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Sample records for care economic evaluation

  1. Payment and economic evaluation of integrated care

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    Apostolos Tsiachristas

    2015-04-01

    Full Text Available Chronic diseases have an increasingly negative impact on (1 population health by increasing morbidity and mortality, (2 society by increasing health inequalities and burden to informal caregivers, and (3 economy by requiring enormous financial resources and jeopardising macro-economic development (e.g. consumption, capital accumulation, labour productivity and labour supply. Integrated care is the most promising concept in redesigning care to tackle the increasing threat of chronic diseases. Several European countries have experimented with models for integrating care, most frequently in the form of disease management programmes. These models were often supported by payment schemes to provide financial incentives to health care providers for implementing integrated care. This thesis aimed to investigate these payment schemes and assess their impact, explore the variability in costs of disease management programmes, and determine the costs and effects of disease management programmes.

  2. Complementary analyses in economic evaluation of health care

    NARCIS (Netherlands)

    M.A. Koopmanschap (Marc)

    1994-01-01

    textabstractThe steady increase in health care costs and the continuous emergence of new medical technologies have forced policy makers in health care to reconsider the current resource allocation and to become more selective with investing in new health care programs. Economic evaluations can suppo

  3. Importance of Economic Evaluation in Health Care: An Indian Perspective.

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    Dang, Amit; Likhar, Nishkarsh; Alok, Utkarsh

    2016-05-01

    Health economic studies provide information to decision makers for efficient use of available resources for maximizing health benefits. Economic evaluation is one part of health economics, and it is a tool for comparing costs and consequences of different interventions. Health technology assessment is a technique for economic evaluation that is well adapted by developed countries. The traditional classification of economic evaluation includes cost-minimization, cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis. There has been uncertainty in the conduct of such economic evaluations in India, due to some hesitancy with respect to the adoption of their guidelines. The biggest challenge in this evolutionary method is lack of understanding of methods in current use by all those involved in the provision and purchasing of health care. In some countries, different methods of economic evaluation have been adopted for decision making, most commonly to address the question of public subsidies for the purchase of medicines. There is limited evidence on the impact of health insurance on the health and economic well-being of beneficiaries in developing countries. India is currently pursuing several strategies to improve health services for its population, including investing in government-provided services as well as purchasing services from public and private providers through various schemes. Prospects for future growth and development in this field are required in India because rapid health care inflation, increasing rates of chronic conditions, aging population, and increasing technology diffusion will require greater economic efficiency into health care systems.

  4. The Impact of Caregiving : The measurement and valuation of informal care for use in economic evaluations

    NARCIS (Netherlands)

    R.J. Hoefman (Renske)

    2015-01-01

    markdownabstractAbstract This thesis studied methods that facilitate the inclusion of informal care in economic evaluations of health care programmes. Economic evaluations that include informal care inform policy makers about the broader impact of interventions in society, and help them to alloca

  5. Effectiveness and Economic Evaluation of Chiropractic Care for the Treatment of Low Back Pain

    DEFF Research Database (Denmark)

    Blanchette, Marc-André; Stochkendahl, Mette Jensen; Borges Da Silva, Roxane;

    2016-01-01

    evidence regarding the effectiveness and economic evaluation of care offered by these provider groups. PURPOSE: To estimate the clinical effectiveness and to systematically review the literature of full economic evaluation of chiropractic care compared to other commonly used care approaches among adult...... patients with non-specific LBP. STUDY DESIGN: Systematic reviews of interventions and economic evaluations. METHODS: A comprehensive search strategy was conducted to identify 1) pragmatic randomized controlled trials (RCTs) and/or 2) full economic evaluations of chiropractic care for low back pain compared...... were scientifically admissible. Five RCTs with low risk of bias compared chiropractic care to exercise therapy (n = 1), physical therapy (n = 3) and medical care (n = 1). Overall, we found similar effects for chiropractic care and the other types of care and no reports of serious adverse events. Three...

  6. Performing economic evaluation of integrated care: Highway to hell or stairway to heaven?

    NARCIS (Netherlands)

    A. Tsiachristas (Apostolos); Stein, K.V. (K. Viktoria); S.M.A.A. Evers (Silvia); M.P.M.H. Rutten-van Mölken (Maureen)

    2016-01-01

    textabstractHealth economists are increasingly interested in integrated care in order to support decision-makers to find cost-effective solutions able to tackle the threat that chronic diseases pose on population health and health and social care budgets. However, economic evaluation in integrated c

  7. Economic evaluation of integrated new technologies for health and social care: Suggestions for policy makers, users and evaluators.

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    Wildman, John; McMeekin, Peter; Grieve, Eleanor; Briggs, Andrew

    2016-11-01

    With an ageing population there is a move towards the use of assisted living technologies (ALTs) to provide social care and health care services, and to improve service processes. These technologies are at the forefront of the integration of health and social care. However, economic evaluations of ALTs, and indeed economic evaluations of any interventions providing both health benefits and benefits beyond health are complex. This paper considers the challenges faced by evaluators and presents a method of economic evaluation for use with interventions where traditional methods may not be suitable for informing funders and decision makers. We propose a method, combining economic evaluation techniques, that can accommodate health outcomes and outcomes beyond health through the use of a common numeraire. Such economic evaluations can benefit both the public and private sector, firstly by ensuring the efficient allocation of resources. And secondly, by providing information for individuals who, in the market for ALTs, face consumption decisions that are infrequent and for which there may be no other sources of information. We consider these issues in the welfarist, extra-welfarist and capabilities frameworks, which we link to attributes in an individual production model. This approach allows for the valuation of the health component of any such intervention and the valuation of key social care attributes and processes. Finally, we present a set of considerations for evaluators highlighting the key issues that need to be considered in this type of economic evaluation.

  8. The concept of cost in the economic evaluation of health care. A theoretical inquiry.

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    Johannesson, M

    1994-01-01

    The costs included in economic evaluations of health care vary from study to study. Based on the theory of cost-benefit analysis, the costs that should be included in an economic evaluation are those not already included in the measurement of willingness to pay (net willingness to pay above any treatment costs paid by the individual) in a cost-benefit analysis or in the measurement of effectiveness in a cost-effectiveness analysis. These costs can be defined as the consumption externality of the treatment (the change in production minus consumption for those included in the treatment program). For a full economic evaluation, the consequences for those included in the treatment program and a caring externality (altruism) should also be added.

  9. Cost-effectiveness of collaborative care for depression in UK primary care: economic evaluation of a randomised controlled trial (CADET.

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    Colin Green

    Full Text Available Collaborative care is an effective treatment for the management of depression but evidence on its cost-effectiveness in the UK is lacking.To assess the cost-effectiveness of collaborative care in a UK primary care setting.An economic evaluation alongside a multi-centre cluster randomised controlled trial comparing collaborative care with usual primary care for adults with depression (n = 581. Costs, quality-adjusted life-years (QALYs, and incremental cost-effectiveness ratios (ICER were calculated over a 12-month follow-up, from the perspective of the UK National Health Service and Personal Social Services (i.e. Third Party Payer. Sensitivity analyses are reported, and uncertainty is presented using the cost-effectiveness acceptability curve (CEAC and the cost-effectiveness plane.The collaborative care intervention had a mean cost of £272.50 per participant. Health and social care service use, excluding collaborative care, indicated a similar profile of resource use between collaborative care and usual care participants. Collaborative care offered a mean incremental gain of 0.02 (95% CI: -0.02, 0.06 quality-adjusted life-years over 12 months, at a mean incremental cost of £270.72 (95% CI: -202.98, 886.04, and resulted in an estimated mean cost per QALY of £14,248. Where costs associated with informal care are considered in sensitivity analyses collaborative care is expected to be less costly and more effective, thereby dominating treatment as usual.Collaborative care offers health gains at a relatively low cost, and is cost-effective compared with usual care against a decision-maker willingness to pay threshold of £20,000 per QALY gained. Results here support the commissioning of collaborative care in a UK primary care setting.

  10. An overview of methods and applications to value informal care in economic evaluations of healthcare.

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    Koopmanschap, Marc A; van Exel, Job N A; van den Berg, Bernard; Brouwer, Werner B F

    2008-01-01

    This paper compares several applied valuation methods for including informal care in economic evaluations of healthcare programmes: the proxy good method; the opportunity cost method; the contingent valuation method (CVM); conjoint measurement (CM); and valuation of health effects in terms of health-related quality of life (HR-QOL) and well-being. The comparison focuses on three questions: what outcome measures are available for including informal care in economic evaluations of healthcare programmes; whether these measures are compatible with the common types of economic evaluation; and, when applying these measures, whether all relevant aspects of informal care are incorporated. All types of economic evaluation can incorporate a monetary value of informal care (using the opportunity cost method, the proxy good method, CVM and CM) on the cost side of an analysis, but only when the relevant aspects of time costs have been valued. On the effect side of a cost-effectiveness or cost-utility analysis, the health effects (for the patient and/or caregiver) measured in natural units or QALYs can be combined with cost estimates based on the opportunity cost method or the proxy good method. One should be careful when incorporating CVM and CM in cost-minimization, cost-effectiveness and cost-utility analyses, as the health effects of patients receiving informal care and the carers themselves may also have been valued separately. One should determine whether the caregiver valuation exercise allows combination with other valuation techniques. In cost-benefit analyses, CVM and CM appear to be the best tools for the valuation of informal care. When researchers decide to use the well-being method, we recommend applying it in a cost-benefit analysis framework. This method values overall QOL (happiness); hence it is broader than just HR-QOL, which complicates inclusion in traditional health economic evaluations that normally define outcomes more narrowly. Using broader, non

  11. A note on the depreciation of the societal perspective in economic evaluation of health care.

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    Johannesson, M

    1995-07-01

    It is common in cost-effectiveness analyses of health care to only include health care costs, with the argument that some fictive 'health care budget' should be used to maximize the health effects. This paper provides a criticism of the 'health care budget' approach to cost-effectiveness analysis of health care. It is argued that the approach is ad hoc and lacks theoretical foundation. The approach is also inconsistent with using a fixed budget as the decision rule for cost-effectiveness analysis. That is the case unless only costs that fall into a single annual actual budget are included in the analysis, which would mean that any cost paid by the patients should be excluded as well as any future cost changes and all costs that fall on other budgets. Furthermore the prices facing the budget holder should be used, rather than opportunity costs. It is concluded that the 'health care budget' perspective should be abandoned and the societal perspective reinstated in economic evaluation of health care.

  12. Effectiveness and Economic Evaluation of Chiropractic Care for the Treatment of Low Back Pain: A Systematic Review of Pragmatic Studies

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    Blanchette, Marc-André; Stochkendahl, Mette Jensen; Borges Da Silva, Roxane; Boruff, Jill; Harrison, Pamela; Bussières, André

    2016-01-01

    Background Context Low back pain (LBP) is one of the leading causes of disability worldwide and among the most common reasons for seeking primary sector care. Chiropractors, physical therapists and general practitioners are among those providers that treat LBP patients, but there is only limited evidence regarding the effectiveness and economic evaluation of care offered by these provider groups. Purpose To estimate the clinical effectiveness and to systematically review the literature of full economic evaluation of chiropractic care compared to other commonly used care approaches among adult patients with non-specific LBP. Study Design Systematic reviews of interventions and economic evaluations. Methods A comprehensive search strategy was conducted to identify 1) pragmatic randomized controlled trials (RCTs) and/or 2) full economic evaluations of chiropractic care for low back pain compared to standard care delivered by other healthcare providers. Studies published between 1990 and 4th June 2015 were considered. Primary outcomes included pain, functional status and global improvement. Study selection, critical quality appraisal and data extraction were conducted by two independent reviewers. Data from RCTs with low risk of bias were included in a meta-analysis to determine effect estimates. Cost estimates of full economic evaluations were converted to 2015 USD and results summarized using Slavin’s qualitative best-evidence synthesis. Results Six RCTs and three full economic evaluations were scientifically admissible. Five RCTs with low risk of bias compared chiropractic care to exercise therapy (n = 1), physical therapy (n = 3) and medical care (n = 1). Overall, we found similar effects for chiropractic care and the other types of care and no reports of serious adverse events. Three low to high quality full economic evaluations studies (one cost-effectiveness, one cost-minimization and one cost-benefit) compared chiropractic to medical care. Given the divergent

  13. Economic evaluation of care for the chronically ill: A literature review

    NARCIS (Netherlands)

    R. Huijsman (Robbert)

    1995-01-01

    textabstractFinancial problems of governments and the consequent urge to set limits on health care growth have increased the importance of economic rationalization. A systematic review of the present body of knowledge might facilitate the need to set priorities in health care policies and research i

  14. Cost for tuberculosis care in developed countries: which data for an economic evaluation?

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    Trieste, Leopoldo; Turchetti, Giuseppe

    2014-05-01

    Tuberculosis (TB) seems to be eradicated in developed countries. However, current migration flows and increasing use of immunosuppressive and biologic drugs for rheumatic diseases are increasing the risk of latent TB and TB onset for citizens of developed countries. Because little is known about the economic burden of TB in developed countries, we set out to describe the order and dimension of the costs of TB care in developed countries. A review of the literature indicated that the cost for anti-TB therapy is about $2000 US per patient. Costs of drugs associated with standard therapy for active TB [2HRZE/4HR, i.e., 2 months of isoniazid (H), rifampin (R), pyrazinamide (Z), and ethambutol (E), followed by 4 months of HR] are about $600. Standard therapy for latent TB care costs about $80 for 9H and $256 for 4R, respectively. However, these data are very limited because of the horizon of analysis and because data are strongly localized. It can be concluded that in developed countries, available data on TB care costs are insufficient for detailed analysis of the economic burden of TB.

  15. Quality of life instruments for economic evaluations in health and social care for older people: a systematic review.

