woods and between conifers and broadleaves. Since 2012, we applied a constant harvest rate, equal to about 1300 Mm3 yr-1, estimated from the average harvest rate for the period 2006-2011. Model results were consistent with similar data reported in the literature. The average biomass C stock was 90 Mg C ha-1 and the biomass C stock change was 0.97 Mg C ha-1 yr-1 and 0.87 Mg C ha-1 yr-1, for the period 1995 -2011 and 2012-2020, respectively. The C stock cumulated by the timber products since 1995 was 96 Gg C yr-1, i.e., about 28% of the average annual C stock change of the forests, equal to 345 Gg C yr-1. CBM also provided estimates on the evolution of the age class distribution of the even-aged forests and on the C stock of the DOM forest pools (litter, dead wood and soil. This study demonstrates the utility of CBM to provide estimates at a regional or local scale, using not only the data provided by the forest

  16. Analysis of the impact of safeguards criteria

    International Nuclear Information System (INIS)

    Mullen, M.F.; Reardon, P.T.

    1981-01-01

    As part of the US Program of Technical Assistance to IAEA Safeguards, the Pacific Northwest Laboratory (PNL) was asked to assist in developing and demonstrating a model for assessing the impact of setting criteria for the application of IAEA safeguards. This report presents the results of PNL's work on the task. The report is in three parts. The first explains the technical approach and methodology. The second contains an example application of the methodology. The third presents the conclusions of the study. PNL used the model and computer programs developed as part of Task C.5 (Estimation of Inspection Efforts) of the Program of Technical Assistance. The example application of the methodology involves low-enriched uranium conversion and fuel fabrication facilities. The effects of variations in seven parameters are considered: false alarm probability, goal probability of detection, detection goal quantity, the plant operator's measurement capability, the inspector's variables measurement capability, the inspector's attributes measurement capability, and annual plant throughput. Among the key results and conclusions of the analysis are the following: the variables with the greatest impact on the probability of detection are the inspector's measurement capability, the goal quantity, and the throughput; the variables with the greatest impact on inspection costs are the throughput, the goal quantity, and the goal probability of detection; there are important interactions between variables. That is, the effects of a given variable often depends on the level or value of some other variable. With the methodology used in this study, these interactions can be quantitatively analyzed; reasonably good approximate prediction equations can be developed using the methodology described here

  17. Free drop impact analysis of shipping cask

    International Nuclear Information System (INIS)

    Pfeiffer, P.A.; Kennedy, J.M.

    1989-01-01

    The WHAMS-2D and WHAMS-3D codes were used to analyze the dynamic response of the RAS/TREAT shielded shipping cask subjected to transient leadings for the purpose of assessing potential damage to the various components that comprise the the cask. The paper describes how these codes can be used to provide and intermediate level of detail between full three-dimensional finite element calculations and hand calculations which are cost effective for design purposes. Three free drops were adressed: (1) a thirty foot axial drop on either end; (2) a thirty foot oblique angle drop with the cask having several different orientations from the vertical with impact on the cask corner; and (3) a thirty foot side drop with simultaneous impact on the lifting trunnion and the bottom end. Results are presented for two models of the side and oblique angle drops; one model includes only the mass of the lapped sleeves of depleted uranium (DU) while the other includes the mass and stiffness of the DU. The results of the end drop analyses are given for models with and without imperfections in the cask. Comparison of the analysis to hand calculations and simplified analyses are given. (orig.)

  18. Global Carbon Budget 2015

    Science.gov (United States)

    Le Quéré, C.; Moriarty, R.; Andrew, R. M.; Canadell, J. G.; Sitch, S.; Korsbakken, J. I.; Friedlingstein, P.; Peters, G. P.; Andres, R. J.; Boden, T. A.; Houghton, R. A.; House, J. I.; Keeling, R. F.; Tans, P.; Arneth, A.; Bakker, D. C. E.; Barbero, L.; Bopp, L.; Chang, J.; Chevallier, F.; Chini, L. P.; Ciais, P.; Fader, M.; Feely, R. A.; Gkritzalis, T.; Harris, I.; Hauck, J.; Ilyina, T.; Jain, A. K.; Kato, E.; Kitidis, V.; Klein Goldewijk, K.; Koven, C.; Landschützer, P.; Lauvset, S. K.; Lefèvre, N.; Lenton, A.; Lima, I. D.; Metzl, N.; Millero, F.; Munro, D. R.; Murata, A.; Nabel, J. E. M. S.; Nakaoka, S.; Nojiri, Y.; O'Brien, K.; Olsen, A.; Ono, T.; Pérez, F. F.; Pfeil, B.; Pierrot, D.; Poulter, B.; Rehder, G.; Rödenbeck, C.; Saito, S.; Schuster, U.; Schwinger, J.; Séférian, R.; Steinhoff, T.; Stocker, B. D.; Sutton, A. J.; Takahashi, T.; Tilbrook, B.; van der Laan-Luijkx, I. T.; van der Werf, G. R.; van Heuven, S.; Vandemark, D.; Viovy, N.; Wiltshire, A.; Zaehle, S.; Zeng, N.

    2015-12-01

    carbon budget. For the last decade available (2005-2014), EFF was 9.0 ± 0.5 GtC yr-1, ELUC was 0.9 ± 0.5 GtC yr-1, GATM was 4.4 ± 0.1 GtC yr-1, SOCEAN was 2.6 ± 0.5 GtC yr-1, and SLAND was 3.0 ± 0.8 GtC yr-1. For the year 2014 alone, EFF grew to 9.8 ± 0.5 GtC yr-1, 0.6 % above 2013, continuing the growth trend in these emissions, albeit at a slower rate compared to the average growth of 2.2 % yr-1 that took place during 2005-2014. Also, for 2014, ELUC was 1.1 ± 0.5 GtC yr-1, GATM was 3.9 ± 0.2 GtC yr-1, SOCEAN was 2.9 ± 0.5 GtC yr-1, and SLAND was 4.1 ± 0.9 GtC yr-1. GATM was lower in 2014 compared to the past decade (2005-2014), reflecting a larger SLAND for that year. The global atmospheric CO2 concentration reached 397.15 ± 0.10 ppm averaged over 2014. For 2015, preliminary data indicate that the growth in EFF will be near or slightly below zero, with a projection of -0.6 [range of -1.6 to +0.5] %, based on national emissions projections for China and the USA, and projections of gross domestic product corrected for recent changes in the carbon intensity of the global economy for the rest of the world. From this projection of EFF and assumed constant ELUC for 2015, cumulative emissions of CO2 will reach about 555 ± 55 GtC (2035 ± 205 GtCO2) for 1870-2015, about 75 % from EFF and 25 % from ELUC. This living data update documents changes in the methods and data sets used in this new carbon budget compared with previous publications of this data set (Le Quéré et al., 2015, 2014, 2013). All observations presented here can be downloaded from the Carbon Dioxide Information Analysis Center (doi:10.3334/CDIAC/GCP_2015).

  19. Integrating health and environmental impact analysis

    DEFF Research Database (Denmark)

    Reis, S; Morris, G.; Fleming, L. E.

    2015-01-01

    which addresses human activity in all its social, economic and cultural complexity. The new approach must be integral to, and interactive, with the natural environment. We see the continuing failure to truly integrate human health and environmental impact analysis as deeply damaging, and we propose...... while equally emphasizing the health of the environment, and the growing calls for 'ecological public health' as a response to global environmental concerns now suffusing the discourse in public health. More revolution than evolution, ecological public health will demand new perspectives regarding...... the interconnections among society, the economy, the environment and our health and well-being. Success must be built on collaborations between the disparate scientific communities of the environmental sciences and public health as well as interactions with social scientists, economists and the legal profession...

  20. Upscaling the impact of convective overshooting (COV) through BRAMS: a continental and wet-season scale study of the water vapour (WV) budget in the tropical tropopause layer (TTL).

    Science.gov (United States)

    Behera, Abhinna; Rivière, Emmanuel; Marécal, Virginie; Rysman, Jean-François; Claud, Chantal; Burgalat, Jérémie

    2017-04-01

    The stratospheric water vapour (WV) has a conceding impact on the radiative and chemical budget of Earth's atmosphere. The convective overshooting (COV) at the tropics is well admitted for playing a role in transporting directly WV to the stratosphere. Nonetheless, its impact on the lower stratosphere is yet to be determined at global scale, as the satellite and other air-borne measurements are not of having fine enough resolution to quantify this impact at large scale. Therefore, efforts have been made to quantify the influence of COV over the WV budget in the tropical tropopause layer (TTL) through modelling. Our approach is to build two synthetic tropical wet-seasons; where one would be having only deep convection (DC) but no COV at all, and the second one would be having the COV, and in both cases the WV budget in the TTL would be estimated. Before that, a French-Brazilian TRO-pico campaign was carried out at Bauru, Brazil in order to understand the influence of COV on the WV budget in the TTL. The radio-sounding, and the small balloon-borne WV measurements from the campaign are being utilized to validate the model simulation. Brazilian version of Regional Atmospheric Modeling System (BRAMS) is used with a single grid system to simulate a WV variability in a wet-season. Grell's convective parameterization with ensemble closure, microphysics with double moment scheme and 7 types of hydrometeors are incorporated to simulate the WV variability for a wet-season at the tropics. The grid size of simulation is chosen to be 20 km x 20 km horizontally and from surface to 30 km altitude, so that there cannot be COV at all, only DC due to such a relatively coarse resolution. The European Centre for Medium-range Weather Forecasts (ECMWF) operational analyses data are used every 6 hours for grid initialization and boundary conditions, and grid center nudging. The simulation is carried out for a full wet-season (Nov 2012 - Mar 2013) at Brazilian scale, so that it would

  1. Policy analysis of the budget used in training program for reducing lower back pain among heavy equipment operators in the construction industry: System dynamics approach

    Science.gov (United States)

    Vitharana, V. H. P.; Chinda, T.

    2018-04-01

    Lower back pain (LBP), prevalence is high among the heavy equipment operators leading to high compensation cost in the construction industry. It is found that proper training program assists in reducing chances of having LBP. This study, therefore aims to examine different safety related budget available to support LBP related training program for different age group workers, utilizing system dynamics modeling approach. The simulation results show that at least 2.5% of the total budget must be allocated in the safety and health budget to reduce the chances of having LBP cases.

  2. Political Budget Cycles

    DEFF Research Database (Denmark)

    Aaskoven, Lasse; Lassen, David Dreyer

    2017-01-01

    The political budget cycle—how elections affect government fiscal policy—is one of the most studied subjects in political economy and political science. The key theoretical question is whether incumbent governments can time or structure public finances in ways that improve their chances of reelec......The political budget cycle—how elections affect government fiscal policy—is one of the most studied subjects in political economy and political science. The key theoretical question is whether incumbent governments can time or structure public finances in ways that improve their chances...... on political budget cycles have recently focused on conditions under which such cycles are likely to obtain. Much recent research focuses on subnational settings, allowing comparisons of governments in similar institutional environments, and a consensus on the presences of cycles in public finances...

  3. 10 CFR 503.13 - Environmental impact analysis.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Environmental impact analysis. 503.13 Section 503.13... Exemptions § 503.13 Environmental impact analysis. In order to enable OFE to comply with NEPA, a petitioner..., and land resources; (3) Direct and indirect environmental impacts of the proposed action including...

  4. ROUTING FINANCIAL FLOWS AT THE EXECUTION OF THE MUNICIPALITY BUDGET

    Directory of Open Access Journals (Sweden)

    Mariya V. Fedotova

    2018-05-01

    Full Text Available Economic development of each administrative-territorial unit is an important factor in the economic development of the Russian Federation. In its turn, the effective execution of the budget at each level of the budget system is invariably topical, influencing the development of a system of both centralized and decentralized finance. The paramount characteristic of the organization of the budget execution of the municipality is an ability to ensure the timely and full execution of their commitments. There is a direct correlation of the budget process on both the revenue and expenditure sides. Cash gap in the local budget execution is actually quite common and, usually, inevitable, because revenues are coming unevenly during the financial year, budgetary expenditures are seasonal, and this threatens the execution of planned budgets; there is a need to raise funds. The article deals with the execution of the cash balance plan, cash flow at the single account of budget, debt and source of financing deficits. The analysis of financial flows in the execution of municipalities’ budget shows problems of execution of budget revenues and allows assessing the scale of emerging cash gaps. An outcome of the review consists in the recognition of an objective need to develop approaches to assessing the effectiveness of budget execution at all its stages and to implement the monitoring of the effectiveness of budget execution and timely effective measures for ensuring its high-quality.

  5. Effects of globalization on state budgeting system in Ukraine

    Directory of Open Access Journals (Sweden)

    Bobukh S.О.

    2017-06-01

    Full Text Available When writing the scientific article the scientific approaches of scientists concerning the essence of budgeting have been described. The paper deals with the principles of budgeting on the basis of which three main methodological components are singled out. It also analyzes the budgeting goals. The author investigates the impact of globalization on the system of state budgeting in Ukraine, its positive and negative effects. Despite significant achievements it is necessary to explore the effects of globalization on the system of state budgeting in Ukraine. Budgeting is the management technology that provides the formation of budgets for the selected objects and their use to ensure optimal structure and correlation of profits and expenses, income and expenditure, assets and liabilities of the organization or its components to achieve the set goals taking into account the influence of the environment. It should be emphasized that budgeting in no way replaces the control system, but only creates a new approach to management from the standpoint of the balance of incomes and expenditures, profits and expenses, assets and liabilities of the organization as a whole or its components. The state budgeting of the country as the part of the financial system is the channel through which economic globalization, namely financial globalization, affects economic development of the state. Favorable global effect occurs, in particular, in terms of the impact on financial development. Therefore, it is necessary to + the nature of the relationship between these two processes.

  6. Public Budget Database - Budget Authority and offsetting receipts 1976-Current

    Data.gov (United States)

    Executive Office of the President — This file contains historical budget authority and offsetting receipts for 1976 through the current budget year, as well as four years of projections. It can be used...

  7. Evaluation of Quality Indicators of Integrated Care in a Regional Psychiatry Budget – A Pre-Post Comparison by Secondary Data Analysis

    Directory of Open Access Journals (Sweden)

    Anne Berghöfer

    2016-12-01

    Full Text Available The Regional Psychiatry Budget (RPB, as a special arrangement within the German Federal Hospital Refund Regulation, is based on the capitation principle. A lump sum is allocated to a major inpatient care provider in a large region on a yearly basis. Under this model, the provider is free to offer all forms of treatment and to construct individual models of integrated care that specifically suit the region and the needs of community members. The present study aimed to evaluate selected aspects that represent a change in the psychiatric health status of patients in the covered region under the conditions of the RPB. We performed a secondary data analysis of administrative data of 19,913 cases generated by the hospital in a pre-post comparison of the periods before and under RPB conditions.  The average length of an inpatient stay was reduced by approximately 22 % and could be partially replaced by day care. Selected indicators suggest equal or higher quality of care with stable cost in the population in need of psychiatric care in the district.

  8. AGF program budget 1991

    International Nuclear Information System (INIS)

    1991-01-01

    The present program budget of the Arbeitsgemeinschaft Grossforschungseinrichtungen (AGF) (Cooperative of Major Research Establishments) describes its research and development objectives and the progress of work in the major research establishments involved and states the medium-term annual financial and personnel effort. (orig.) [de

  9. Budget Pressures Churn Workforce

    Science.gov (United States)

    Cavanagh, Sean

    2011-01-01

    When the budget-cutting ended this year in one rural North Texas school district, the people-moving began. Forced to chop its total staff to 55 employees from 64, the Perrin-Whitt Consolidated Independent school system went the route of many districts across the country: It made the majority of its reductions by encouraging early retirements and…

  10. AGF program budget 1992

    International Nuclear Information System (INIS)

    1992-01-01

    The program budget of the Arbeitsgemeinschaft Grossforschungseinrichtungen (AGF) (Cooperative of Major Research Establishments) describes its research and development objectives and the progress of work in the major research establishments involved and states the medium-term annual financial and personnel effort. (orig.)