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    Makai, Peter; Brouwer, Werner B F; Koopmanschap, Marc A; Stolk, Elly A; Nieboer, Anna P

    2014-02-01

    Gaining health may not be the main goal of healthcare services aimed at older people, which may (also) seek to improve wellbeing. This emphasizes the need of finding appropriate outcome measures for economic evaluation of such services, particularly in long-term care, capturing more than only health-related quality of life (HrQol). This review assesses the usefulness of HrQol and wellbeing instruments for economic evaluations specifically aimed at older people, focusing on generic and preference-based questionnaires measuring wellbeing in particular. We systematically searched six databases and extracted instruments used to assess HrQol and wellbeing outcomes. Instruments were compared based on their usefulness for economic evaluation of services aimed at older people (dimensions measured, availability of utility scores, extent of validation). We identified 487 articles using 34 generic instruments: 22 wellbeing (two of which were preference-based) and 11 HrQol instruments. While standard HrQol instruments measure physical, social and psychological dimensions, wellbeing instruments contain additional dimensions such as purpose in life and achievement, security, and freedom. We found four promising wellbeing instruments for inclusion in economic evaluation: Ferrans and Powers QLI and the WHO-Qol OLD, ICECAP-O and the ASCOT. Ferrans and Powers QLI and the WHO-Qol OLD are widely validated but lack preference-weights while for ICECAP-O and the ASCOT preference-weights are available, but are less widely validated. Until preference-weights are available for the first two instruments, the ICECAP-O and the ASCOT currently appear to be the most useful instruments for economic evaluations in services aimed at older people. Their limitations are that (1) health dimensions may be captured only partially and (2) the instruments require further validation. Therefore, we currently recommend using the ICECAP-O or the ASCOT alongside the EQ-5D or SF-6D when evaluating interventions

  16. Managed care and economic dynamics.

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    Riggs, J E

    1996-09-01

    Over the past several decades, health care delivery in the United States evolved in an environment lacking marketplace constraints. The unforeseen result was the current health care crisis--uncontrolled costs, shrinking access, and redundant technological capabilities. Managed care is a strategy to impose fiscal constraints on health care delivery. A diagrammatic analysis of the economic dynamics between consumers and producers in an open marketplace is compared with that of patients, providers, and payers under the health care scheme that produced the health care crisis and under managed care. Patient demands, expectations, and needs for health care are not subject to fiscal constraint under managed care since the dislinkage between consumer and payer still exits. Managed care does not impose true open marketplace fiscal constraints on health care delivery. Furthermore, any solution to the US health care crisis that used true marketplace fiscal constraints would necessitate fundamental changes in societal values concerning individual rights to health care.

  17. Differences in primary health care delivery to Australia’s Indigenous population: a template for use in economic evaluations

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    Ong Katherine S

    2012-09-01

    Full Text Available Abstract Background Health economics is increasingly used to inform resource allocation decision-making, however, there is comparatively little evidence relevant to minority groups. In part, this is due to lack of cost and effectiveness data specific to these groups upon which economic evaluations can be based. Consequently, resource allocation decisions often rely on mainstream evidence which may not be representative, resulting in inequitable funding decisions. This paper describes a method to overcome this deficiency for Australia’s Indigenous population. A template has been developed which can adapt mainstream health intervention data to the Indigenous setting. Methods The ‘Indigenous Health Service Delivery Template’ has been constructed using mixed methods, which include literature review, stakeholder discussions and key informant interviews. The template quantifies the differences in intervention delivery between best practice primary health care for the Indigenous population via Aboriginal Community Controlled Health Services (ACCHSs, and mainstream general practitioner (GP practices. Differences in costs and outcomes have been identified, measured and valued. This template can then be used to adapt mainstream health intervention data to allow its economic evaluation as if delivered from an ACCHS. Results The template indicates that more resources are required in the delivery of health interventions via ACCHSs, due to their comprehensive nature. As a result, the costs of such interventions are greater, however this is accompanied by greater benefits due to improved health service access. In the example case of the polypill intervention, 58% more costs were involved in delivery via ACCHSs, with 50% more benefits. Cost-effectiveness ratios were also altered accordingly. Conclusions The Indigenous Health Service Delivery Template reveals significant differences in the way health interventions are delivered from ACCHSs compared to

  18. The cost-effectiveness of grip on challenging behaviour: an economic evaluation of a care programme for managing challenging behaviour

    NARCIS (Netherlands)

    Zwijsen, S.A.; Bosmans, J.E.; Gerritsen, D.L.; Pot, A.M.; Hertogh, C.M.; Smalbrugge, M.

    2016-01-01

    OBJECTIVE: The objective of the study was to evaluate the cost-effectiveness of implementing the Grip on Challenging Behaviour care programme (GRIP) on dementia special care units in comparison with usual care. METHODS: A stepped wedge design was used. Challenging behaviour and quality of life were

  19. Cost-effectiveness of involving nurse specialists for adult patients with urinary incontinence in primary care compared to care-as-usual: an economic evaluation alongside a pragmatic randomized controlled trial.

    NARCIS (Netherlands)

    Albers-Heitner, C.P.; Joore, M.A.; Winkens, R.A.G.; Lagro-Janssen, A.L.M.; Severens, J.L.; Berghmans, L.C.M.

    2012-01-01

    AIMS: To determine the 12-month, societal cost-effectiveness of involving urinary incontinence (UI) nurse specialists in primary care compared to care-as-usual by general practitioners (GPs). METHODS: From 2005 until 2008 an economic evaluation was performed alongside a pragmatic multicenter randomi

  20. Public health interventions: evaluating the economic evaluations

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    Martin Forster

    2013-10-01

    Full Text Available Recent years have witnessed much progress in the incorporation of economic considerations into the evaluation of public health interventions. In England, the Centre for Public Health Excellence within the National Institute for Health and Care Excellence works to develop guidance for preventing illness and assessing which public health interventions are most effective and provide best value for money...

  1. The greatest happiness of the greatest number? Policy actors' perspectives on the limits of economic evaluation as a tool for informing health care coverage decisions in Thailand

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    Russell Steve

    2008-09-01

    Full Text Available Abstract Background This paper presents qualitative findings from an assessment of the acceptability of using economic evaluation among policy actors in Thailand. Using cost-utility data from two economic analyses a hypothetical case scenario was created in which policy actors had to choose between two competing interventions to include in a public health benefit package. The two competing interventions, laparoscopic cholecystectomy (LC for gallbladder disease versus renal dialysis for chronic renal disease, were selected because they highlighted conflicting criteria influencing the allocation of healthcare resources. Methods Semi-structured interviews were conducted with 36 policy actors who play a major role in resource allocation decisions within the Thai healthcare system. These included 14 policy makers at the national level, five hospital directors, ten health professionals and seven academics. Results Twenty six out of 36 (72% respondents were not convinced by the presentation of economic evaluation findings and chose not to support the inclusion of a proven cost-effective intervention (LC in the benefit package due to ethical, institutional and political considerations. There were only six respondents, including three policy makers at national level, one hospital director, one health professional and one academic, (6/36, 17% whose decisions were influenced by economic evaluation evidence. Conclusion This paper illustrates limitations of using economic evaluation information in decision making priorities of health care, perceived by different policy actors. It demonstrates that the concept of maximising health utility fails to recognise other important societal values in making health resource allocation decisions.

  2. Who can afford health care? Evaluating the socio-economic conditions and the ability to contribute to health care in a post-conflict area in DR Congo.

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    Sibylle Gerstl

    Full Text Available INTRODUCTION: The Democratic Republic of the Congo is today one of the poorest countries in the world; the health status of the population ranks among the worst in Sub-Saharan Africa. Public health services charge user fees and drug prices. Since 2008, north-eastern Congo is facing a guerrilla war. Malteser International is assisting with free health care for internally displaced persons as well as the general population. Before the incursion the health system was based on user fees. The aim of this study was to determine the socio-economic conditions of the population and to assess their ability to contribute to health care. METHODOLOGY: Heads of 552 randomly selected households in 23 clusters in two health zones were interviewed using a standardised questionnaire. FINDINGS: The demographic description and socio-economic conditions of the study population were homogenous. Major source of income was agriculture (57%; 47% of the households earned less than US$ 5.5/week. Ninety-two percent of the interviewed households estimated that they would be able to contribute to consultation fees (maximum amount of US$ 0.27 and 79% to the drug prices (maximum amount of US$ 1.10. Six percent opted for free consultations and 19% for free drugs. CONCLUSIONS: Living conditions were very basic; the estimated income of the study population was low. Almost half of the population perceived their current living situation as fairly good/good. More than 90% of the study population estimated to be able to contribute to consultation fees and 80% to drug prices. As a result Malteser International suggested introducing flat-rates for health care services. Once the project ends, the population will have to pay again for their health service. One solution would be the introduction of a health care financing system with the goal to reach universal coverage to health care.

  3. Systematic review of economic evaluations of human cell-derived wound care products for the treatment of venous leg and diabetic foot ulcers

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    Langer Astrid

    2009-07-01

    Full Text Available Abstract Background Tissue engineering is an emerging field. Novel bioengineered skin substitutes and genetically derived growth factors offer innovative approaches to reduce the burden of diabetic foot and venous leg ulcers for both patients and health care systems. However, they frequently are very costly. Based on a systematic review of the literature, this study assesses the cost-effectiveness of these growth factors and tissue-engineered artificial skin for treating chronic wounds. Methods On the basis of an extensive explorative search, an appropriate algorithm for a systematic database search was developed. The following databases were searched: BIOSIS Previews, CRD databases, Cochrane Library, EconLit, Embase, Medline, and Web of Science. Only completed and published trial- or model-based studies which contained a full economic evaluation of growth factors and bioengineered skin substitutes for the treatment of chronic wounds were included. Two reviewers independently undertook the assessment of study quality. The relevant studies were assessed by a modified version of the Consensus on Health Economic Criteria (CHEC list and a published checklist for evaluating model-based economic evaluations. Results Eleven health economic evaluations were included. Three biotechnology products were identified for which topical growth factors or bioengineered skin substitutes for the treatment of chronic leg ulceration were economically assessed: (1 Apligraf®, a bilayered living human skin equivalent indicated for the treatment of diabetic foot and venous leg ulcers (five studies; (2 Dermagraft®, a human fibroblast-derived dermal substitute, which is indicated only for use in the treatment of full-thickness diabetic foot ulcers (one study; (3 REGRANEX® Gel, a human platelet-derived growth factor for the treatment of deep neuropathic diabetic foot ulcers (five studies. The studies considered in this review were of varying and partly low

  4. Forecast model for the evaluation of economic resources employed in the health care of patients with HIV infection

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    Sacchi P

    2012-05-01

    Full Text Available Paolo Sacchi1, Savino FA Patruno1, Raffaele Bruno1, Serena Maria Benedetta Cima1, Pietro Previtali2, Alessia Franchini2, Luca Nicolini3, Carla Rognoni4, Lucia Sacchi5, Riccardo Bellazzi4, Gaetano Filice11Divisione di Malattie Infettive e Tropicali - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; 2Università degli Studi di Pavia – Facoltà di Economia, Pavia, Italy; 3Controllo di Gestione Fondazione IRCCS Policlinico San Matteo di Pavia, Pavia, Italy; 4Dipartimento di Informatica e Sistemistica, Universita' degli Studi di Pavia, Pavia, Italy; 5Department of Information Systems and Computing, Brunel University, London, UKBackground and aims: The total health care cost for human immunodeficiency virus (HIV patients has constantly grown in recent years. To date, there is no information about how this trend will behave over the next few years. The aim of the present study is to define a pharmacoeconomic model for the forecast of the costs of a group of chronically treated patients followed over the period 2004–2009.Methods: A pharmacoeconomics model was built to describe the probability of transition among different health states and to modify the therapy over time. A Markov model was applied to evaluate the temporal evolution of the average cost. The health care resources exploited during hospitalization were analyzed by using an “activity-based costing” method.Results: The Markov model showed that the mean total cost, after an initial increase, tended to remain stable. A total of 20 clinical records were examined. The average daily cost for each patient was EUR 484.42, with a cost for admission of EUR 6781.88.Conclusion: The treatment of HIV infection in compliance with the guidelines is also effective from the payer perspective, as it allows a good health condition to be maintained and reduces the need and the costs of hospitalizations.Keywords: health care cost, HIV, Markov model, activity-based costing

  5. Productivity Costs in Economic Evaluations

    NARCIS (Netherlands)

    H.M. Krol (Marieke)

    2012-01-01

    textabstractThe increase in health expenditures has raised important questions about the appropriate height of health care spending as well as the justification of these expenditures. One tool in the search of ensuring the optimal allocation of scarce societal and health care resources is economic e

  6. An economic evaluation alongside a randomized controlled trial evaluating an individually tailored lifestyle intervention compared with usual care in people with Familial Hypercholesterolemia

    NARCIS (Netherlands)

    Broekhuizen, K.; Wier, M.F. van; Koppes, L.L.J.; Brug, J.; Mechelen, W. van; Bosmans, J.E.; Poppel, M.N.

    2015-01-01

    Background: Cost-effectiveness analyses provide insight in the use of lifestyle interventions. To evaluate the cost-effectiveness of a lifestyle intervention compared to usual care in people with Familial Hypercholesterolemia, 340 people with FH were randomized to the intervention or control group.

  7. An economic evaluation alongside a randomized controlled trial evaluating an individually tailored lifestyle intervention compared with usual care in people with Familial Hypercholesterolemia.

    NARCIS (Netherlands)

    Broekhuizen, K.; Wier, M.F. van; Koppes, L.L.J.; Brug, J.; Mechelen, W. van; Bosmans, J.E.; Poppel, M.N.M. van

    2015-01-01

    Background: Cost-effectiveness analyses provide insight in the use of lifestyle interventions. To evaluate the cost-effectiveness of a lifestyle intervention compared to usual care in people with Familial Hypercholesterolemia, 340 people with FH were randomized to the intervention or control group.

  8. Accountable Care Organizations and Transaction Cost Economics.

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    Mick, Stephen S Farnsworth; Shay, Patrick D

    2016-12-01

    Using a Transaction Cost Economics (TCE) approach, this paper explores which organizational forms Accountable Care Organizations (ACOs) may take. A critical question about form is the amount of vertical integration that an ACO may have, a topic central to TCE. We posit that contextual factors outside and inside an ACO will produce variable transaction costs (the non-production costs of care) such that the decision to integrate vertically will derive from a comparison of these external versus internal costs, assuming reasonably rational management abilities. External costs include those arising from environmental uncertainty and complexity, small numbers bargaining, asset specificity, frequency of exchanges, and information "impactedness." Internal costs include those arising from human resource activities including hiring and staffing, training, evaluating (i.e., disciplining, appraising, or promoting), and otherwise administering programs. At the extreme, these different costs may produce either total vertical integration or little to no vertical integration with most ACOs falling in between. This essay demonstrates how TCE can be applied to the ACO organization form issue, explains TCE, considers ACO activity from the TCE perspective, and reflects on research directions that may inform TCE and facilitate ACO development.

  9. An Economic Evaluation of TENS in Addition to Usual Primary Care Management for the Treatment of Tennis Elbow: Results from the TATE Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Martyn Lewis

    Full Text Available The TATE trial was a multicentre pragmatic randomized controlled trial of supplementing primary care management (PCM-consisting of a GP consultation followed by information and advice on exercises-with transcutaneous electrical nerve stimulation (TENS, to reduce pain intensity in patients with tennis elbow. This paper reports the health economic evaluation.Adults with new diagnosis of tennis elbow were recruited from 38 general practices in the UK, and randomly allocated to PCM (n = 120 or PCM plus TENS (n = 121. Outcomes included reduction in pain intensity and quality-adjusted-life-years (QALYs based on the EQ5D and SF6D. Two economic perspectives were evaluated: (i healthcare-inclusive of NHS and private health costs for the tennis elbow; (ii societal-healthcare costs plus productivity losses through work absenteeism. Mean outcome and cost differences between the groups were evaluated using a multiple imputed dataset as the base case evaluation, with uncertainty represented in cost-effectiveness planes and through probabilistic cost-effectiveness acceptability curves. Incremental healthcare cost was £33 (95%CI -40, 106 and societal cost £65 (95%CI -307, 176 for PCM plus TENS. Mean differences in outcome were: 0.11 (95%CI -0.13, 0.35 for change in pain (0-10 pain scale; -0.015 (95%CI -0.058, 0.029 for QALYEQ5D; 0.007 (95%CI -0.022, 0.035 for QALYSF6D (higher score differences denote greater benefit for PCM plus TENS. The ICER (incremental cost effectiveness ratio for the main evaluation of mean difference in societal cost (£ relative to mean difference in pain outcome was -582 (95%CI -8666, 8113. However, incremental ICERs show differences in cost-effectiveness of additional TENS, according to the outcome being evaluated.Our findings do not provide evidence for or against the cost-effectiveness of TENS as an adjunct to primary care management of tennis elbow.

  10. Value for money: economic evaluation of two different caries prevention programmes compared with standard care in a randomized controlled trial

    NARCIS (Netherlands)

    J.H. Vermaire; C. van Loveren; W.B.F. Brouwer; M. Krol

    2014-01-01

    A cost-effectiveness analysis was conducted during a 3-year randomized controlled clinical trial in a general dental practice in the Netherlands in which 230 6-year-old children (± 3 months) were assigned to either regular dental care, an increased professional fluoride application (IPFA) programme

  11. Value for Money: Economic Evaluation of Two Different Caries Prevention Programmes Compared with standard Care in a Randomized Controlled Trial

    NARCIS (Netherlands)

    Vermaire, J.H.; Loveren, C. van; Brouwer, W.B.F.; Krol, M.

    2014-01-01

    A cost-effectiveness analysis was conducted during a 3-year randomized controlled clinical trial in a general dental practice in the Netherlands in which 230 6-year-old children (± 3 months) were assigned to either regular dental care, an increased professional fluoride application (IPFA) programme

  12. Economic evaluation of angiographic interventions including a whole-radiology in- and outpatient care; Wirtschaftliche Evaluation angiographischer Interventionen einschliesslich einer radiologischen stationaeren und ambulanten Patientenbetreuung

    Energy Technology Data Exchange (ETDEWEB)

    Nolte-Ernsting, C.; Abel, K.; Krupski, G.; Lorenzen, J.; Adam, G. [Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie, Universitaetsklinikum Hamburg-Eppendorf (Germany)

    2006-01-01

    Purpose: To determine the economic efficiency of a whole-radiology in- and outpatient treatment with angiographic interventions performed as the main or sole therapy. Materials and Methods: The calculations represent the data of a university radiology department, including the following angiographic interventions (neuroradiology not considered): Vascular intervention (PTA, stent implantation) of kidneys and extremities, recanalization of hemodialysis access, chemoembolization, diagnostic arterioportal liver CT, port implantation, varicocele embolization, PTCD, percutaneous implantation of biliary stent. First, the different angiographic interventions are categorized with reference to the German DRG system 2005. Considering the example of a university hospital, the individual cost of each intervention is calculated and correlated with reimbursements by G-DRG2005 and so-called ''ambulant operation'' (EBM200plus). With these data, profits and losses are calculated for both in- and outpatient care. Results: Radiologic interventions of inpatients yield a profit in the majority of cases. With a base rate of 2900 Euro, the profits in our university hospital range between -872 Euro and +3411 Euro (mean: +1348 Euro). On the other hand, those angiographic interventions suitable for ''ambulant operation'' generate average profits of +372 Euro, if only direct costs are considered. The data of outpatient radiological interventions average between 381 Euro up to 1612 Euro lower than compared with profits obtained from in patient care. (orig.)

  13. Understanding the essentials of economic evaluation.

    Science.gov (United States)

    Schmid, G P

    1995-01-01

    Economic evaluation (EE) answers the following simple question: "From which course of action do we get the most value for our money?" We ask this question because resources are always limited, i.e., we never have enough money to do all the things we would like to do. Three types of economic evaluations are used: cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis. Although all involve a monetary and outcome comparison of two or more courses of action, the methodologies and outcomes of each type vary, making each one particularly suited for specific and different indications. Although the performance of an EE may be complex, its concept is intuitively simple. Understanding the basic elements of economic analysis is more and more important to all health-care providers because health-care policy makers at all levels are increasingly using EE for allocating resources.

  14. Using Economic Methods Evaluatively

    Science.gov (United States)

    King, Julian

    2017-01-01

    As evaluators, we are often asked to determine whether policies and programs provide value for the resources invested. Addressing that question can be a quandary, and, in some cases, evaluators question whether cost-benefit analysis is fit for this purpose. With increased interest globally in social enterprise, impact investing, and social impact…

  15. Measurement of costs for health economic evaluation.

    Science.gov (United States)

    Riewpaiboon, Arthorn

    2014-05-01

    The provision of guidelines on cost measurement for health economic evaluations enable research to be more standardized and hence more comparable, which offers clear benefits for policy formulation and health management. The guidelines herein focus on three aspects-the cost of health intervention/health care programs, the cost of illness/health risks, and use of costs in health economic evaluation. For each aspect, the main concepts and methods are outlined, and recommendations for the Thai context are presented. There is particular focus on how to calculate various costs according to different evaluation methods and perspectives, how to evaluate source of cost data, how to make value adjustments and how to present cost measurement findings.

  16. Approaches to economic evaluations of stroke rehabilitation.

    Science.gov (United States)

    Craig, Louise E; Wu, Olivia; Bernhardt, Julie; Langhorne, Peter

    2014-01-01

    Many stroke rehabilitation services and interventions are complex in that they involve a number of components, interactions, and outcomes. Much of the onus of stroke care lies with rehabilitation services and because stroke rehabilitation is highly resource intensive, it is important for policy makers to consider the potential trade-offs between all relevant costs and benefits. The primary aim of this systematic review was to assess the methods used to conduct economic evaluations of stroke rehabilitation. Studies that compared two or more alternative stroke rehabilitation interventions or services with the costs and outcomes being examined for each alternative were included. EMBASE, MEDLINE In-Process, and National Health Service's Economic Evaluation Database were searched using search strategies. The methodological quality of the included studies was appraised using a checklist for the conduct and reporting of economic evaluations. Twenty-one studies met the selection criteria. The economic evaluations in the majority of these studies were inadequate based on their ability to identify, measure, and value all resources and benefits pertinent to the complexity of stroke rehabilitation. This study highlights that complex interventions such as stroke rehabilitation have widespread effects, which may not be represented by the changes on a single outcome. This study recommends the adoption of a wider cost and benefit perspective in the economic evaluations of complex interventions. It supports a move away from conventional economic evaluation and decision making, based purely on cost-effectiveness, toward multicriteria decision analysis frameworks for complex interventions, where a broader range of criteria may be assessed by policy makers.

  17. The economic value of health care data.

    Science.gov (United States)

    Harper, Ellen M

    2013-01-01

    The amount of health care data in our world has been exploding, and the ability to store, aggregate, and combine data and then use the results to perform deep analyses have become ever more important. "Big data," large pools of data that can be captured, communicated, aggregated, stored, and analyzed, are now part of every sector and function of the global economy. While most research into big data thus far has focused on the question of their volume, there is evidence that the business and economic possibilities of big data and their wider implications are important for consideration. It is even offering the possibility that health care data could become the most valuable asset over the next 5 years as "secondary use" of electronic health record data takes off.

  18. Economic value evaluation in disease management programs.

    Science.gov (United States)

    Magnezi, Racheli; Reicher, Sima; Shani, Mordechai

    2008-05-01

    Chronic disease management has been a rapidly growing entity in the 21st century as a strategy for managing chronic illnesses in large populations. However, experience has shown that disease management programs have not been able to demonstrate their financial value. The objectives of disease management programs are to create quality benchmarks, such as principles and guidelines, and to establish a uniform set of metrics and a standardized methodology for evaluating them. In order to illuminate the essence of disease management and its components, as well as the complexity and the problematic nature of performing economic calculations of their profitability and value, we collected data from several reports that dealt with the economic intervention of disease management programs. The disease management economic evaluation is composed of a series of steps, including the following major categories: data/information technology, information generation, assessment/recommendations, actionable customer plans, and program assessment/reassessment. We demonstrate the elements necessary for economic analysis. Disease management is one of the most innovative tools in the managed care environment and is still in the process of being defined. Therefore, objectives should include the creation of quality measures, such as principles and guidelines, and the establishment of a uniform set of metrics and a standardized methodology for evaluating them.

  19. Cost effectiveness of amoxicillin for lower respiratory tract infections in primary care : An economic evaluation accounting for the cost of antimicrobial resistance

    NARCIS (Netherlands)

    Oppong, Raymond; Smith, Richard D.; Little, Paul; Verheij, Theo; Butler, Christopher C.; Goossens, Herman; Coenen, Samuel; Moore, Michael; Coast, Joanna

    2016-01-01

    Background Lower respiratory tract infections (LRTIs) are a major disease burden and are often treated with antibiotics. Typically, studies evaluating the use of antibiotics focus on immediate costs of care, and do not account for the wider implications of antimicrobial resistance. Aim This study so

  20. Ghana--medical care amid economic problems.

    Science.gov (United States)

    Bacon, L

    1980-07-01

    Describing the pattern of disease encountered in primary health care (PHC) in Ghana and the facilities available to treat it, this discussion provides an account of the rapidly deteriorating economic situation and its effects on the inhabitants and on medical practice. During the 1977-79 period Ghana suffered severe economic and political difficulties, affecting work at the University Hospital in Legon, Ghana. The workload differs from that in developed countries in several ways: tropical diseases are common; the diseases of proverty are rife; diseases due to poor public health and an absence of some diseases, e.g., myocardial infarct and multiple sclerosis. There is no equivalent of the British general practioner, but there are 4 main sources of care: 54 government hospitals with 137 health centrs and health posts distributed around the country; 57 private but relatively low cost hospitals and clinics; exclusive, high cost private clinics; and traditional healers and herbalists practicing their art. Between 1976-79 the economy of Ghana went into a steep decline. Exact figures for inflation are difficult to come by; 15% per year was popularly quoted. The cedi (the Ghanaian unit of currency) was officially devalued. Goods became very scarce as well as expensive. Basic food items, spare parts for vehicles and other machinery, petroleum products, soap, and all medical supplies were hard to obtain. There was public unrest during this period. Strikes became frequent. Notable from the health perspective was a strike of all professionals, including doctors, in June 1977, strikes of government employed nurses in April 1978 and May 1979. The main events were 3 changes of government. Although exact data are not easy to obtain, the diseases of poverty appeared to be on the increase. Lack of money tended to keep those not entitled to free treatment away from private hospitals, but the deteriorating situation at the clinics seemed to more than compensate for this. Shortages

  1. Industry-sponsored economic studies in critical and intensive care versus studies sponsored by nonprofit organizations.

    Science.gov (United States)

    Hartmann, Michael; Knoth, Holger; Schulz, Diane; Knoth, Sven; Meier-Hellmann, Andreas

    2003-01-01

    The purpose of this analysis of health economic studies in the field of intensive and critical care was to investigate whether any relationship could be established between type of sponsorship and (1) type of economic analysis, (2) health technology assessed, (3) sensitivity analysis performed, (4) publication status, and (5) qualitative cost assessment. Using the terms critical care or intensive care, all health economics publications in the field of critical and intensive care were identified in the Health Economic Evaluations Database (HEED, Version 1995-2001) on the basis of sponsorship and comparative studies. This search yielded a total of 42 eligible articles. Their evaluations were prepared independently by 2 investigators on the basis of specific criteria. When evaluators disagreed, a third investigator provided a deciding evaluation. There was no statistically demonstrable relationship between types of sponsorship and sensitivity analysis performed, publication status, types of economic analysis, or qualitative cost assessment.

  2. [Telemedicine in acute stroke care--a health economics view].

    Science.gov (United States)

    Günzel, F; Theiss, S; Knüppel, P; Halberstadt, S; Rose, G; Raith, M

    2010-05-01

    Specialized stroke units offer optimal treatment of patients with an acute stroke. Unfortunately, their installation is limited by an acute lack of experienced neurologists and the small number of stroke patients in sparsely populated rural areas. This problem is increasingly being solved by the use of telemedicine, so that neurological expertise is made available to basic and regular care. It has been demonstrated by national and international pilot studies that solidly based and rapid decisions can be made by telemedicine regrading the use of thrombolysis, as the most important acute treatment, but also of other interventions. So far studies have only evaluated improvement in the quality of care achieved by networking, but not of any lasting effect on any economic benefit. Complementary to a medical evaluation, the qualitative economic assessment presented here of German and American concepts of telemetric care indicate no difference in efficacy between various ways of networking. Most noteworthy, when comparing two large American and German studies, is the difference in their priorities. While the American networks achieved targeted improvements in efficacy of care that go beyond the immediate wishes of the doctors involved, this was of only secondary importance in the German studies. Also, in contrast to several American networks, the German telemetry networks have not tended to be organized for future growth. In terms of economic benefits, decentralized organized networks offer a greater potential of efficacy than purely local ones. Furthermore, the integration of inducements into the design of business models is a fundamental factor for achieving successful and lasting existence, especially within a highly competitive market.