  11. Implementing Responsibility Centre Budgeting

    Science.gov (United States)

    Vonasek, Joseph

    2011-01-01

    Recently, institutes of higher education (universities) have shown a renewed interest in organisational structures and operating methodologies that generate productivity and innovation; responsibility centre budgeting (RCB) is one such process. This paper describes the underlying principles constituting RCB, its origin and structural elements, and…

  12. Budgeting Academic Space

    Science.gov (United States)

    Harris, Watson

    2011-01-01

    There are many articles about space management, including those that discuss space calculations, metrics, and categories. Fewer articles discuss the space budgeting processes used by administrators to allocate space. The author attempts to fill this void by discussing her administrative experiences with Middle Tennessee State University's (MTSU)…

  13. Integrated Budget Office Toolbox

    Science.gov (United States)

    Rushing, Douglas A.; Blakeley, Chris; Chapman, Gerry; Robertson, Bill; Horton, Allison; Besser, Thomas; McCarthy, Debbie

    2010-01-01

    The Integrated Budget Office Toolbox (IBOT) combines budgeting, resource allocation, organizational funding, and reporting features in an automated, integrated tool that provides data from a single source for Johnson Space Center (JSC) personnel. Using a common interface, concurrent users can utilize the data without compromising its integrity. IBOT tracks planning changes and updates throughout the year using both phasing and POP-related (program-operating-plan-related) budget information for the current year, and up to six years out. Separating lump-sum funds received from HQ (Headquarters) into separate labor, travel, procurement, Center G&A (general & administrative), and servicepool categories, IBOT creates a script that significantly reduces manual input time. IBOT also manages the movement of travel and procurement funds down to the organizational level and, using its integrated funds management feature, helps better track funding at lower levels. Third-party software is used to create integrated reports in IBOT that can be generated for plans, actuals, funds received, and other combinations of data that are currently maintained in the centralized format. Based on Microsoft SQL, IBOT incorporates generic budget processes, is transportable, and is economical to deploy and support.

  14. Reforming the EU Budget

    DEFF Research Database (Denmark)

    Citi, Manuele

    The marginal involvement of the EU in redistributive policies and its limited fiscal resources have led to a lack of attention to the EU budget and its determinants. In this paper I analyse an original dataset containing yearly data on the main macrocategories of expenditure and how they have...

  15. Zero-Based Budgeting.

    Science.gov (United States)

    Wichowski, Chester

    1979-01-01

    The zero-based budgeting approach is designed to achieve the greatest benefit with the fewest undesirable consequences. Seven basic steps make up the zero-based decision-making process: (1) identifying program goals, (2) classifying goals, (3) identifying resources, (4) reviewing consequences, (5) developing decision packages, (6) implementing a…

  16. Budgeting and Finance

    NARCIS (Netherlands)

    F.K.M. van Nispen tot Pannerden (Frans)

    2012-01-01

    textabstractThe Call for a Budgetary Theory: The appeal of Valdimer Key for a budgetary theory marks the interest in public budgeting in modern history. He clearly referred to a normative theory, raising the question: ‘on what basis shall it be decided to allocate X dollars to activity A instead of

  17. Kinetic energy budget details

    Indian Academy of Sciences (India)

    Abstract. This paper presents the detailed turbulent kinetic energy budget and higher order statistics of flow behind a surface-mounted rib with and without superimposed acoustic excitation. Pattern recognition technique is used to determine the large-scale structure magnitude. It is observed that most of the turbulence ...

  18. A Better Budget Rule

    Science.gov (United States)

    Dothan, Michael; Thompson, Fred

    2009-01-01

    Debt limits, interest coverage ratios, one-off balanced budget requirements, pay-as-you-go rules, and tax and expenditure limits are among the most important fiscal rules for constraining intertemporal transfers. There is considerable evidence that the least costly and most effective of such rules are those that focus directly on the rate of…

  19. Global Carbon Budget 2016

    NARCIS (Netherlands)

    Le Quéré, Corinne; Andrew, Robbie M.; Canadell, Josep G.; Sitch, Stephen; Ivar Korsbakken, Jan; Peters, Glen P.; Manning, Andrew C.; Boden, Thomas A.; Tans, Pieter P.; Houghton, Richard A.; Keeling, Ralph F.; Alin, Simone; Andrews, Oliver D.; Anthoni, Peter; Barbero, Leticia; Bopp, Laurent; Chevallier, Frédéric; Chini, Louise P.; Ciais, Philippe; Currie, Kim; Delire, Christine; Doney, Scott C.; Friedlingstein, Pierre; Gkritzalis, Thanos; Harris, Ian A; Hauck, Judith; Haverd, Vanessa; Hoppema, Mario; Klein Goldewijk, Kees; Jain, Atul K.; Kato, Etsushi; Körtzinger, Arne; Landschützer, Peter; Lefèvre, Nathalie; Lenton, Andrew; Lienert, Sebastian; Lombardozzi, Danica; Melton, Joe R.; Metzl, Nicolas; Millero, Frank; Monteiro, Pedro M S; Munro, David R.; Nabel, Julia E M S; Nakaoka, Shin Ichiro; O'Brien, Kevin; Olsen, Are; Omar, Abdirahman M.; Ono, Tsuneo; Pierrot, Denis; Poulter, Benjamin; Rödenbeck, Christian; Salisbury, Joe; Schuster, Ute; Schwinger, Jörg; Séférian, Roland; Skjelvan, Ingunn; Stocker, Benjamin D.; Sutton, Adrienne J.; Takahashi, Taro; Tian, Hanqin; Tilbrook, Bronte; Van Der Laan-Luijkx, Ingrid T.; Van Der Werf, Guido R.; Viovy, Nicolas; Walker, Anthony P.; Wiltshire, Andrew J.; Zaehle, Sönke

    2016-01-01

    Accurate assessment of anthropogenic carbon dioxide (CO2) emissions and their redistribution among the atmosphere, ocean, and terrestrial biosphere-the "global carbon budget"-is important to better understand the global carbon cycle, support the development of climate policies, and project future

  20. Sabotage in Capital Budgeting

    DEFF Research Database (Denmark)

    Brunner, Markus; Ostermaier, Andreas

    2018-01-01

    for honesty inhibits sabotage. Moreover, honesty suppresses negative reciprocity and thus reduces sabotage not only directly but also indirectly. Our findings warn firms to consider the sabotage of investments as a hidden cost of control in budgeting. They show that honesty has a spill-over effect...

  1. Pathology economic model tool: a novel approach to workflow and budget cost analysis in an anatomic pathology laboratory.

    Science.gov (United States)

    Muirhead, David; Aoun, Patricia; Powell, Michael; Juncker, Flemming; Mollerup, Jens

    2010-08-01

    The need for higher efficiency, maximum quality, and faster turnaround time is a continuous focus for anatomic pathology laboratories and drives changes in work scheduling, instrumentation, and management control systems. To determine the costs of generating routine, special, and immunohistochemical microscopic slides in a large, academic anatomic pathology laboratory using a top-down approach. The Pathology Economic Model Tool was used to analyze workflow processes at The Nebraska Medical Center's anatomic pathology laboratory. Data from the analysis were used to generate complete cost estimates, which included not only materials, consumables, and instrumentation but also specific labor and overhead components for each of the laboratory's subareas. The cost data generated by the Pathology Economic Model Tool were compared with the cost estimates generated using relative value units. Despite the use of automated systems for different processes, the workflow in the laboratory was found to be relatively labor intensive. The effect of labor and overhead on per-slide costs was significantly underestimated by traditional relative-value unit calculations when compared with the Pathology Economic Model Tool. Specific workflow defects with significant contributions to the cost per slide were identified. The cost of providing routine, special, and immunohistochemical slides may be significantly underestimated by traditional methods that rely on relative value units. Furthermore, a comprehensive analysis may identify specific workflow processes requiring improvement.