  3. Considerations for planning and evaluating economic analyses of telemental health.

    Science.gov (United States)

    Luxton, David D

    2013-08-01

    The economic evaluation of telemental health (TMH) is necessary to inform ways to decrease the cost of delivering care, to improve access to care, and to make decisions about the allocation of resources. Previous reviews of telehealth economic analysis studies have concluded that there are significant methodological deficiencies and inconsistencies that limit the ability to make generalized conclusions about the costs and benefits of telehealth programs. Published economic evaluations specific to TMH are also limited. There are unique factors that influence costs in TMH that are necessary for those who are planning and evaluating economic analyses to consider. The purpose of this review is to summarize the main problems and limitations of published economic analyses, to discuss considerations specific to TMH, and to inform and encourage the economic evaluation of TMH in both the public and private sectors. The topics presented here include perspective of costs, direct and indirect costs, and technology, as well as research methodology considerations. The integration of economic analyses into effectiveness trials, the standardization of outcome measurement, and the development of TMH economic evaluation guidelines are recommended.

  4. Protocol for an economic evaluation alongside the University Health Network Whiplash Intervention Trial: cost-effectiveness of education and activation, a rehabilitation program, and the legislated standard of care for acute whiplash injury in Ontario

    Directory of Open Access Journals (Sweden)

    van der Velde Gabrielle

    2011-07-01

    Full Text Available Abstract Background Whiplash injury affects 83% of persons in a traffic collision and leads to whiplash-associated disorders (WAD. A major challenge facing health care decision makers is identifying cost-effective interventions due to lack of economic evidence. Our objective is to compare the cost-effectiveness of: 1 physician-based education and activation, 2 a rehabilitation program developed by Aviva Canada (a group of property and casualty insurance providers, and 3 the legislated standard of care in the Canadian province of Ontario: the Pre-approved Framework Guideline for Whiplash developed by the Financial Services Commission of Ontario. Methods/Design The economic evaluation will use participant-level data from the University Health Network Whiplash Intervention Trial and will be conducted from the societal perspective over the trial's one-year follow-up. Resource use (costs will include all health care goods and services, and benefits provided during the trial's 1-year follow-up. The primary health effect will be the quality-adjusted life year. We will identify the most cost-effective intervention using the incremental cost-effectiveness ratio and incremental net-benefit. Confidence ellipses and cost-effectiveness acceptability curves will represent uncertainty around these statistics, respectively. A budget impact analysis will assess the total annual impact of replacing the current legislated standard of care with each of the other interventions. An expected value of perfect information will determine the maximum research expenditure Canadian society should be willing to pay for, and inform priority setting in, research of WAD management. Discussion Results will provide health care decision makers with much needed economic evidence on common interventions for acute whiplash management. Trial Registration http://ClinicalTrials.gov identifier NCT00546806 [Trial registry date: October 18, 2007; Date first patient was randomized: February

  5. A Framework for Including Family Health Spillovers in Economic Evaluation.

    Science.gov (United States)

    Al-Janabi, Hareth; van Exel, Job; Brouwer, Werner; Coast, Joanna

    2016-02-01

    Health care interventions may affect the health of patients' family networks. It has been suggested that these "health spillovers" should be included in economic evaluation, but there is not a systematic method for doing this. In this article, we develop a framework for including health spillovers in economic evaluation. We focus on extra-welfarist economic evaluations where the objective is to maximize health benefits from a health care budget (the "health care perspective"). Our framework involves adapting the conventional cost-effectiveness decision rule to include 2 multiplier effects to internalize the spillover effects. These multiplier effects express the ratio of total health effects (for patients and their family networks) to patient health effects. One multiplier effect is specified for health benefit generated from providing a new intervention, one for health benefit displaced by funding this intervention. We show that using multiplier effects to internalize health spillovers could change the optimal funding decisions and generate additional health benefits to society.

  6. Economic evaluation of Internet-based problem-solving guided self-help treatment in comparison with enhanced usual care for depressed outpatients waiting for face-to-face treatment

    DEFF Research Database (Denmark)

    Kolovos, Spyros; Kenter, Robin M F; Bosmans, Judith E

    2016-01-01

    at outpatient clinics. METHODS: An economic evaluation was performed alongside a randomized controlled trial with 12 months follow-up. Outcomes were improvement in depressive symptom severity (measured by CES-D), response to treatment and Quality-Adjusted Life-Years (QALYs). Statistical uncertainty around cost...... differences and incremental cost-effectiveness ratios were estimated using bootstrapping. RESULTS: Mean societal costs for the intervention group were €1579 higher than in usual care, but this was not statistically significant (95% CI - 1395 to 4382). Cost-effectiveness acceptability curves showed...

  7. Economic evaluation of the CARDS study

    Directory of Open Access Journals (Sweden)

    Simona de Portu

    2006-09-01

    Full Text Available Introduction: cardiovascular diseases (CVD are the major component of premature mortality, generate disability and are a relevant source of cost. The growing incidence of CVD is associated with lifestyle and other modifiable risk factors. Prevention and preclinical detection of CVD reduce morbidity and mortality. Type 2 diabetes is associated with a substantially increased risk of cardiovascular disease. Objective: the aim of the study was to evaluate the health economic consequence of medical therapy with atorvastatin for primary prevention of major cardiovascular events in patients with type 2 diabetes in Italy. Materials and method: in order to reach our objective we drew clinical information from the CARDS study. This economic evaluation was carried out conducting a cost/effectiveness analysis from the perspective of National Health Service (NHS. The analysis was applied to a time horizon in conformity with the observational period adopted in the CARDS study (3.9 years. An incremental cost/effectiveness ratio (ICER was calculated and is expressed as cost per life years gained (LYG. In order to test the robustness of the results, a one-way sensitivity analysis was performed. Results: the total cost of atorvastatin therapy over 3.9 years amounts to around 1.5 million of euros per 1,000 patients. The total cost of adding atorvastatin to standard care in people treated for primary prevention of major cardiovascular events in type 2 diabetes as those involved in the CARDS study would entail an additional cost of about 1,2 million of euros per 1,000 patients treated per 3.9 years, with an incremental cost/effectiveness ratio (ICER equivalent to 36,566 euros per patient per LYG. Discussion: the current study is the first economic evaluation of CARDS study to the Italian situation. The results of the current study show that hypolipemic therapy with atorvastatin 10 mg in diabetic individuals is to be considered cost effective.

  8. [Evaluation of the effectiveness of health care].

    Science.gov (United States)

    Strnad, L

    1990-01-01

    During the last two decades, the economic aspects of health care acquired an outstanding attentiveness in all developed countries. Simultaneously, the methods have been searched for a more intensive and perfect application of internal health sources, i.e. manpower, materials and money. New approaches in evaluating health care efficacy (conception of health provision as a branch of national economy) have been made. In accord with them, the efficiency of either individual or partial health actions such as health care programs, preventive measures, diagnostical and curative procedures etc.) is measured. All these questions are the up to date topic for Health care of Czechoslovakia which now is far to dispose of sources comparable with the majority of economically developed countries in Europe. At present, they are approximately similar in supplying 1 person health care needs with 500-1000 dol. a year and even more in several countries, whereas Czechoslovakia spends about 200 dol. on health needs of 1 inhabitant a year. This fact is closely connected with relatively low efficacy of our economy incapable to produce the sufficient sources for providing health care on one hand, and on the other it is due both to the budgetary politics as practiced now and the conception of national product division. The shortage in Health care sources is manifested mainly in retardation of material and technical base of health service altogether with low levelled renumeration of health workers consequential in psychologic, social and political problems. The consequences of this condition are reflected negatively in a level of health service provision. This is as far important as the czechoslovac population health status viewed from the so-called strategic health indices (averaged life expectancy, specific mortality, occurrence of cardiovascular diseases and malignancies etc.) is not favourable due to a number of factors, and its improvement will require considerable efforts from both the

  9. Economic evaluation of CISM : a pilot study

    DEFF Research Database (Denmark)

    Vogt, Joachim

    2004-01-01

    air traffic controllers, critical incident stress management, CISM, critical incidents, critical incident stress, cost-benefit-analysis, economic evaluation, efficiency, return on investment......air traffic controllers, critical incident stress management, CISM, critical incidents, critical incident stress, cost-benefit-analysis, economic evaluation, efficiency, return on investment...

  10. ECONOMIC THEORY OF LOBBYING: EVALUATION OF ECONOMIC EFFICIENCY

    Directory of Open Access Journals (Sweden)

    Tolstyh Pavel Aleksandrovich

    2013-01-01

    Full Text Available In this article the author continues to analyze lobbying with regards to economic paradigm. [The author has started discussing lobbying in terms of economic theory in the article Politico-economic theory of lobbying / / Historical, philosophical, political and legal sciences, culture and art. Theory and practice. Tambov: Gramota, 2013. No 1. Part 2. p. 177-189.] Researcher evaluates the cost effectiveness of the lobbying function. Lobbying is understood as activity of specifically authorized employees of corporations and lobbying firms representing their interests, trade associations. This activity is aimed at improving the profitability of integrated and sustainable business development by representing long-term, comfortable, predictable system of relationships with the relevant field-specific political stakeholders of the federal and regional levels. The article presents an in-depth analysis of economic concepts of lobbying function.

  11. ECONOMIC THEORY OF LOBBYING: EVALUATION OF ECONOMIC EFFICIENCY

    Directory of Open Access Journals (Sweden)

    Павел Александрович Толстых

    2013-04-01

    Full Text Available In this article the author continues to analyze lobbying with regards to economic paradigm. [The author has started discussing lobbying in terms of economic theory in the article Politico-economic theory of lobbying / / Historical, philosophical, political and legal sciences, culture and art. Theory and practice. Tambov: Gramota, 2013. No 1. Part 2. p. 177-189.] Researcher evaluates the cost effectiveness of the lobbying function. Lobbying is understood as activity of specifically authorized employees of corporations and lobbying firms representing their interests, trade associations. This activity is aimed at improving the profitability of integrated and sustainable business development by representing  long-term, comfortable, predictable system of relationships with the relevant field-specific political stakeholders of the federal and regional levels. The article presents an in-depth analysis of economic concepts of lobbying function.DOI: http://dx.doi.org/10.12731/2218-7405-2013-1-3

  12. Economic analysis of health care interventions.

    Science.gov (United States)

    Konski, Andre

    2008-07-01

    According to US government statistics, health care expenditures approached $2 trillion in 2005 or $6,697/person, with spending expected to exceed $4.1 trillion by 2016 (http://www.cms.hhs.gov/NationalHealthExpendData/). Total Centers for Medicare and Medicaid Services spending (including Medicaid, State Children's Health Insurance Program (SCHIP), and Medicare) was $660.7 million in 2005. Despite the decline in the growth rate of health care spending growth over the past 4 years, health care spending increased 6.9% from 2004 to 2005 and was 16% of the gross domestic product (GDP) in 2005 and forecasted to be 19.6% of the GDP by 2016. Although the percentage of GDP may not concern providers of health care products or services, it has an affect on the rest of the economy. Spending on health care by employers or patients increases the cost of the products produced, making goods produced here in the United States less attractive to world markets in the age of globalization in addition to leaving less money for patients to spend on other goods and services or save.

  13. Economic evaluations in gastroenterology in Brazil: A systematic review

    Institute of Scientific and Technical Information of China (English)

    Luciana Bertocco de Paiva Haddad; Tassia Cristina Decimoni; Jose Antonio Turri; Roseli Leandro; Patrícia Coelho de Soárez

    2016-01-01

    AIM: To systematically review economic evaluations in gastroenterology, relating to Brazil, published between 1980 and 2013. METHODS: We selected full and partial economic evaluations from among those retrieved by searching the following databases: MEDLINE(PubM ed); Excerpta Medica; the Latin American and Caribbean Health Sciences Literature database; the Scientific Electronic Library Online; the database of the Centre for Reviews and Dissemination; the National Health Service(NHS) Economic Evaluation Database; the NHS Health Technology Assessment database; the Health Economics database of the Brazilian Virtual Library of Health; Scopus; Web of Science; and the Brazilian Network for the Evaluation of Health Technologies. Two researchers, working independently, selected the studies and extracted the data. RESULTS: We ide nt if ie d 535 he alt h e c onomic evaluations relating to Brazil and published in the 1980-2013 period. Of those 535 articles, only 40 dealt with gastroenterology. Full and partial economic evaluations respectively accounted for 23(57.5%) and 17(42.5%) of the 40 studies included. Among the 23 full economic evaluations, there were 11 cost-utility analyses, seven cost-effectiveness analyses, four costconsequence analyses, and one cost-minimization analysis. Of the 40 studies, 25(62.5%) evaluated medications; 7(17.5%) evaluated procedures; and 3(7.5%) evaluated equipment. Most(55%) of the studies were related to viral hepatitis, and most(63.4%) were published after 2010. Other topics included gastrointestinal cancer, liver transplantation, digestive diseases and hernias. Over the 33-year period examined, the number of such economic evaluations relating to Brazil, especially of those evaluating medications for the treatment of hepatitis, increased considerably. CONCLUSION: Further studies are needed in order to ensure that expenditures on health care in Brazil are made as fairly and efficiently as possible.

  14. [Empirical standard costs for health economic evaluation in Germany -- a proposal by the working group methods in health economic evaluation].

    Science.gov (United States)

    Krauth, C; Hessel, F; Hansmeier, T; Wasem, J; Seitz, R; Schweikert, B

    2005-10-01

    Measurement of health care costs is a crucial task in health economic evaluation. Various guidelines with different amount of details have been set up for costing methods in economic evaluation which, however, do not precisely stipulate how to value resource consumption. In this article we present a proposal for the standardisation of the monetary valuation of health care utilisation occurring in the follow up period after the actual intervention to be evaluated. From a societal perspective the primary direct and indirect cost components are considered, such as outpatient medical care, pharmaceuticals, non-physician health services, inpatient care, days of sick leave and early retirement due to sickness. The standard costs are based on administrative charges and rates or on official statistics. They are based on the most current data sources which are mainly from 2002 and 2003. This system of standard costs aims at an average valuation of resource consumption. This makes for the comparability of different health economic studies. Most standard costs are not based on market prices but on administratively specified charges and rates. This implies that institutional changes which are quite common in the health care system, may also affect the valuation rates, for example the introduction of DRGs. This should be taken into account when updating the system of standard costs.