  2. Determining the Budget of Marketing Communication in Big Advertisers

    Directory of Open Access Journals (Sweden)

    Fabiano Palhares Galão

    2015-09-01

    Full Text Available This study aims to analyze the criteria and procedures adopted by companies for determining the budget communication. Specifically, we intend to identify how companies organize the system of deciding the budget and deal with the budget cuts throughout the process of implementation of promotional activities. The data collection involved in-depth interviews conducted with communications professionals from ten companies belonging to the ranking of the 300 largest advertisers in Brazil. As data analysis technique, we have chosen content analysis. The main results showed little or no participation by the communication manager's final decision on the budget area, the lack of criteria to justify budget cuts during the promotional period and the adoption by firms of judgment methods and percentage of sales to determine the budget amount of communication

  3. Variability and budget of CO2 in Europe: analysis of the CAATER airborne campaigns - Part 1: Observed variability

    International Nuclear Information System (INIS)

    Xueref-Remy, I.; Messager, C.; Ramonet, M.; Paris, J.D.; Ciais, P.; Filippi, D.; Pastel, M.; Nedelec, P.

    2011-01-01

    Atmospheric airborne measurements of CO 2 are very well suited for estimating the time-varying distribution of carbon sources and sinks at the regional scale due to the large geographical area covered over a short time. We present here an analysis of two cross-European airborne campaigns carried out on 23-26 May 2001 (CAATER-1) and 2-3 October 2002 (CAATER-2) over Western Europe. The area covered during CAATER-1 and CAATER-2 was 4 degrees W to 14 degrees E long; 44 degrees N to 52 degrees N lat and 1 degree E to 17 degrees E long; 46 degrees N to 52 degrees N lat respectively. High precision in situ CO 2 , CO and Radon 222 measurements were recorded. Flask samples were collected during both campaigns to cross-validate the in situ data. During CAATER-1 and CAATER-2, the mean CO 2 concentration was 370.1±4.0 (1-σ standard deviation) ppm and 371.7±5.0 (1-σ) ppm respectively. A HYSPLIT back-trajectories analysis shows that during CAATER 1, northwesterly winds prevailed. In the planetary boundary layer (PBL) air masses became contaminated over Benelux and Western Germany by emissions from these highly urbanized areas, reaching about 380 ppm. Air masses passing over rural areas were depleted in CO 2 because of the photosynthesis activity of the vegetation, with observations as low as 355 ppm. During CAATER-2, the back-trajectory analysis showed that air masses were distributed among the 4 sectors. Air masses were enriched in CO 2 and CO over anthropogenic emission spots in Germany but also in Poland, as these countries have part of the most CO 2 -emitting coal-based plants in Europe. Simultaneous measurements of in situ CO 2 and CO combined with back-trajectories helped us to distinguish between fossil fuel emissions and other CO 2 sources. The ΔCO/ΔCO 2 ratios (R 2 =0.33 to 0.88, slopes=2.42 to 10.37), calculated for anthropogenic-influenced air masses over different countries/regions matched national inventories quite well, showing that airborne measurements can

  4. Variability and budget of CO2 in Europe: analysis of the CAATER airborne campaigns – Part 1: Observed variability

    Directory of Open Access Journals (Sweden)

    J. D. Paris

    2011-06-01

    Full Text Available Atmospheric airborne measurements of CO2 are very well suited for estimating the time-varying distribution of carbon sources and sinks at the regional scale due to the large geographical area covered over a short time. We present here an analysis of two cross-European airborne campaigns carried out on 23–26 May 2001 (CAATER-1 and 2–3 October 2002 (CAATER-2 over Western Europe. The area covered during CAATER-1 and CAATER-2 was 4° W to 14° E long; 44° N to 52° N lat and 1° E to 17° E long; 46° N to 52° N lat respectively. High precision in situ CO2, CO and Radon 222 measurements were recorded. Flask samples were collected during both campaigns to cross-validate the in situ data. During CAATER-1 and CAATER-2, the mean CO2 concentration was 370.1 ± 4.0 (1-σ standard deviation ppm and 371.7 ± 5.0 (1-σ ppm respectively. A HYSPLIT back-trajectories analysis shows that during CAATER 1, northwesterly winds prevailed. In the planetary boundary layer (PBL air masses became contaminated over Benelux and Western Germany by emissions from these highly urbanized areas, reaching about 380 ppm. Air masses passing over rural areas were depleted in CO2 because of the photosynthesis activity of the vegetation, with observations as low as 355 ppm. During CAATER-2, the back-trajectory analysis showed that air masses were distributed among the 4 sectors. Air masses were enriched in CO2 and CO over anthropogenic emission spots in Germany but also in Poland, as these countries have part of the most CO2-emitting coal-based plants in Europe. Simultaneous measurements of in situ CO2 and CO combined with back-trajectories helped us to distinguish between fossil fuel emissions and other CO2 sources. The ΔCO/ΔCO2 ratios (R2 = 0.33 to 0.88, slopes = 2.42 to 10.37, calculated for anthropogenic-influenced air masses over different countries/regions matched national inventories quite well, showing that airborne measurements can help to identify the origin of

  5. MG-RAST version 4-lessons learned from a decade of low-budget ultra-high-throughput metagenome analysis.

    Science.gov (United States)

    Meyer, Folker; Bagchi, Saurabh; Chaterji, Somali; Gerlach, Wolfgang; Grama, Ananth; Harrison, Travis; Paczian, Tobias; Trimble, William L; Wilke, Andreas

    2017-09-26

    As technologies change, MG-RAST is adapting. Newly available software is being included to improve accuracy and performance. As a computational service constantly running large volume scientific workflows, MG-RAST is the right location to perform benchmarking and implement algorithmic or platform improvements, in many cases involving trade-offs between specificity, sensitivity and run-time cost. The work in [Glass EM, Dribinsky Y, Yilmaz P, et al. ISME J 2014;8:1-3] is an example; we use existing well-studied data sets as gold standards representing different environments and different technologies to evaluate any changes to the pipeline. Currently, we use well-understood data sets in MG-RAST as platform for benchmarking. The use of artificial data sets for pipeline performance optimization has not added value, as these data sets are not presenting the same challenges as real-world data sets. In addition, the MG-RAST team welcomes suggestions for improvements of the workflow. We are currently working on versions 4.02 and 4.1, both of which contain significant input from the community and our partners that will enable double barcoding, stronger inferences supported by longer-read technologies, and will increase throughput while maintaining sensitivity by using Diamond and SortMeRNA. On the technical platform side, the MG-RAST team intends to support the Common Workflow Language as a standard to specify bioinformatics workflows, both to facilitate development and efficient high-performance implementation of the community's data analysis tasks. Published by Oxford University Press on behalf of Entomological Society of America 2017. This work is written by US Government employees and is in the public domain in the US.

  6. Ecological niche modeling for visceral leishmaniasis in the state of Bahia, Brazil, using genetic algorithm for rule-set prediction and growing degree day-water budget analysis

    Directory of Open Access Journals (Sweden)

    Prixia Nieto

    2006-11-01

    Full Text Available Two predictive models were developed within a geographic information system using Genetic Algorithm Rule-Set Prediction (GARP and the growing degree day (GDD-water budget (WB concept to predict the distribution and potential risk of visceral leishmaniasis (VL in the State of Bahia, Brazil. The objective was to define the environmental suitability of the disease as well as to obtain a deeper understanding of the eco-epidemiology of VL by associating environmental and climatic variables with disease prevalence. Both the GARP model and the GDDWB model, using different analysis approaches and with the same human prevalence database, predicted similar distribution and abundance patterns for the Lutzomyia longipalpis-Leishmania chagasi system in Bahia. High and moderate prevalence sites for VL were significantly related to areas of high and moderate risk prediction by: (i the area predicted by the GARP model, depending on the number of pixels that overlapped among eleven annual model years, and (ii the number of potential generations per year that could be completed by the Lu. longipalpis-L. chagasi system by GDD-WB analysis. When applied to the ecological zones of Bahia, both the GARP and the GDD-WB prediction models suggest that the highest VL risk is in the interior region of the state, characterized by a semi-arid and hot climate known as Caatinga, while the risk in the Bahia interior forest and the Cerrado ecological regions is lower. The Bahia coastal forest was predicted to be a low-risk area due to the unsuitable conditions for the vector and VL transmission.