  15. Economic evaluation and mental health: sparse past. fertile future?

    Science.gov (United States)

    Knapp, Martin

    1999-12-01

    BACKGROUND: Demands for economic inputs to mental health policy-making, practice decisions and research evaluations have grown considerably in recent years, but the overall supply response has been modest and uneven. AIMS: This paper examines the key historical phases in the development of mental health economics research, and what they imply for the way economics is received and employed. Focusing on the quest for cost-effectiveness, the paper considers challenges for mental health economics. METHODS: An informal review of the growing demand for mental health economics (and how that demand has been expressed), and how economists have responded. RESULTS: Five historical development phases characterize this growth. Initially, the dominant feature is innocence or neglect of scarcity. Cost measures are rarely calculated, cost-effectiveness is not part of the decision-making lexicon and the potential for inefficiency is huge. In the second phase, innocence turns to criticism of attempts to introduce resource rationality, and many clinicians actively reject economics. Health is seen as priceless, and not to be compromised by the pursuit of efficiency. After a period of reluctance there follows impetuosity as the need for economic insights is recognized, but the search for data is desperate and undiscriminating. Poor quality research is conducted, with the risk that decisions are misinformed and perhaps damaging. Once again, resources are inappropriately used. Next follows the constructive development phase: previous mistakes are appreciated and the standards of evaluation improve markedly. Studies are better designed, more likely to be integrated into clinical or policy evaluations, carefully conducted and sensibly interpreted. Inefficiency should be reduced, along with inequity. Finally, there is perhaps a nirvana-like fifth phase in which sophisticated economic studies are widely undertaken, where systematic reviews and meta-analyses help to reveal the wider picture

  16. Dairy plants financial and economic security evaluation

    Directory of Open Access Journals (Sweden)

    Ganna Misko

    2015-06-01

    Full Text Available The essence of the concept “financial and economic security of the enterprise” is covered. Methodological approaches to the enterprise financial and economic security evaluation are considered, enabling the method of index numberrating score of the enterprise financial and economic security to be found. Dynamics of milk anddairy production in Ukraine has been studied. Ukrainian regions leading in liquid processed milk production have been identified. Dynamics of milk and dairy production per man has been analyzed which allowed to find out the annual increase in demand per man. Integrated index of the dairy enterprise financial and economic security has been evaluated. As a result, the ways to increase the managerial efficiency of financial and economic security of the following enterprises:PJSC "Dubnomoloko", PJSC "Kupyans'ki milk canning plant", PJSC the "Yagotyns'ki creamery", PJSC the "Pervomais'ki milk canning plant" are offered.

  17. Prevention of fall incidents in patients with a high risk of falling: design of a randomised controlled trial with an economic evaluation of the effect of multidisciplinary transmural care

    Directory of Open Access Journals (Sweden)

    Bouter Lex M

    2007-07-01

    Full Text Available Abstract Background Annually, about 30% of the persons of 65 years and older falls at least once and 15% falls at least twice. Falls often result in serious injuries, such as fractures. Therefore, the prevention of accidental falls is necessary. The aim is to describe the design of a study that evaluates the efficacy and cost-effectiveness of a multidisciplinary assessment and treatment of multiple fall risk factors in independently living older persons with a high risk of falling. Methods/Design The study is designed as a randomised controlled trial (RCT with an economic evaluation. Independently living persons of 65 years and older who recently experienced a fall are interviewed in their homes and screened for risk of recurrent falling using a validated fall risk profile. Persons at low risk of recurrent falling are excluded from the RCT. Persons who have a high risk of recurrent falling are blindly randomised into an intervention (n = 100 or usual care (n = 100 group. The intervention consists of a multidisciplinary assessment and treatment of multifactorial fall risk factors. The transmural multidisciplinary appraoch entails close cooperation between geriatrician, primary care physician, physical therapist and occupational therapist and can be extended with other specialists if relevant. A fall calendar is used to record falls during one year of follow-up. Primary outcomes are time to first and second falls. Three, six and twelve months after the home visit, questionnaires for economic evaluation are completed. After one year, during a second home visit, the secondary outcome measures are reassessed and the adherence to the interventions is evaluated. Data will be analysed according to the intention-to-treat principle and also an on-treatment analysis will be performed. Discussion Strengths of this study are the selection of persons at high risk of recurrent falling followed by a multidisciplinary intervention, its transmural character and

  18. Economic evaluation of enhanced asthma management: a systematic review

    Directory of Open Access Journals (Sweden)

    Yong YV

    2014-12-01

    Full Text Available Objectives: To evaluate and compare full economic evaluation studies on the cost-effectiveness of enhanced asthma management (either as an adjunct to usual care or alone vs. usual care alone. Methods: Online databases were searched for published journal articles in English language from year 1990 to 2012, using the search terms ‘“asthma” AND (“intervene” OR “manage” AND (“pharmacoeconomics” OR “economic evaluation” OR “cost effectiveness” OR “cost benefit” OR “cost utility”’. Hand search was done for local publishing. Only studies with full economic evaluation on enhanced management were included (cost consequences (CC, cost effectiveness (CE, cost benefit (CB, or cost utility (CU analysis. Data were extracted and assessed for the quality of its economic evaluation design and evidence sources. Results: A total of 49 studies were included. There were 3 types of intervention for enhanced asthma management: education, environmental control, and self-management. The most cost-effective enhanced management was a mixture of education and self-management by an integrated team of healthcare and allied healthcare professionals. In general, the studies had a fair quality of economic evaluation with a mean QHES score of 73.7 (SD=9.7, and had good quality of evidence sources. Conclusion: Despite the overall fair quality of economic evaluations but good quality of evidence sources for all data components, this review showed that the delivered enhanced asthma managements, whether as single or mixed modes, were overall effective and cost-reducing. Whilst the availability and accessibility are an equally important factor to consider, the sustainability of the cost-effective management has to be further investigated using a longer time horizon especially for chronic diseases such as asthma.

  19. Applying the AHP in health economic evaluations of new technology

    NARCIS (Netherlands)

    Hummel, Marjan; Steuten, Lotte; Groothuis-Oudshoorn, Karin; IJzerman, Maarten

    2011-01-01

    Much research in health care is devoted to health economical modelling. Even though the Analytic Hierarchy Process (AHP) is increasingly being applied in health care, its value to health economical modelling is still unrecognized. We explored the value of using AHP-derived results in a health econom

  20. An economic evaluation of solar radiation management

    Energy Technology Data Exchange (ETDEWEB)

    Aaheim, Asbjørn; Romstad, Bård; Wei, Taoyuan [CICERO — Center for International Climate and Environmental Research Oslo (Norway); Kristjánsson, Jón Egill; Muri, Helene [Department of Geosciences, University of Oslo (Norway); Niemeier, Ulrike; Schmidt, Hauke [Max Planck Institute for Meteorology, Hamburg (Germany)

    2015-11-01

    Economic evaluations of solar radiation management (SRM) usually assume that the temperature will be stabilized, with no economic impacts of climate change, but with possible side-effects. We know from experiments with climate models, however, that unlike emission control the spatial and temporal distributions of temperature, precipitation and wind conditions will change. Hence, SRM may have economic consequences under a stabilization of global mean temperature even if side-effects other than those related to the climatic responses are disregarded. This paper addresses the economic impacts of implementing two SRM technologies; stratospheric sulfur injection and marine cloud brightening. By the use of a computable general equilibrium model, we estimate the economic impacts of climatic responses based on the results from two earth system models, MPI-ESM and NorESM. We find that under a moderately increasing greenhouse-gas concentration path, RCP4.5, the economic benefits of implementing climate engineering are small, and may become negative. Global GDP increases in three of the four experiments and all experiments include regions where the benefits from climate engineering are negative.

  1. Economic Evaluation Guide for alternative transportation fuels

    Energy Technology Data Exchange (ETDEWEB)

    de Percin, D.; Werner, J.F. Jr.

    1992-01-01

    The production of this Economic Evaluation Guide is one activity of AVFCAP. The guide is intended for use by project managers and fleet operators in the public sector. Public fleets have been identified as one of the most likely areas where ATFs will first gain widespread use, because of existing and impending state and federal legislative mandates, as well as for practical reasons such as centralized servicing and refueling. The purpose of this guide is to provide balanced decision-support information to project managers who are considering conducting, or currently managing, ATF demonstration programs. Information for this guide was gathered as part of a related AVFCAP activity, the development of an Information Resource Database. Economic issues related to the development and implementation of ATF programs at the local government level are extremely complex, and require an analysis of federal policies and national and international economics that is generally beyond the scope of local government project managers. The intent of this guide is to examine the information available on the economic evaluation of ATFs, and identify key elements that will help local governments realistically assess the potential costs and savings of an ATF program. The guide also discusses how these various economic factors are related, and how local government priorities affect how different factors are weighed.

  2. Economic Evaluation Guide for alternative transportation fuels

    Energy Technology Data Exchange (ETDEWEB)

    de Percin, D.; Werner, J.F. Jr.

    1992-12-31

    The production of this Economic Evaluation Guide is one activity of AVFCAP. The guide is intended for use by project managers and fleet operators in the public sector. Public fleets have been identified as one of the most likely areas where ATFs will first gain widespread use, because of existing and impending state and federal legislative mandates, as well as for practical reasons such as centralized servicing and refueling. The purpose of this guide is to provide balanced decision-support information to project managers who are considering conducting, or currently managing, ATF demonstration programs. Information for this guide was gathered as part of a related AVFCAP activity, the development of an Information Resource Database. Economic issues related to the development and implementation of ATF programs at the local government level are extremely complex, and require an analysis of federal policies and national and international economics that is generally beyond the scope of local government project managers. The intent of this guide is to examine the information available on the economic evaluation of ATFs, and identify key elements that will help local governments realistically assess the potential costs and savings of an ATF program. The guide also discusses how these various economic factors are related, and how local government priorities affect how different factors are weighed.

  3. Avaliação econômica em Saúde na esfera de atenção local à saúde Health economic evaluation in a local level government health care system

    Directory of Open Access Journals (Sweden)

    Leyla Gomes Sancho

    2009-10-01

    possibility to apply a health economic evaluation research and have the results used in a local level government health care system.

  4. Economic analysis of the cost of Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Mazetas D.

    2014-04-01

    Full Text Available The cost of Intensive Care Units has the greatest impact on overall medical costs and the overall cost for the health of a country and an increasing number of studies from around the world presenting the quantification of these costs. Aim: Review of the Economic Analysis of the Cost of Intensive Care Units. Method: Search was made in the SCOPUS, MEDLINE and CINAHL databases using the key-words “Intensive Care Units (ICU”, “Cost”, “Cost Analysis”, “Health Care Costs”, “Health Resources”, “ICU resources”. The study was based on articles published in English from 2000 to 2011 investigating the Economic Analysis of the Cost of Intensive Care Units. Results: The cost of ICU is a significant percentage of gross domestic product in developed countries. Most cost analysis studies that relate to plans that include the study of staff costs, duration of stay in the ICU, the clinical situations of hospitalized patients, engineering support, medications and diagnostic tests costing scales and in relation to the diagnostic criteria. Conclusions: most studies conclude that the remuneration of staff, particularly nurses, in the ICU is the largest cost of ICU, while for the duration of stay in the ICU results are conflicting. The analysis on the cost-effectiveness of ICU can help to better apply these findings to the therapeutic context of ICU.

  5. Energy production from agriculture: an economic evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Becker, J.J.

    1986-05-01

    The crisis in sales on the world market of the European Economic Community's traditional agricultural products as well as Europe's concern for its energy independence, have led to the elaboration of agricultural diversification strategies and more specifically of agricultural projects which produce energy. This article evaluates the interest of such schemes in relation to the criterion of collective profitability.

  6. Economic evaluations of personalized medicine: existing challenges and current developments

    Directory of Open Access Journals (Sweden)

    Shabaruddin FH

    2015-06-01

    Full Text Available Fatiha H Shabaruddin,1 Nigel D Fleeman,2 Katherine Payne3 1Department of Pharmacy, University of Malaya, Kuala Lumpur, Malaysia; 2Liverpool Reviews and Implementation Group (LRiG, University of Liverpool, Liverpool, UK; 3Institute of Population Health, The University of Manchester, Manchester, UK Abstract: Personalized medicine, with the aim of safely, effectively, and cost-effectively targeting treatment to a prespecified patient population, has always been a long-time goal within health care. It is often argued that personalizing treatment will inevitably improve clinical outcomes for patients and help achieve more effective use of health care resources. Demand is increasing for demonstrable evidence of clinical and cost-effectiveness to support the use of personalized medicine in health care. This paper begins with an overview of the existing challenges in conducting economic evaluations of genetics- and genomics-targeted technologies, as an example of personalized medicine. Our paper illustrates the complexity of the challenges faced by these technologies by highlighting the variations in the issues faced by diagnostic tests for somatic variations, generally referring to genetic variation in a tumor, and germline variations, generally referring to inherited genetic variation in enzymes involved in drug metabolic pathways. These tests are typically aimed at stratifying patient populations into subgroups on the basis of clinical effectiveness (response or safety (avoidance of adverse events. The paper summarizes the data requirements for economic evaluations of genetics and genomics-based technologies while outlining that the main challenges relating to data requirements revolve around the availability and quality of existing data. We conclude by discussing current developments aimed to address the challenges of assessing the cost-effectiveness of genetics and genomics-based technologies, which revolve around two central issues that are

  7. On the Economic Evaluation of Volatility Forecasts

    DEFF Research Database (Denmark)

    Voev, Valeri

    We analyze the applicability of economic criteria for volatility forecast evaluation based on unconditional measures of portfolio performance. The main theoretical finding is that such unconditional measures generally fail to rank conditional forecasts correctly due to the presence of a bias term...... driven by the variability of the conditional mean and portfolio weights. Simulations and a small empirical study suggest that the bias can be empirically substantial and lead to distortions in forecast evaluation. An important implication is that forecasting superiority of models using high frequency...

  8. Economics of periodontal care: market trends, competitive forces and incentives.

    Science.gov (United States)

    Flemmig, Thomas F; Beikler, Thomas

    2013-06-01

    The adoption of new technologies for the treatment of periodontitis and the replacement of teeth has changed the delivery of periodontal care. The objective of this review was to conduct an economic analysis of a mature periodontal service market with a well-developed workforce, including general dentists, dental hygienists and periodontists. Publicly available information about the delivery of periodontal care in the USA was used. A strong trend toward increased utilization of nonsurgical therapy and decreased utilization of surgical periodontal therapy was observed. Although periodontal surgery remained the domain of periodontists, general dentists had taken over most of the nonsurgical periodontal care. The decline in surgical periodontal therapy was associated with an increased utilization of implant-supported prosthesis. Approximately equal numbers of implants were surgically placed by periodontists, oral and maxillofacial surgeons, and general dentists. Porter's framework of the forces driving industry competition was used to analyze the role of patients, dental insurances, general dentists, competitors, entrants, substitutes and suppliers in the periodontal service market. Estimates of out-of-pocket payments of self-pay and insured patients, reimbursement by dental insurances and providers' earnings for various periodontal procedures and alternative treatments were calculated. Economic incentives for providers may explain some of the observed shifts in the periodontal service market. Given the inherent uncertainty about treatment outcomes in dentistry, which makes clinical judgment critical, providers may yield to economic incentives without jeopardizing their ethical standards and professional norms. Although the economic analysis pertains to the USA, some considerations may also apply to other periodontal service markets.