  7. Integrating health and environmental impact analysis.

    Science.gov (United States)

    Reis, S; Morris, G; Fleming, L E; Beck, S; Taylor, T; White, M; Depledge, M H; Steinle, S; Sabel, C E; Cowie, H; Hurley, F; Dick, J McP; Smith, R I; Austen, M

    2015-10-01

    Scientific investigations have progressively refined our understanding of the influence of the environment on human health, and the many adverse impacts that human activities exert on the environment, from the local to the planetary level. Nonetheless, throughout the modern public health era, health has been pursued as though our lives and lifestyles are disconnected from ecosystems and their component organisms. The inadequacy of the societal and public health response to obesity, health inequities, and especially global environmental and climate change now calls for an ecological approach which addresses human activity in all its social, economic and cultural complexity. The new approach must be integral to, and interactive, with the natural environment. We see the continuing failure to truly integrate human health and environmental impact analysis as deeply damaging, and we propose a new conceptual model, the ecosystems-enriched Drivers, Pressures, State, Exposure, Effects, Actions or 'eDPSEEA' model, to address this shortcoming. The model recognizes convergence between the concept of ecosystems services which provides a human health and well-being slant to the value of ecosystems while equally emphasizing the health of the environment, and the growing calls for 'ecological public health' as a response to global environmental concerns now suffusing the discourse in public health. More revolution than evolution, ecological public health will demand new perspectives regarding the interconnections among society, the economy, the environment and our health and well-being. Success must be built on collaborations between the disparate scientific communities of the environmental sciences and public health as well as interactions with social scientists, economists and the legal profession. It will require outreach to political and other stakeholders including a currently largely disengaged general public. The need for an effective and robust science-policy interface has

  8. Global lateral transfer and evasion of C in freshwater systems - a revised high-resolution budget analysis

    Science.gov (United States)

    Lauerwald, Ronny; Laruelle, Goulven; Hartmann, Jens; Ciais, Philippe; Regnier, Pierre

    2016-04-01

    included in our analysis. With the exception of dry and mountainous areas, the riverine CO2 evasion from large river basins exceeds the export to the ocean. In tropical Africa and South America, the proportion exceeds even 75%. In SE-Asia, FCO2 rates are similar to those in tropical Africa and S-America, but the POC exports are important as well in this region. To further investigate the C dynamics through the terrestrial-aquatic interface, fluvial C transport is now integrated into the land-surface scheme ORCHIDEE of the IPSL-Earth System Model. Preliminary results of the DOC and CO2 dynamics in the largest world river (the Amazon) will also be presented.

  9. Epidemiological and partial budget analysis for treatment of subclinical Staphylococcus aureus intramammary infections considering microbiological and cytological scenarios.

    Science.gov (United States)

    Petzer, Inge-Marié; Etter, Eric M C; Donkin, Edward F; Webb, Edward C; Karzis, Joanne

    2017-12-01

    An innovative method was investigated to aid in the elimination of Staphylococcus aureus (S. aureus) intramammary infections (IMI) from dairy herds. A stochastic model explore the economic benefit of three-day or eight-day treatment of subclinical IMI in all S. aureus infected cows or in only those with a somatic cell count (SCC) exceeding 200,000 cells/ml. An epidemiological model was developed to run parallel to the economic model that would predict the S. aureus IMI likely to persist, develop new infections and clinical mastitis. In the economic model a first algorithm was used to consider the low prevalence (LP) scenario and made use of S. aureus prevalence information provided by retrospective analysis of microbiological and cytological results in South Africa (2008-2012). The data used considered Staphylococcus aureus prevalence from [1.495; 1.595] 95% to [6.72; 6.95] 95% for SCC≤200,000 and SCC>200,000 cells/ml respectively. A second algorithm considered the high prevalence (HP) scenario to evaluate a simulated situation with a 5[U1] [R12] to 25% prevalence. Scenarios of low or high transmission ratio (TR) were included in the model according to the hygiene management on the farm. Probabilities and costs were calculated over 255days. The economic models predicted average cost indices for low S. aureus IMI and low TR to vary from -3179 ZAR (South African Rands) when subclinical cases with SCC higher than 200,000 cell/ml were treated for eight days, to -3663 ZAR when all subclinical S. aureus IMI were treated for three days. With a HP and high TR of S. aureus the average cost indices changed from -18,042 ZAR when none to -5433 ZAR per 255days when all S. aureus IMI were treated for eight days. The epidemiological model in this study predicted substantial benefit of treatment mainly in high TR scenarios. New IMI decreased up to77% in the three-day and up to 91% in the eight-day treatment scenarios. In the HP scenarios, persistent IMI were reduced by 94%. The

  10. Nitrogen rhizodeposition from soybean (Glycine max) and its impact on nutrient budgets in two contrasting environments of the Guinean savannah zone of Nigeria

    DEFF Research Database (Denmark)

    Laberge, G.; Franke, A. C.; Ambus, Per

    2009-01-01

    Nitrogen (N) rhizodeposition by grain legumes such as soybean is potentially a large but neglected source of N in cropping systems of Sub-Saharan Africa. Field studies were conducted to measure soybean N rhizodeposition in two environments of the Guinean savannah of Nigeria using 15N leaf labelling...... removed. If residues were left in the field or recycled as manure after being fed to steers, soybean cultivation led to positive N budgets of up to +95 kg N ha−1. The role and potential of grain legumes as N purveyors have been underestimated in the past by neglecting the N contained...... techniques. The first site was located in Ibadan in the humid derived savannah. The second site was in Zaria in the drier Northern Guinean savannah. Soybean N rhizodeposition in the top 0.30 m of soil varied from 7.5 kg ha−1 on a diseased crop in Ibadan to 33 kg ha−1 in Zaria. More than two-thirds of soybean...

  11. Bounded Rationality and Budgeting

    OpenAIRE

    Ibrahim, Mukdad

    2016-01-01

    This article discusses the theory of bounded rationality which had been introduced by Herbert Simon in the 1950s. Simon introduced the notion of bounded rationality stating that while decision-makers strive for rationality, they are limited by the effect of the environment, their information process capacity and by the constraints on their information storage and retrieval capabilities. Moreover, this article tries to specifically blend this notion into budgeting, using the foundations of inc...

  12. Programme budget 1981

    International Nuclear Information System (INIS)

    1980-01-01

    There are 11 main fields of KfK R + D activities which are connected with one or more of the research goals of a) assurance of nuclear fuel supply, b) nuclear waste management, c) safety of nuclear facilities, d) basic research and research on new technologies. The scientific and technical tasks connected with these goals in 1981 and on a medium-term basis as well as the financial requirements are presented in the programme budget. (orig.) [de

  13. The Incredible Shrinking Budget

    Science.gov (United States)

    T.H.E. Journal, 2013

    2013-01-01

    If district technology leaders had a nickel for every time they heard the phrase "the new normal," they'd have all the money they need to run their IT departments. In an effort to help readers think about their budgets in creative and practical ways, "T.H.E. Journal" and the Consortium for School Networking (CoSN) recently convened a panel of CTOs…

  14. Crumple zone design for pedestrian protection using impact analysis

    Energy Technology Data Exchange (ETDEWEB)

    Moon, Hyung Il; Jeon, Young Eun; Kim, Dae Young; Kim, Heon Young [Kangwon National Univ., Chuncheon si (Korea, Republic of); Kim, Yong Soo [Product Development Team, Gyeongsan si (Korea, Republic of)

    2012-08-15

    This paper describes the design process for an automobile crumple zone for pedestrian protection. The impact load and bending moments predicted by impact analysis were used to design a plastic structure that may help reduce pedestrian injuries to the thigh area. The fracture effect was incorporated into the model by calculating the damage to the plastic material during impact, and the analysis was conducted under the European New Car Assessment Program (Euro NCAP) test conditions, using the upper legform developed by ESI Corporation. In addition, the values predicted by the analysis were validated by comparison with results of actual impact tests.

  15. Crumple zone design for pedestrian protection using impact analysis

    International Nuclear Information System (INIS)

    Moon, Hyung Il; Jeon, Young Eun; Kim, Dae Young; Kim, Heon Young; Kim, Yong Soo

    2012-01-01

    This paper describes the design process for an automobile crumple zone for pedestrian protection. The impact load and bending moments predicted by impact analysis were used to design a plastic structure that may help reduce pedestrian injuries to the thigh area. The fracture effect was incorporated into the model by calculating the damage to the plastic material during impact, and the analysis was conducted under the European New Car Assessment Program (Euro NCAP) test conditions, using the upper legform developed by ESI Corporation. In addition, the values predicted by the analysis were validated by comparison with results of actual impact tests

  16. Impacts of habitat loss and fragmentation on the activity budget, ranging ecology and habitat use of Bale monkeys (Chlorocebus djamdjamensis) in the southern Ethiopian Highlands.

    Science.gov (United States)

    Mekonnen, Addisu; Fashing, Peter J; Bekele, Afework; Hernandez-Aguilar, R Adriana; Rueness, Eli K; Nguyen, Nga; Stenseth, Nils Chr

    2017-07-01

    Understanding the extent to which primates in forest fragments can adjust behaviorally and ecologically to changes caused by deforestation is essential to designing conservation management plans. During a 12-month period, we studied the effects of habitat loss and degradation on the Ethiopian endemic, bamboo specialist, Bale monkey (Chlorocebus djamdjamensis) by comparing its habitat quality, activity budget, ranging ecology and habitat use in continuous forest and two fragments. We found that habitat loss and fragmentation resulted in major differences in vegetation composition and structure between forest types. We also found that Bale monkeys in continuous forest spent more time feeding and traveling and less time resting and socializing than monkeys in fragments. Bale monkeys in continuous forest also had higher movement rates (m/hr) than monkeys in fragments. Bale monkeys in continuous forest used exclusively bamboo and mixed bamboo forest habitats while conspecifics in fragments used a greater variety of habitats including human use areas (i.e., matrix). Our findings suggest that Bale monkeys in fragments use an energy minimization strategy to cope with the lower availability of the species' primary food species, bamboo (Arundinaria alpina). We contend that Bale monkeys may retain some of the ancestral ecological flexibility assumed to be characteristic of the genus Chlorocebus, within which all extant species except Bale monkeys are regarded as ecological generalists. Our results suggest that, like other bamboo eating primates (e.g., the bamboo lemurs of Madagascar), Bale monkeys can cope with a certain threshold of habitat destruction. However, the long-term conservation prospects for Bale monkeys in fragments remain unclear and will require further monitoring to be properly evaluated. © 2017 Wiley Periodicals, Inc.

  17. Revisiting global mean sea level budget closure : Preliminary results from an integrative study within ESA's Climate Change Initiative -Sea level Budget Closure-Climate Change Initiative

    Science.gov (United States)

    Palanisamy, H.; Cazenave, A. A.

    2017-12-01

    The global mean sea level budget is revisited over two time periods: the entire altimetry era, 1993-2015 and the Argo/GRACE era, 2003-2015 using the version '0' of sea level components estimated by the SLBC-CCI teams. The SLBC-CCI is an European Space Agency's project on sea level budget closure using CCI products. Over the entire altimetry era, the sea level budget was performed as the sum of steric and mass components that include contributions from total land water storage, glaciers, ice sheets (Greenland and Antarctica) and total water vapor content. Over the Argo/GRACE era, it was performed as the sum of steric and GRACE based ocean mass. Preliminary budget analysis performed over the altimetry era (1993-2015) results in a trend value of 2.83 mm/yr. On comparison with the observed altimetry-based global mean sea level trend over the same period (3.03 ± 0.5 mm/yr), we obtain a residual of 0.2 mm/yr. In spite of a residual of 0.2 mm/yr, the sea level budget result obtained over the altimetry era is very promising as this has been performed using the version '0' of the sea level components. Furthermore, uncertainties are not yet included in this study as uncertainty estimation for each sea level component is currently underway. Over the Argo/GRACE era (2003-2015), the trend estimated from the sum of steric and GRACE ocean mass amounts to 2.63 mm/yr while that observed by satellite altimetry is 3.37 mm/yr, thereby leaving a residual of 0.7 mm/yr. Here an ensemble GRACE ocean mass data (mean of various available GRACE ocean mass data) was used for the estimation. Using individual GRACE data results in a residual range of 0.5 mm/yr -1.1 mm/yr. Investigations are under way to determine the cause of the vast difference between the observed sea level and the sea level obtained from steric and GRACE ocean mass. One main suspect is the impact of GRACE data gaps on sea level budget analysis due to lack of GRACE data over several months since 2011. The current action plan

  18. Economic impact analysis of short line railroads.

    Science.gov (United States)

    2014-10-01

    This research project assesses the economic role and impact of short line railroads in the state of Louisiana. While relatively small in : scope, with 11 operators and approximately 500 miles of track, short line railroads play a significant role in ...

  19. PUBLIC EXPENDITURE ON HEALTH IN LOCAL BUDGETS

    Directory of Open Access Journals (Sweden)

    Cristinel ICHIM

    2017-06-01

    Full Text Available This paper entitled "Public expenditure on health in local budgets" aims analysing and deepening major spending categories that public authorities finance at local level, namely health expenditure. In the first part of the article we have specified the content and role of this category of expenditure in local budgets and also made some feedback on decentralization in health. In the second part of the work, based on data available in Statistical Yearbook of Romania, we have carried out an analysis of the dynamics of health spending from local budgets to emphasize their place and role in the health care expenses. The research carried out follows that the evolution and structure of health expenditure financed from local budgets is determined, along with the legislative framework in the field, by several variables that differ from one territorial administrative unit to another: the existence of sanitary units, their type, the involving of local public authorities in their development and modernization, the number and the social structure of the population. The research shows that over the period 1993-2015, the dynamics of the share of health spending in total expenditures of local budgets is sinusoidal, with a minimum threshold in 2000 of only 0.3%.

  20. Performance Budgeting in Practice: the Case of Danish Hospital Management

    DEFF Research Database (Denmark)

    Jakobsen, Mads Leth; Pallesen, Thomas

    2017-01-01

    Danish public hospitals to see how performance budgeting works in the regions where the fundamental problems of performance information are negligible and the regions statutorily obligated to increase public sector efficiency by performance budgeting. The analysis shows that the regions in general have...

  1. Ozone and carbon monoxide budgets over the Eastern Mediterranean

    NARCIS (Netherlands)

    Myriokefalitakis, S.; Daskalakis, N.; Fanourgakis, G.S.; Voulgarakis, A.; Krol, M.C.; Brugh, Aan de J.M.J.; Kanakidou, M.

    2016-01-01

    The importance of the long-range transport (LRT) on O3 and CO budgets over the Eastern Mediterranean has been investigated using the state-of-the-art 3-dimensional global chemistry-transport model TM4-ECPL. A 3-D budget analysis has been performed separating the Eastern from the

  2. Budgeting-Based Organization of Internal Control

    Science.gov (United States)

    Rogulenko, Tatiana; Ponomareva, Svetlana; Bodiaco, Anna; Mironenko, Valentina; Zelenov, Vladimir

    2016-01-01

    The article suggests methodical approaches to the budgeting-based organization of internal control, determines the tasks and subtasks of control that consist in the construction of an efficient system for the making, implementation, control, and analysis of managerial decisions. The organization of responsibility centers by means of implementing…

  3. The impact of the 2015-2016 El Niño-Southern Oscillation (ENSO) event on greenhouse gas exchange and surface energy budget in an Indonesian oil palm plantation

    Science.gov (United States)

    Stiegler, C.; Meijide, A.; June, T.; Knohl, A.