  9. Using Behavioral Economics to Design Physician Incentives That Deliver High-Value Care.

    Science.gov (United States)

    Emanuel, Ezekiel J; Ubel, Peter A; Kessler, Judd B; Meyer, Gregg; Muller, Ralph W; Navathe, Amol S; Patel, Pankaj; Pearl, Robert; Rosenthal, Meredith B; Sacks, Lee; Sen, Aditi P; Sherman, Paul; Volpp, Kevin G

    2016-01-19

    Behavioral economics provides insights about the development of effective incentives for physicians to deliver high-value care. It suggests that the structure and delivery of incentives can shape behavior, as can thoughtful design of the decision-making environment. This article discusses several principles of behavioral economics, including inertia, loss aversion, choice overload, and relative social ranking. Whereas these principles have been applied to motivate personal health decisions, retirement planning, and savings behavior, they have been largely ignored in the design of physician incentive programs. Applying these principles to physician incentives can improve their effectiveness through better alignment with performance goals. Anecdotal examples of successful incentive programs that apply behavioral economics principles are provided, even as the authors recognize that its application to the design of physician incentives is largely untested, and many outstanding questions exist. Application and rigorous evaluation of infrastructure changes and incentives are needed to design payment systems that incentivize high-quality, cost-conscious care.

  10. Long-term socio-economic consequences and health care costs of poliomyelitis

    DEFF Research Database (Denmark)

    Nielsen, Nete Munk; Kay, Lise; Wanscher, Benedikte

    2016-01-01

    Worldwide 10-20 million individuals are living with disabilities after acute poliomyelitis. However, very little is known about the socio-economic consequences and health care costs of poliomyelitis. We carried out a historical register-based study including 3606 individuals hospitalised...... for poliomyelitis in Copenhagen, Denmark 1940-1954, and 13,795 age and gender-matched Danes. Participants were followed from 1980 until 2012, and family, socio-economic conditions and health care costs were evaluated in different age groups using chi-squared tests, boot-strapped t tests or hazard ratios (HR....... Paralytic and non-paralytic polio survivors had a 2.5 [HR = 2.52 (95 % confidence interval (CI); 2.29-2.77)] and 1.4 [HR = 1.35 (95 % CI; 1.23-1.49)]-fold higher risk, respectively, of receiving disability pension compared with controls. Personal health care costs were considerably higher in all age groups...

  11. [Economic aspects of anesthesia. I. Health care reform in the German Republic].

    Science.gov (United States)

    Bach, A; Bauer, M

    1998-03-01

    Implications for Hospitals and Departments of Anaesthesiology. This article outlines the new German health care laws and their impact on the statutory health care system, hospitals and anaesthesia departments. The German health care system provides coverage for all citizens, although financial support from the public sector is on the downgrade. Hence, pressure to reduce public sector health care spending is likely to continue in the near future. Hospital costs account for one-third of total health care spending in Germany, and hospitals are facing increasing economic constraints: the volume and the charges for specific medical treatments are negotiated between the hospitals and the insurance agencies (or sickness funds) in advance. Only part of hospital care is still reimbursed on the basis of a per diem rate, and an increasing number of services are based on fixed payments per case or treatment. Reducing the costs for this treatment is therefore of utmost importance for hospitals and hospital departments. The prospective payment system and the pressure to contain costs demand a controlling system that allows for cost accounting per case. However, an economic evaluation must include comparative analysis of alternative therapeutic options in terms of both costs and outcome. Economic aspects challenge the traditional relationship between physicians and patients: doctors are still the advocates of their patients, but also act as agents for their institutions. Nevertheless, not only economic issues, but also ethical priorities and the value of an anaesthetic practice must be considered in the era of cost containment. Anaesthetists must be actively involved in providing high-quality care with its obvious benefits for the patient and be able to resist efforts to cut out expensive treatment modalities regardless of their benefits.

  12. Romanian Health Care Reform in the Context of Economic Crisis

    Directory of Open Access Journals (Sweden)

    Victoria Gheonea

    2010-12-01

    Full Text Available The effects of financial crisis are strongly felt in Romania, which already face with asignificant slowdown in economic growth or even economic recession. The current and internationalsituation remains still difficult, and requires high budget constraints. Under these conditions, thehealth system in Romania has become one of the most inefficient in Europe, mainly characterized bylack of transparency in the allocation of funds and inefficiency in resource use. The lack of clear andcoherent criteria to evaluate the performance of health institutions results in a difficultimplementation of efficient managerial systems to reward the efficient manager.

  13. Inter ministerial commission clean and careful vehicles; commission interministerielle vehicules propres et economes. Rapport annuel

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2005-10-15

    The first report of the CIVEPE in 2004 established an evaluation and proposed a first approach with five working groups implemented. This second report presents the activities and the main events in a technological, economical and political points of view. The six chapters of the report concerns the context and the challenges, the public float, the biofuels, the research and development, the definition of a clean and careful vehicle and the regulations. (A.L.B.)

  14. Managing the physics of the economics of integrated health care.

    Science.gov (United States)

    Zismer, Daniel K; Werner, Mark J

    2012-01-01

    The physics metaphor, as applied to the economics (and financial performance) of the integrated health system, seems appropriate when considered together with the nine principles of management framework provided. The nature of the integrated design enhances leaders' management potential as they consider organizational operations and strategy in the markets ahead. One question begged by this argument for the integrated design is the durability, efficiency and ultimate long-term survivability of the more "traditional" community health care delivery models, which, by design, are fragmented, internally competitive and less capital efficient. They also cannot exploit the leverage of teams, optimal access management or the pursuit of revenues made available in many forms. For those who wish to move from the traditional to the more integrated community health system designs (especially those who have not yet started the journey), the path requires: * Sufficient balance sheet capacity to fund the integration process-especially as the model requires physician practice acquisitions and electronic health record implementations * A well-prepared board13, 14 * A functional, durable and sustainable physician services enterprise design * A redesigned organizational and governance structure * Favorable internal financial incentives alignment design * Effective accountable physician leadership * Awareness that the system is not solely a funding strategy for acquired physicians, rather a fully -.. committed clinical and business model, one in which patient-centered integrated care is the core service (and not acute care hospital-based services) A willingness to create and exploit the implied and inherent potential of an integrated design and unified brand Last, it's important to remember that an integrated health system is a tool that creates a "new potential" (a physics metaphor reference, one last time). The design doesn't operate itself. Application of the management principles

  15. Economic valuation of informal care: the contingent valuation method applied to informal caregiving.

    Science.gov (United States)

    van den Berg, Bernard; Brouwer, Werner; van Exel, Job; Koopmanschap, Marc

    2005-02-01

    This paper reports the results of the application of the contingent valuation method (CVM) to determine a monetary value of informal care. We discuss the current practice in valuing informal care and a theoretical model of the costs and benefits related to the provision of informal care. In addition, we developed a survey in which informal caregivers' willingness to accept (WTA) to provide an additional hour of informal care was elicited. This method is better than normally recommended valuation methods able to capture the heterogeneity and dynamics of informal care. Data were obtained from postal surveys. A total of 153 informal caregivers and 149 care recipients with rheumatoid arthritis returned a completed survey. Informal caregivers reported a mean WTA to provide a hypothetical additional hour of informal care of 9.52 Euro (n=124). Many hypotheses derived from the theoretical model and the literature were supported by the data.CVM is a promising alternative for existing methods like the opportunity cost method and the proxy good method to determine a monetary value of informal care that can be incorporated in the numerator of any economic evaluation.

  16. ECONOMIC EVALUATION OF CO2 SEQUESTRATION TECHNOLOGIES

    Energy Technology Data Exchange (ETDEWEB)

    Bert R. Bock; Richard G. Rhudy; David E. Nichols

    2001-07-01

    In order to plan for potential CO{sub 2} mitigation mandates, utilities need better information on CO{sub 2} mitigation options, especially carbon sequestration options that involve non-utility operations. One of the major difficulties in evaluating CO{sub 2} sequestration technologies and practices, both geologic storage of captured CO{sub 2} and storage in biological sinks, is obtaining consistent, transparent, accurate, and comparable economics. This project is comparing the economics of major technologies and practices under development for CO{sub 2} sequestration, including captured CO{sub 2} storage options such as active oil reservoirs, depleted oil and gas reservoirs, deep aquifers, coal beds, and oceans, as well as the enhancement of biological sinks such as forests and croplands. An international group of experts has been assembled to compare on a consistent basis the economics of this diverse array of CO{sub 2} sequestration options. Designs and data collection are nearly complete for each of the CO{sub 2} sequestration options being compared. Initial spreadsheet development has begun on concepts involving storage of captured CO{sub 2}. No significant problems have been encountered, but some additional outside expertise will be accessed to supplement the team's expertise in the areas of life cycle analysis, oil and gas exploration and production, and comparing CO{sub 2} sequestration options that differ in timing and permanence of CO{sub 2} sequestration. Plans for the next reporting period are to complete data collection and a first approximation of the spreadsheet. We expect to complete this project on time and on budget.

  17. Solar energy system economic evaluation: Fern Tunkhannock, Tunkhannock, Pennsylvania

    Science.gov (United States)

    1980-01-01

    The economic performance of an Operational Test Site (OTS) is described. The long term economic performance of the system at its installation site and extrapolation to four additional selected locations to demonstrate the viability of the design over a broad range of environmental and economic conditions is reported. Topics discussed are: system description, study approach, economic analysis and system optimization, and technical and economical results of analysis. Data for the economic analysis are generated through evaluation of the OTS. The simulation is based on the technical results of the seasonal report simulation. In addition localized and standard economic parameters are used for economic analysis.

  18. Methodological Challenges to Economic Evaluations of Vaccines: Is a Common Approach Still Possible?

    Science.gov (United States)

    Jit, Mark; Hutubessy, Raymond

    2016-06-01

    Economic evaluation of vaccination is a key tool to inform effective spending on vaccines. However, many evaluations have been criticised for failing to capture features of vaccines which are relevant to decision makers. These include broader societal benefits (such as improved educational achievement, economic growth and political stability), reduced health disparities, medical innovation, reduced hospital beds pressures, greater peace of mind and synergies in economic benefits with non-vaccine interventions. Also, the fiscal implications of vaccination programmes are not always made explicit. Alternative methodological frameworks have been proposed to better capture these benefits. However, any broadening of the methodology for economic evaluation must also involve evaluations of non-vaccine interventions, and hence may not always benefit vaccines given a fixed health-care budget. The scope of an economic evaluation must consider the budget from which vaccines are funded, and the decision-maker's stated aims for that spending to achieve.

  19. Health economic evaluation in Japan: a case study of one aspect of health technology assessment.

    Science.gov (United States)

    Oliver, Adam

    2003-02-01

    There is a burgeoning literature in health economic evaluation, with this form of analysis becoming increasingly influential at the health policy making level in a number of countries. However, a search of the literature reveals that in Japan, the world's second largest health care market, very little health economic evaluation has been undertaken. The main reason for the lack of interest in economic evaluation is that the fee-for-service and strict price regulation that characterises the system of health care financing in Japan is not conducive to this form of analysis. Moreover, the government and many researchers are satisfied that the current organisation of health care has given long life and low infant mortality at low cost. Even if it is accepted that low health care costs and good health prevail in Japan, slower economic growth rates, an ageing population and the development of new medical technologies will place increasing pressure on health care resources and will necessitate a more rational use of these resources. Good economic evaluation, by weighing benefits against costs, has an important role to play.

  20. Health Economics Studies Information Exchange; Reports of Current Research in Health Economics, and Medical Care Administration. Publication No. 1719.

    Science.gov (United States)

    Public Health Service (DHEW), Arlington, VA. Home Economics Branch.

    The first volume of a continuing series reporting research in progress in health economics and medical care organization and administration was compiled by contacting (1) graduate schools offering degrees in the health professions, sociology, economics, public administration, and public health, (2) charitable foundations indicating an interest in…

  1. An Evaluation of SMR Economic Attractiveness

    Directory of Open Access Journals (Sweden)

    Sara Boarin

    2014-01-01

    Full Text Available The nuclear “renaissance” that is taking place worldwide concerns the new build of GW size reactor plants, but smaller GenIII+ NPP (Small Modular Reactors, SMR are on the verge to be commercially available and are raising increasing public interest. These reactor concepts rely on the pressurized water technology, capitalizing on thousands of reactor-years operations and enhancing the passive safety features, thanks to the smaller plant and equipment size. On the other hand, smaller plant size pays a loss of economy of scale, which might have a relevant impact on the generation costs of electricity, given the capital-intensive nature of nuclear power technology. The paper explores the economic advantages/disadvantages of multiple SMR compared to alternative large plants of the same technology and equivalent total power installed. The metrics used in the evaluation is twofold, as appropriate for liberalized markets of capital and electricity: investment profitability and investment risk are assessed, from the point of view of the plant owner. Results show that multiple SMR deployed on the same site may prove competitive with investment returns of larger plants, while offering, in addition, unique features that mitigate the investment risk.

  2. Improving early cycle economic evaluation of diagnostic technologies

    NARCIS (Netherlands)

    Steuten, Lotte M.G.; Ramsey, Scott D.