    2016-12-01

    Oil palm plantations cover a large fraction of tropical lowlands in Southeast Asia. However, despite their growing areal extent, measurements and observations of greenhouse gas exchange and surface energy balance are still scarce. In addition, the effects of extreme events such as El Niño-Southern Oscillation (ENSO) on carbon sequestration and the partitioning of surface energy balance components are widely unknown. In this study, we use micrometeorological measurements located in commercial oil palm plantations in the Jambi province (Sumatra, Indonesia) to assess the impact of the 2015-2016 ENSO event on greenhouse gas exchange and surface energy budget. Measurements are in operation since July 2013 and we assess continuously turbulent fluxes of carbon dioxide (CO2), water vapour and sensible heat using the eddy covariance technique before, during and after the 2015-2016 ENSO event. The full surface energy budget is completed by measurements of radiative components, ground heat fluxes, and soil thermal and hydrological properties. The study is part of a large interdisciplinary project focussing on the ecological and socioeconomic functions of lowland rainforest transformation systems (EFForTS). During the ENSO event, the area experienced a strong drought with decreasing soil moisture and increasing air and surface temperatures. During the peak in September and October 2015, hundreds of fires in the area resulted in strong smoke production decreasing incoming solar radiation and increasing the diffuse fraction. Compared to regular years, the carbon uptake of the oil palm plantation decreased during the ENSO event. The turbulent heat fluxes experienced an increase in sensible heat fluxes due to drought conditions at the cost of latent heat fluxes resulting in an increase in the Bowen-ratio. Overall, the ENSO event resulted in a major anomaly of exchange processes between the oil palm plantation and the atmosphere.

  4. Extended analysis on impact of nuclear technology

    International Nuclear Information System (INIS)

    Ainul Hayati Daud; Hazmimi Kasim

    2010-01-01

    This chapter discusses a number of economic, social and knowledge impacts of the applications of nuclear technology in Malaysia as well as benchmarking with Japan and the Republic of Korea. Under economic impacts, index of gross value of products and services, index of gross value of exports, index of gross value of training expenditures, and index of total number of human resource trained are developed. In addition, the contribution of the application of nuclear technology to both Gross Domestic Products (GDP) and GDP per capita are also highlighted. The impact of the application of nuclear technology to Total Factor Productivity (TFP) is also covered in this chapter. Much of the discussions on economic impacts are based on findings in private companies. That is because many of their operations can be expressed in monetary terms by virtue of them operating in commercial environment. Public agencies, however, play crucial role in enabling the private companies attain the level of development reported in this study. Towards that end, public agencies invested in Research and development activities, human capital development, as well as in the setting-up, operation and maintenance of both technical and administrative infrastructures. The impact of such activities is discussed in the later part of this chapter. (author)

  5. [Budget impact analysis of idarucizumab for the management of patients treated with dabigatran in emergency / urgent situations in Italy

    Directory of Open Access Journals (Sweden)

    Andrea Belisari

    2016-06-01

    CONCLUSION: Idarucizumab for the management of patients treated with dabigatran in emergency / urgent situations has the potential for substantial savings, compared to treatments currently available. This preliminary assessment will require further confirmatory evidence when the product will become available in Italian healthcare setting. [Article in Italian

  6. On the accuracy of the simple ocean data assimilation analysis for estimating heat Budgets of the Near-Surface Arabian Sea and Bay of Bengal

    Digital Repository Service at National Institute of Oceanography (India)

    Shenoi, S.S.C.; Shankar, D.; Shetye, S.R.

    The accuracy of data from the Simple Ocean Data Assimilation (SODA) model for estimating the heat budget of the upper ocean is tested in the Arabian Sea and the Bay of Bengal. SODA is able to reproduce the changes in heat content when...

  7. Galactic and Circumgalactic O VI and its Impact on the Cosmological Metal and Baryon Budgets at 2 < z <~ 3.5

    Science.gov (United States)

    Lehner, N.; O'Meara, J. M.; Fox, A. J.; Howk, J. C.; Prochaska, J. X.; Burns, V.; Armstrong, A. A.

    2014-06-01

    We present the first results from our NASA Keck Observatory Database of Ionized Absorbers toward Quasars (KODIAQ) survey which aims to characterize the properties of the highly ionized gas of galaxies and their circumgalactic medium (CGM) at 2 1, log N_{H\\,\\scriptsize{I}} \\textgreater 17.3) as probes of these galaxies and their CGM where both transitions of the O VI doublet have little contamination from the Lyα, β forests. We found 20 absorbers that satisfy these rules: 7 Lyman limit systems (LLSs), 8 super-LLSs (SLLSs) and 5 damped Lyα (DLAs). The O VI detection rate is 100% for the DLAs, 71% for the LLSs, and 63% for the SLLSs. When O VI is detected, log \\langle N_{O\\,\\scriptsize{VI}} \\rangle = 14.9 +/- 0.3, an average O VI column density substantially larger and with a smaller dispersion than found in blind O VI surveys at similar redshifts. Strong O VI absorption is therefore nearly ubiquitous in the CGM of z ~ 2-3 galaxies. The total velocity widths of the O VI profiles are also large (200 \\le \\Delta v_{O\\,\\scriptsize{VI}} \\le 400 km s-1). These properties are quite similar to those seen for O VI in low-z star-forming galaxies, and therefore we hypothesize that these strong CGM O VI absorbers (with τLL > 1) at 2 account, we determine that the τLL > 1 absorbers could contain as much as 3%-14% of the cosmic baryon budget at z ~ 2-3, only second to the Lyα forest. We conservatively show that 5%-20% of the metals ever produced at z ~ 2-3 are in form of highly ionized metals ejected in the CGM of galaxies. We dedicate this paper and the KODIAQ project to the memory and families of Wal Sargent and Arthur M. Wolfe. Without the vision and terrific efforts of these two scientists, this survey would not exist. Their careers have greatly inspired and influenced our own, and we hope that their work continues to flourish with this archival data set.

  8. EXPENSES FOR ECONOMIC ACTIVITIES FROM LOCAL BUDGETS

    Directory of Open Access Journals (Sweden)

    CRISTINEL ICHIM

    2015-04-01

    Full Text Available In the present article we propose to analyze and deepen significant categories of costs funded from the local budgets, namely the expenditure for economic activities. Our scientific approach begins with determining the place occupied by such expenses in local public expenditure by specifying their content and role. The center of gravity of the study is to treat and deepen the three subgroups of expenses that we consider representative: "The expenses for production, transportation, distribution and supply of heat in a centralized system", "Transport Costs" and Expenditure for agriculture and forestry ". The reaserch is based on the quantitative analysis of the expenses for economic actions, in local budgets, based on the existing data from the Statistical Yearbook of Romania, and highlights the structure of this type of expenses as well as the place they hold in the expediture of local budgets.The study includes an analysis of the dynamics of the share held by economic costs within total expenses from local budgets. From the reaserch carried out, it is shown that the evolution and structure of the expenditures for economic actions from local budgets is determined by the action of certain economical and social factors that vary from one administrative teritorial unit to another: the ray of economical develpoment of the administrative ter itorial unit, urbanization, the number and social structure of the population. The reaserch shows that in the field of expenses for economic actions, the largest share is held by expenditures for transportation (almost 80%, far away from the expenses for fuel and energy (13,66%. During the 1999-2013 the dynamic of expenses for economical actions in the total of expenditures of local budgets, is sinusoidal due to the intervention of certain legislative changes.

  9. Regional analysis and environmental impact assessment

    International Nuclear Information System (INIS)

    Parzyck, D.C.; Brocksen, R.W.; Emanuel, W.R.

    1976-01-01

    This paper presents a number of techniques that can be used to assess environmental impacts on a regional scale. Regional methodologies have been developed which examine impacts upon aquatic and terrestrial biota in regions through consideration of changes in land use, land cover, air quality, water resource use, and water quality. Techniques used to assess long-range atmospheric transport, water resources, effects on sensitive forest and animal species, and impacts on man are presented in this paper, along with an optimization approach which serves to integrate the analytical techniques in an overall assessment framework. A brief review of the research approach and certain modeling techniques used within one regional studies program is provided. While it is not an all inclusive report on regional analyses, it does present an illustration of the types of analyses that can be performed on a regional scale

  10. Impact analysis of spent fuel jacket assemblies

    International Nuclear Information System (INIS)

    Aramayo, G.A.