    2014-01-01

    The rapidly increasing range and expense of new diagnostics, compels consideration of a different, more proactive approach to health economic evaluation of diagnostic technologies. Early cycle economic evaluation is a decision analytic approach to evaluate technologies in development so as to increa

  3. Economic evaluation of a guided and unguided internet-based CBT intervention for major depression: Results from a multi-center, three-armed randomized controlled trial conducted in primary care

    Science.gov (United States)

    García-Ruiz, Antonio; Luciano, Juan V.; García Campayo, Javier; Gili, Margalida; Botella, Cristina; Baños, Rosa; Castro, Adoración; López-Del-Hoyo, Yolanda; Pérez Ara, Mª Ángeles; Modrego-Alarcón, Marta; Mayoral Cleríes, Fermín

    2017-01-01

    Depression is one of the most common mental disorders and will become one of the leading causes of disability in the world. Internet-based CBT programs for depression have been classified as “well established” following the American Psychological Association criteria for empirically supported treatments. The aim of this study is to analyze the cost effectiveness at 12-month follow-up of the Internet-based CBT program “Smiling is fun” with (LITG) and without psychotherapist support (TSG) compared to usual care. The perspective used in our analysis is societal. A sample of 296 depressed patients (mean age of 43.04 years; 76% female; BDI-II mean score = 22.37) from primary care services in four Spanish regions were randomized in the RCT. The complete case and intention-to-treat (ITT) perspectives were used for the analyses. The results demonstrated that both Internet-based CBT interventions exhibited cost utility and cost effectiveness compared with a control group. The complete case analyses revealed an incremental cost-effectiveness ratio (ICER) of €-169.50 and an incremental cost-utility ratio (ICUR) of €-11389.66 for the TSG group and an ICER of €-104.63 and an ICUR of €-6380.86 for the LITG group. The ITT analyses found an ICER of €-98.37 and an ICUR of €-5160.40 for the TSG group and an ICER of €-9.91 and an ICUR of €496.72 for the LITG group. In summary, the results of this study indicate that the two Internet-based CBT interventions are appropriate from both economic and clinical perspectives for depressed patients in the Spanish primary care system. These interventions not only help patients to improve clinically but also generate societal savings. Trial Registration: clinicaltrials.gov NCT01611818 PMID:28241025

  4. Generic antiretroviral drugs and HIV care: An economic review.

    Science.gov (United States)

    Yazdanpanah, Y; Schwarzinger, M

    2016-03-01

    The cost of HIV care in European countries is high. Direct medical costs, in France, have been estimated at 500,000 Euros per patient's lifetime (20,000 Euros/year/patient). Overall, 73% of these costs are related to antiretroviral treatments. In the current financial crisis context, some European countries are beginning to make economic decisions on the drugs to be used. These approaches are likely to become more frequent. It is obviously essential to prescribe the most effective, appropriate, best tolerated, and easy-to-use antiretroviral treatments to patients. However, while taking the above into consideration, and if various treatment options or combinations are available, cost should also be considered in the treatment choice. One may thus reflect on the use of generic antiretroviral agents as they have just been launched in France. We aimed to review the cost and cost-effectiveness of generic antiretroviral drugs and to review treatment strategies other than generic drugs that could help reduce HIV-related costs. HIV clinicians should consider treatment costs to avoid any future coercive measures.

  5. Evaluation of economic effects of population ageing--methodology of estimating indirect costs.

    Science.gov (United States)

    Schubert, Agata; Czech, Marcin; Gębska-Kuczerowska, Anita

    2015-01-01

    Process of demographic ageing, especially in recent decades, is steadily growing in dynamics and importance due to increasing health-related needs and expectations with regard to a guarantee of social services. Elaboration of the most effective model of care, tailored to Polish conditions, requires an estimation of actual costs of this care, including indirect costs which are greatly related to informal care. The fact that the costs of informal care are omitted, results from a determined approach to analyses. It is discussed only from a perspective of budget for health and does not cover societal aspects. In such situation, however, the costs borne by a receiver of services are neglected. As a consequence, the costs of informal care are underestimated or often excluded from calculations, even if they include indirect costs. Comprehensive methodological approach for estimating the costs of informal care seems to be important for a properly conducted economic evaluation in health care sector.

  6. The TOPSIS Evaluation on Carbon Emission Economic Efficiency

    Institute of Scientific and Technical Information of China (English)

    Sheng; XU; Chao; ZHANG; Juan; YANG

    2013-01-01

    Based on carbon emission data of 17 cities in Shandong Province in 2005-2009,this paper analyzes carbon emission economic efficiency. It conducts weight distribution by the Ordered Weighted Averaging ( OWA) method,and takes systematic evaluation on carbon emission economic efficiency using TOPSIS method. In eastern coastal regions,including Dongying,Yantai,Weihai and Qingdao,the carbon emission economic efficiency is generally higher than inland regions of Shandong Province. The conclusion reached after correction of time weight is basically consistent with traditional TOPSIS overall evaluation,further proves validity of the evaluation. Finally,it gives recommendations for improving carbon emission economic efficiency in Shandong Province.

  7. Tapering off benzodiazepines in long-term users : an economic evaluation

    NARCIS (Netherlands)

    Oude Voshaar, Richard C; Krabbe, Paul F M; Gorgels, Wim J M J; Adang, Eddy M M; van Balkom, Anton J L M; van de Lisdonk, Eloy H; Zitman, Frans G

    2006-01-01

    BACKGROUND: Discontinuation of benzodiazepine usage has never been evaluated in economic terms. This study aimed to compare the relative costs and outcomes of tapering off long-term benzodiazepine use combined with group cognitive behavioural therapy (TO+CBT), tapering off alone (TOA) and usual care

  8. Tapering off benzodiazepines in long-term users: an economic evaluation.

    NARCIS (Netherlands)

    Oude Voshaar, R.C.; Krabbe, P.F.M.; Gorgels, W.J.M.J.; Adang, E.M.M.; Balkom, A.J.L.M. van; Lisdonk, E.H. van de; Zitman, F.G.

    2006-01-01

    BACKGROUND: Discontinuation of benzodiazepine usage has never been evaluated in economic terms. This study aimed to compare the relative costs and outcomes of tapering off long-term benzodiazepine use combined with group cognitive behavioural therapy (TO+CBT), tapering off alone (TOA) and usual care

  9. A systematic review of care delivery models and economic analyses in lymphedema: health policy impact (2004-2011).

    Science.gov (United States)

    Stout, N L; Weiss, R; Feldman, J L; Stewart, B R; Armer, J M; Cormier, J N; Shih, Y-C T

    2013-03-01

    A project of the American Lymphedema Framework Project (ALFP), this review seeks to examine the policy and economic impact of caring for patients with lymphedema, a common side effect of cancer treatment. This review is the first of its kind undertaken to investigate, coordinate, and streamline lymphedema policy initiatives in the United States with potential applicability worldwide. As part of a large scale literature review aiming to systematically evaluate the level of evidence of contemporary peer-reviewed lymphedema literature (2004 to 2011), publications on care delivery models, health policy, and economic impact were retrieved, summarized, and evaluated by a team of investigators and clinical experts. The review substantiates lymphedema education models and clinical models implemented at the community, health care provider, and individual level that improve delivery of care. The review exposes the lack of economic analysis related to lymphedema. Despite a dearth of evidence, efforts towards policy initiatives at the federal and state level are underway. These initiatives and the evidence to support them are examined and recommendations for translating these findings into clinical practice are made. Medical and community-based disease management interventions, taking on a public approach, are effective delivery models for lymphedema care and demonstrate great potential to improve cancer survivorship care. Efforts to create policy at the federal, state, and local level should target implementation of these models. More research is needed to identify costs associated with the treatment of lymphedema and to model the cost outlays and potential cost savings associated with comprehensive management of chronic lymphedema.

  10. Evaluating replicability of laboratory experiments in economics.

    Science.gov (United States)

    Camerer, Colin F; Dreber, Anna; Forsell, Eskil; Ho, Teck-Hua; Huber, Jürgen; Johannesson, Magnus; Kirchler, Michael; Almenberg, Johan; Altmejd, Adam; Chan, Taizan; Heikensten, Emma; Holzmeister, Felix; Imai, Taisuke; Isaksson, Siri; Nave, Gideon; Pfeiffer, Thomas; Razen, Michael; Wu, Hang

    2016-03-25

    The replicability of some scientific findings has recently been called into question. To contribute data about replicability in economics, we replicated 18 studies published in the American Economic Review and the Quarterly Journal of Economics between 2011 and 2014. All of these replications followed predefined analysis plans that were made publicly available beforehand, and they all have a statistical power of at least 90% to detect the original effect size at the 5% significance level. We found a significant effect in the same direction as in the original study for 11 replications (61%); on average, the replicated effect size is 66% of the original. The replicability rate varies between 67% and 78% for four additional replicability indicators, including a prediction market measure of peer beliefs.

  11. [Justice in health care systems from an economic perspective].

    Science.gov (United States)

    Schreyögg, J

    2004-01-01

    Due to rising health care expenditures international comparisons of health care systems are recently gaining more importance. These benchmarks can provide interesting information for improving health care systems. Many of these comparisons implicitly assume that countries have a universal understanding of justice. But this assumption is rather questionable. With regard to the existing cultural differences in the understanding of justice the transferability of elements of health care systems is not always assured. A transfer usually requires a thorough examination of the judicial systems in each country. This article analyses the influence of different judicial systems applying to health care. In this context theories of justice by Rawls, Nozick and Confucius representing the possible understanding of justice in different cultures are described and analysed with regards to their influence on health care systems. The example of financing health care shows that the three theories of justice have very different consequences for designing health care systems especially concerning the role of governments.

  12. The logic of transaction cost economics in health care organization theory.

    Science.gov (United States)

    Stiles, R A; Mick, S S; Wise, C G

    2001-01-01

    Health care is, at its core, comprised of complex sequences of transactions among patients, providers, and other stakeholders; these transactions occur in markets as well as within systems and organizations. Health care transactions serve one of two functions: the production of care (i.e., the laying on of hands) or the coordination of that care (i.e., scheduling, logistics). Because coordinating transactions is integral to care delivery, it is imperative that they are executed smoothly and efficiently. Transaction cost economics (TCE) is a conceptual framework for analyzing health care transactions and quantifying their impact on health care structures (organizational forms), processes, and outcomes.

  13. Economic evaluation of prevention; further evidence

    NARCIS (Netherlands)

    Wit GA de; Verweij A; Baal PHM van; Vijgen SMC; Berg M van den; Busch MCM; Barnhoorn MJM; Schuit AJ; Wit GA de; Schuit AJ; Berg M van den; ZonMw; VTV; PZO

    2007-01-01

    This report is the third in a series of reports that aim to identify cost-effective preventive interventions that have not yet been diffused into the Dutch health care system or into a public health setting. In the first part of this report, five new interventions are presented and at the same time,

  14. HEALTH CARE ECONOMICS IN ROMANIA--DYNAMICS AND EVOLUTION.

    Science.gov (United States)

    Tamba, B I; Azoicăi, Doina; Druguş, Daniela

    2016-01-01

    Health economics refers to the analysis of medical institutions considering their economic and social efficacy, but also the regularity and the relationships that govern the phenomena and the processes from the field of health with the final purpose of achieving better results with the minimum of resources; it represents the study of health price in its complexity. The economics of the population's health needs and in particular the health needs in case of the poor groups of the population, consider health to be the main component of global human vulnerability. Health economics tries to change the simple interpretation of health price and disease cost into a wider consideration of a system administration similar to educational and social economics and the study of health in the context of the multiple specializations of the macro economy of the national group, as it is an instrument in the country's great economics symphony.

  15. Solar energy system economic evaluation: IBM System 2, Togus, Maine

    Science.gov (United States)

    1980-01-01

    The economic analysis of the solar energy system, is developed for Torgus and four other sites typical of a wide range of environmental and economic conditions in the continental United States. This analysis is accomplished based on the technical and economic models in the f-chart design procedure with inputs taken on the characteristics of the installed system and local conditions. The results are expressed in terms of the economic parameters of present worth of system cost over a projected twenty year life, life cycle savings, year of positive savings and year of payback for the optimized solar energy system at each of the analysis sites. The sensitivity of the economic evaluation to uncertainties in constituent system and economic variables is also investigated. Results demonstrate that the solar energy system is economically viable at all of the five sites for which the analysis was conducted.

  16. Comprehensive Evaluation of Economic Indicators in Guangxi Economic Zone Based on Parallel Analysis

    Institute of Scientific and Technical Information of China (English)

    Guangdong; ZENG; Chunxiang; ZHAO

    2015-01-01

    When making comprehensive evaluation on economy of an area,it is always hard to choose evaluation indicator system and composite indicators reasonably. This article uses parallel analysis to choose the number of principal component and classify indicators by R clustering and load rotation matrix to assess the economy of various cities in the economic zone and analyze economic status of each city,to provide a scientific basis for the government functional department to make correct decisions.

  17. An early evaluation of clinical and economic costs and benefits of implementing point of care NAAT tests for Chlamydia trachomatis and Neisseria gonorrhoea in genitourinary medicine clinics in England

    Science.gov (United States)

    Turner, Katherine M E; Round, Jeff; Horner, Patrick; Macleod, John; Goldenberg, Simon; Deol, Arminder; Adams, Elisabeth J

    2013-01-01

    Objectives To estimate the costs and benefits of clinical pathways incorporating a point of care (POC) nucleic acid amplification test (NAAT) for chlamydia and gonorrhoea in genitourinary medicine (GUM) clinics compared with standard off-site laboratory testing. Method We simulated 1.2 million GUM clinic attendees in England. A simulation in Microsoft Excel was developed to compare existing standard pathways of management for chlamydia and gonorrhoea with a POC NAAT. We conducted scenario analyses to evaluate the robustness of the model findings. The primary outcome was the incremental cost-effectiveness ratio. Secondary outcomes included the number of inappropriate treatments, complications and transmissions averted. Results The baseline cost of using the point of POC NAAT was £103.9 million compared with £115.6 million for standard care. The POC NAAT was also associated with a small increase of 46 quality adjusted life years, making the new test both more effective and cheaper. Over 95 000 inappropriate treatments might be avoided by using a POC NAAT. Patients receive diagnosis and treatment on the same day as testing, which may also prevent 189 cases of pelvic inflammatory disease and 17 561 onward transmissions annually. Discussion Replacing standard laboratory tests for chlamydia and gonorrhoea with a POC test could be cost saving and patients would benefit from more accurate diagnosis and less unnecessary treatment. Overtreatment currently accounts for about a tenth of the reported treatments for chlamydia and gonorrhoea and POC NAATs would effectively eliminate the need for presumptive treatment. PMID:24273127

  18. THE ECONOMIC EVALUATION OF FOREST ROAD BUILDING

    OpenAIRE

    Muška, Aina; Bičevskis, Matīss

    2010-01-01

    Forest road density in Latvia is insufficient, although the Joint Stock Company ‘‘Latvijas valsts meži” (“Latvian State Forestry”) performs active forest road building. The hypothesis of the research is that the resources invested in a forest road building pay off during its use. The goal of the research is to study the economic benefit from forest road building. The authors’ research showed that the total costs of forest road building and use could result in Ls 246,779 over 40 years or Ls 6,...