    1994-01-01

    As part of the analyses performed in support of the reracking of the High Flux Isotope Reactor pool, it became necessary to prove the structural integrity of the spent fuel jacket assemblies subjected to gravity drop that result from postulated accidents associated with the handling of these assemblies while submerged in the pool. The spent fuel jacket assemblies are an integral part of the reracking project, and serve to house fuel assemblies. The structure integrity of the jacket assemblies from loads that result from impact from a height of 10 feet onto specified targets has been performed analytically using the computer program LS-DYNA3D. Nine attitudes of the assembly at the time of impact have been considered. Results of the analyses show that there is no failure of the assemblies as a result of the impact scenarios considered

  11. Minimization of local impact of energy systems through exergy analysis

    International Nuclear Information System (INIS)

    Cassetti, Gabriele; Colombo, Emanuela

    2013-01-01

    Highlights: • The model proposed aims at minimizing local impact of energy systems. • The model is meant to minimize the impact starting from system thermodynamics. • The formulation combines exergy analysis and quantitative risk analysis. • The approach of the model is dual to Thermoeconomics. - Abstract: For the acceptability of energy systems, environmental impacts are becoming more and more important. One primary way for reducing impacts related to processes is by improving efficiency of plants. A key instrument currently used to verify such improvements is exergy analysis, extended to include also the environmental externalities generated by systems. Through exergy-based analyses, it is possible indeed to evaluate the overall amount of resources consumed along all the phases of the life cycle of a system, from construction to dismantling. However, resource consumption is a dimension of the impact of a system at global level, while it may not be considered a measure of its local impact. In the paper a complementary approach named Combined Risk and Exergy Analysis (CRExA) to assess impacts from major accidents in energy systems is proposed, based on the combination of classical exergy analysis and quantitative risk analysis (QRA). Impacts considered are focused on effects on human health. The approach leads to the identification of solutions to minimize damages of major accidents by acting on the energy system design

  12. NATURE AND CLASSIFICATION ASPECTS OF LOCAL BUDGET REVENUES

    Directory of Open Access Journals (Sweden)

    Oksana Vinnytska

    2015-11-01

    Full Text Available The purpose of the article is to determine the essential characteristics of local budgets and justify their classification aspects. Methodology. In the course of writing used general scientific and special methods of knowledge: dialectical and systemic-functional – to summarize the theoretical concepts of income of local budgets; analysis and synthesis – to detail the subject of research and study its components; logic synthesis – to justify approaches and proposals for the formulation of local budgets. Results. Proved that today there is no single view on the interpretation of economic categories “revenues of local budgets.” A refined concept of “local budget revenues” from the standpoint of material content, form, organizational structure and nature of local budgets. Local budget revenues determined as part of the financial resources of society, which is accumulated by local authorities to enforce their tasks and functions to implement current and future challenges of social infrastructure in the regions. Proved that the revenues of local budgets are derived from their own, and assigned to the established order of state taxes, fees and other mandatory payments. The main feature of their own revenues is the direct subordination of local government. The main feature is the fixed income long-term nature of their attachment to the appropriate budget. Value/originality. Proved that the presence in the economic literature of different classification criteria of local budget on various grounds provides multi classification that reflects all the features of the formation, use and functional differences revenues of local budgets. This approach provides the basis for improving the functioning of the theoretical foundations of the budget process in Ukraine at the level of local authorities.

  13. Mechanism for Corrective Action on Budget Imbalances

    Directory of Open Access Journals (Sweden)

    Ion Lucian CATRINA

    2014-02-01

    Full Text Available The European Fiscal Compact sets the obligation for the signatory states to establish an automatic mechanism for taking corrective action on budget imbalances. Nevertheless, the European Treaty says nothing about the tools that should be used in order to reach the desired equilibrium of budgets, but only that it should aim at correcting deviations from the medium-term objective or the adjustment path, including their cumulated impact on government debt dynamics. This paper is aiming at showing that each member state has to build the correction mechanism according to the impact of the chosen tools on economic growth and on general government revenues. We will also emphasize that the correction mechanism should be built not only exacerbating the corrective action through spending/ tax based adjustments, but on a high quality package of economic policies as well.

  14. Marketing with limited budget

    OpenAIRE

    Smirnova, Daria

    2017-01-01

    The purpose of this research-based thesis was to get an idea how managers of two small resembling hotels of a specific region deal with marketing process with a limited budget. In addition, the aim of the thesis was to examine if hotel managers who were interviewed perceive marketing only in the way of ‘promotion’ rather than marketing research, marketing mix and marketing environment theories. It was also found out if hotel managers of those hotels consider marketing as a key to successful h...

  15. Environmental impact statement analysis: dose methodology

    International Nuclear Information System (INIS)

    Mueller, M.A.; Strenge, D.L.; Napier, B.A.

    1981-01-01

    Standardized sections and methodologies are being developed for use in environmental impact statements (EIS) for activities to be conducted on the Hanford Reservation. Five areas for standardization have been identified: routine operations dose methodologies, accident dose methodology, Hanford Site description, health effects methodology, and socioeconomic environment for Hanford waste management activities

  16. Analysis of the Younger Dryas Impact Layer

    Energy Technology Data Exchange (ETDEWEB)

    Firestone, Richard B.; West, Allen; Revay, Zsolt; Hagstrum, Jonathon T,; Belgya, Thomas; Hee, Shane S. Que; Smith, Alan R.

    2010-02-27

    We have uncovered a thin layer of magnetic grains and microspherules, carbon spherules, and glass-like carbon at nine sites across North America, a site in Belgium, and throughout the rims of 16 Carolina Bays. It is consistent with the ejecta layer from an impact event and has been dated to 12.9 ka BP coinciding with the onset of Younger Dryas (YD) cooling and widespread megafaunal extinctions in North America. At many locations the impact layer is directly below a black mat marking the sudden disappearance of the megafauna and Clovis people. The distribution pattern of the Younger Dryas boundary (YDB) ejecta layer is consistent with an impact near the Great Lakes that deposited terrestrial-like ejecta near the impact site and unusual, titanium-rich projectile-like ejecta further away. High water content associated with the ejecta, up to 28 at. percent hydrogen (H), suggests the impact occurred over the Laurentide Ice Sheet. YDB microspherules and magnetic grains are highly enriched in TiO{sub 2}. Magnetic grains from several sites are enriched in iridium (Ir), up to 117 ppb. The TiO{sub 2}/FeO, K/Th, TiO{sub 2}/Zr, Al{sub 2}O{sub 3}/FeO+MgO, CaO/Al{sub 2}O{sub 3}, REE/ chondrite, FeO/MnO ratios and SiO{sub 2}, Na{sub 2}O, K{sub 2}O, Cr{sub 2}O{sub 3}, Ni, Co, U, Th and other trace element abundances are inconsistent with all terrestrial and extraterrestrial (ET) sources except for KREEP, a lunar igneous rock rich in potassium (K), rare-earth elements (REE), phosphorus (P), and other incompatible elements including U and Th. Normal Fe, Ti, and {sup 238}U/{sup 235}U isotopic abundances were found in the magnetic grains, but {sup 234}U was enriched over equilibrium values by 50 percent in Murray Springs and by 130 percent in Belgium. 40K abundance is enriched by up to 100 percent in YDB sediments and Clovis chert artifacts. Highly vesicular carbon spherules containing nanodiamonds, glass-like carbon, charcoal and soot found in large quantities in the YDB layer are

  17. The lending channel and budget balance: empirical evidences from Central and Eastern European economies

    Directory of Open Access Journals (Sweden)

    Bogdan-Gabriel MOINESCU

    2013-03-01

    Full Text Available The study aims to deepen the analysis on the indirect dependence of government budget balance on private sector credit flow in the countries of Central and Eastern Europe. The added value of this approach consists of two elements. First, the analysis suggests developing the traditional analytical framework of assessing risks to public finance stability by including second round effects of negative fiscal impulses on credit to private sector during recession periods. Second, the study provides empirical evidence on the importance of economic growth transmission channel for the impact of credit accelerator effects on primary deficit. At the same time, nonperforming loans channel proved to be insignificant, especially in relation to the persistency of last year’s budget deficit and the effects of