  19. Economical evaluation of electricity generation considering externalities

    Energy Technology Data Exchange (ETDEWEB)

    El-Kordy, M.N.; Badr, M.A.; Abed, K.A. [National Research Center, Mechanical Engineering Dept., Giza (Egypt); Ibrahim, Said M.A. [Al-Azhar Univ., Mechanical Engineering Dept., Cairo (Egypt)

    2002-02-01

    The economics of renewable energy are the largest barrier to renewable penetration. Nevertheless, the strong desire to reduce environmental emissions is considered a great support for renewable energy sources. In this paper, a full analysis for the cost of the kWh of electricity generated from different systems actually used in Egypt is presented. Also renewable energy systems are proposed and their costs are analyzed. The analysis considers the external cost of emissions from different generating systems. A proposed large scale PV plant of 3.3 MW, and a wind farm 11.25 MW grid connected at different sites are investigated. A life cycle cost analysis for each system was performed using the present value criterion. The comparison results showed that wind energy generation has the lowest cost, followed by a combined cycle-natural gas fired system. A photovoltaic system still uses comparatively expensive technology for electricity generation; even when external costs are considered the capital cost of photovoltaic needs to be reduced by about 60% in order to be economically competitive. (Author)

  20. [Economic evaluation in health: applications in infectious diseases].

    Science.gov (United States)

    Vanni, Tazio; Luz, Paula Mendes; Ribeiro, Rodrigo Antonini; Novaes, Hillegonda Maria Dutilh; Polanczyk, Carisi A

    2009-12-01

    The rise in healthcare expenditures due to the incorporation of new diagnostic and therapeutic technologies and increasing life expectancy is a major concern, particularly in developing countries. The role of economic evaluation in health is to optimize the benefits of available resources. This article aims to allow readers to identify the basic characteristics and types of economic evaluation in health and understand its methods, with an emphasis on infectious diseases. We thus review the following concepts: study perspective, analytic scope, costs, and discount rate. We also focus on characteristics of cost-minimization, cost-effectiveness, cost-utility, and cost-benefit analyses, with examples. The article describes the most popular study designs for economic evaluation, discusses different models, and examines the importance of sensitivity analysis. Our final comments address the importance of adopting economic evaluations in health in Brazil.

  1. Evaluation of Ecological and Economic Index in Poyang Lake Ecological Economic Zone

    Institute of Scientific and Technical Information of China (English)

    Heping; HUANG; Xiaolin; PENG

    2015-01-01

    The society and related research fields were paying close attention to make great efforts to promote the construction level of ecological civilization in China. And measuring and evaluating the status of eco-economic development always was the focus and difficulty in current researches. Based on the methods of Analytic Hierarchy Process( AHP) and the concept of Eco-Factor of Economic Growth and Ecological Efficiency,combined with the fact of research area,the index system of Ecological Economy Index( EEI),which includes social development,economic growth,ecological building,resource use and environmental protection,was built up to measure and evaluate the eco-economic system’s development situation. The weights of all indicators in the EEI system were acquired from the method of expert consultation. All the methods were applied to assess the eco-economic development situation in Poyang Lake Ecological Economic Zone of Jiangxi Province. The results showed that:( i) The model of EEI could intuitively apply to reflect the eco-economic development situation and coordinate extent of the assessment units in the Poyang Lake Eco-economic Zone,which could provide some scientific guides on finding breakthrough point of evaluating eco-economic level for concerned management departments and policies making organizations.( ii) There were distinct differences of Ecological Economy Index value between the counties,cities or districts. Wannian county was on the best situation with the highest EEI value( EEI = 55.74),and Ruichang city was found to be on the worst eco-economic development situation with the lowest EEI value( EEI = 28. 65).( iii) The developed counties( cities or districts) with high EEI value should improve resource use’s efficiency,protect environment and strengthen ecological construction. The other areas should effectively combine the speed with the quality of economic growth in the process of eco-economic development.( iv) The counties( cities or districts

  2. EVALUATION OF ECONOMIC CONVERGENCE IN ROMANIA

    Directory of Open Access Journals (Sweden)

    CUCO PAULA – ROXANA,

    2016-10-01

    Full Text Available This article aims to highlight the process of regional convergence (regarding income wage per capita or on the contrary, the process of regional divergence, between the 42 counties as reference territorial units in Romania, within the period 2005-2014. In the econometric analyze, the models that were developed had the aim to assess the role of macroeconomic determinants on the average net income per capita, exactly the possibility of a more dynamic growth of wages in poorer counties. The results showed a clear trend towards wage convergence, under the impact of multidimensional factors of influence. Our findings confirm the literature on regional convergence, pointing out the importance of economic development level, quality of human capital, technical progress and intensity of innovation activity, improving labor market integration and even a dynamic entrepreneurial activity.

  3. Can we do better? Economic analysis of human resource investment to improve home care service for the elderly in Serbia

    Directory of Open Access Journals (Sweden)

    Mihic MM

    2016-01-01

    Full Text Available Marko M Mihic, Marija Lj Todorovic, Vladimir Lj Obradovic, Zorica M Mitrovic Department for Management and Specialised Management Disciplines, Faculty of Organisational Sciences, University of Belgrade, Belgrade, Serbia Background: Social services aimed at the elderly are facing great challenges caused by progressive aging of the global population but also by the constant pressure to spend funds in a rational manner.Purpose: This paper focuses on analyzing the investments into human resources aimed at enhancing home care for the elderly since many countries have recorded progress in the area over the past years. The goal of this paper is to stress the significance of performing an economic analysis of the investment.Methods: This paper combines statistical analysis methods such as correlation and regression analysis, methods of economic analysis, and scenario method.Results: The economic analysis of investing in human resources for home care service in Serbia showed that the both scenarios of investing in either additional home care hours or more beneficiaries are cost-efficient. However, the optimal solution with the positive (and the highest value of economic net present value criterion is to invest in human resources to boost the number of home care hours from 6 to 8 hours per week and increase the number of the beneficiaries to 33%.Conclusion: This paper shows how the statistical and economic analysis results can be used to evaluate different scenarios and enable quality decision-making based on exact data in order to improve health and quality of life of the elderly and spend funds in a rational manner. Keywords: home care, social investment, human resources, economic analysis, elderly

  4. Solar energy system economic evaluation for Seeco Lincoln, Lincoln, Nebraska

    Science.gov (United States)

    1980-01-01

    The economic analysis of the solar energy system that was installed at Lincoln, Nebraska is developed for this and four other sites typical of a wide range of environmental and economic conditions in the continental United States. This analysis is accomplished based on the technical and economic models in the f chart design procedure with inputs based on the characteristics of the installed system and local conditions. The results are expressed in terms of the economic parameters of present worth of system cost over projected twenty year life: life cycle savings, year of positive savings and year of payback for the optimized solar energy system at each of the analysis sites. The sensitivity of the economic evaluation to uncertainties in constituent system and economic variables is also investigated.

  5. Solar energy system economic evaluation: IBM System 4, Clinton, Mississippi

    Science.gov (United States)

    1980-01-01

    An economic analysis of the solar energy system was developed for five sites, typical of a wide range of environmental and economic conditions in the continental United States. The analysis was based on the technical and economic models in the F-chart design procedure, with inputs based on the characteristic of the installed system and local conditions. The results are of the economic parameters of present worth of system cost over a 20 year time span: life cycle savings, year of positive savings and year of payback for the optimized solar energy system at each of the analysis sites. The sensitivity of the economic evaluation to uncertainties in constituent system and economic variables is also investigated.

  6. Economic evaluation of home blood pressure telemonitoring

    DEFF Research Database (Denmark)

    Madsen, Line Bille; Christiansen, Terkel; Kirkegaard, Peder

    2011-01-01

    Aims. The purpose of the present study was to compare the costs of home blood pressure (BP) telemonitoring (HBPM) with the costs of conventional office BP monitoring. In a randomized controlled trial, 105 hypertensive patients performed HBPM and 118 patients received usual care with conventional......-time ambulatory BP (ABP) were reduced in both groups. The uncertainty around the incremental cost effectiveness ratio point estimates was considerable for both systolic and diastolic ABP. For systolic ABP, the difference in cost effectiveness ratio between the two groups was 256 Danish kroner (DKK)/mmHg [95......% uncertainty interval, UI -860 to 4544]. For diastolic ABP, the difference in cost effectiveness ratio between the two groups was 655 DKK/mmHg [95% UI -674 to 69315]. Medication and consultation costs were lowest in the intervention group, but were offset by the cost of the telemonitoring equipment...

  7. Economic evaluation in long-term clinical trials.

    Science.gov (United States)

    Hlatky, Mark A; Boothroyd, Derek B; Johnstone, Iain M

    2002-10-15

    Economic endpoints have been increasingly included in long-term clinical trials, but they pose several methodologic challenges, including how best to collect, describe, analyse and interpret medical cost data. Cost of care can be measured by converting billed charges, performing detailed micro-costing studies, or by measuring use of key resources and assigning cost weights to each resource. The latter method is most commonly used, with cost weights based either on empirical regression models or administratively determined reimbursement rates. In long-term studies, monetary units should be adjusted to reflect cost inflation and discounting. The temporal pattern of accumulating costs can be described using a modification of the Kaplan-Meier curve. Regression analyses to evaluate factors associated with cost are best performed on the log of costs due to their typically skewed distribution.Cost-effectiveness analysis attempts to measure the value of a new therapy by calculating the difference in cost between the new therapy and the standard therapy, divided by the difference in benefit between the new therapy and the standard therapy. The cost-effectiveness ratio based on the results of a randomized trial may change substantially with longer follow-up intervals, particularly for therapies that are initially expensive but eventually improve survival. A model that projects long-term patterns of cost and survival expected beyond the end of completed follow-up can provide an important perspective in the setting of limited trial duration.

  8. Integrating economic evaluation methods into clinical and translational science award consortium comparative effectiveness educational goals.

    Science.gov (United States)

    Iribarne, Alexander; Easterwood, Rachel; Russo, Mark J; Wang, Y Claire

    2011-06-01

    With the ongoing debate over health care reform in the United States, public health and policy makers have paid growing attention to the need for comparative effectiveness research (CER). Recent allocation of federal funds for CER represents a significant move toward increased evidence-based practice and better-informed allocation of constrained health care resources; however, there is also heated debate on how, or whether, CER may contribute to controlling national health care expenditures. Economic evaluation, in the form of cost-effectiveness or cost-benefit analysis, is often an aspect of CER studies, yet there are no recommendations or guidelines for providing clinical investigators with the necessary skills to collect, analyze, and interpret economic data from clinical trials or observational studies. With an emphasis on multidisciplinary research, the Clinical and Translational Science Award (CTSA) consortium and institutional CTSA sites serve as an important resource for training researchers to engage in CER. In this article, the authors discuss the potential role of CTSA sites in integrating economic evaluation methods into their comparative effectiveness education goals, using the Columbia University Medical Center CTSA as an example. By allowing current and future generations of clinical investigators to become fully engaged not only in CER but also in the economic evaluations that result from such analyses, CTSA sites can help develop the necessary foundation for advancing research to guide clinical decision making and efficient use of limited resources.

  9. Social, Economic, and Political Issues Affecting End-of-Life Care.

    Science.gov (United States)

    Sopcheck, Janet

    2016-02-01

    For many decades, Americans showed a preference for delaying death through a technological imperative that often created challenges for nurses in caring for dying patients and their families. Because of their vast knowledge of health and healing, and their proximity to patients' bedsides, nurses are often well positioned to advocate for healthcare reform and legislation to improve end-of-life care. This article provides an overview of the social, economic, and political factors that are shaping end-of-life care in the United States. First, historical perspectives on end-of-life care are presented to enhance understanding of why some clinicians and patients seem to resist change to current practices. Second, end of care issues related to advanced technology utilization, societal expectations of care, clinical practices, financial incentives, palliative care services, and policy reforms are discussed. Finally, future recommendations are provided to encourage nurses and other healthcare providers to improve care for individuals facing end-of-life care decisions.

  10. The changing role of economic evaluation in valuing medical technologies.

    Science.gov (United States)

    Rotter, Jason S; Foerster, Douglas; Bridges, John Fp

    2012-12-01

    Economic evaluation is established within health-technology assessment but is challenged by those wanting to use economic evaluation to inform pricing and/or incorporate nontraditional sources of value and the views of diverse stakeholders. The changing role of economic evaluation in (formally or informally) assessing prices/values in four jurisdictions (UK, Australia, Germany and USA) is detailed and the authors propose a taxonomy of factors impacting the value of medical technology spanning clinical utility (effectiveness, safety/tolerability and quality of evidence), consumer demand (consumer preferences, process utility and unmet need), economic incentives (innovation, option value and market competition) and the societal perspective (social justice, social values and national interest). The authors suggest that multicriteria decision analysis methods grounded in hedonic-pricing theory can facilitate the valuing/pricing of medical technologies. The use of such an approach is hindered by a paucity of relevant educational opportunities, vested interests and aversion to placing prices/values on health.

  11. Evaluating the effectiveness of health care teams.

    Science.gov (United States)

    Mickan, Sharon M

    2005-05-01

    While it is recognised that effective health care teams are associated with quality patient care, the literature is comparatively sparse in defining the outcomes of effective teamwork. This literature review of the range of organisational, team and individual benefits of teamwork complements an earlier article which summarised the antecedent conditions for (input) and team processes (throughput) of effective teams. This article summarises the evidence for a range of outcome measures of effective teams. Organisational benefits of teamwork include reduced hospitalisation time and costs, reduced unanticipated admissions, better accessibility for patients, and improved coordination of care. Team benefits include efficient use of health care services, enhanced communication and professional diversity. Patients report benefits of enhanced satisfaction, acceptance of treatment and improved health outcomes. Finally, team members report enhanced job satisfaction, greater role clarity and enhanced well-being. Due to the inherent complexity of teamwork, a constituency model of team evaluation is supported where key stakeholders identify and measure the intended benefits of a team.

  12. ECONOMIC EVALUATION OF BEEKEEPING IN KARLOVACKA COUNTY

    Directory of Open Access Journals (Sweden)

    Janja Kezić

    2009-03-01

    Full Text Available Beekeeping in Croatia has a long tradition. There are favourable climate and vegetation conditions for development of beekeeping in Croatia. The number of registered beekeepers in Croatia is 3.404 with total of 313.978 beehives. Most of them are part–time beekeepers (53 %, hobby beekeepers comprise 37 % and professional beekeepers represent the smallest part with 11 % [3]. Beekeeping production is mainly organized on family farms [5]. Karlovačka county, in the cental part of Croatia, was chosen to analyse the economic attributes of beekeeping. The number of beekeepers in Karlovačka county in 2007. was 179 with total of 17.636 beehives [3]. Beekeepers were interviewed during the regular meeting of the Beekeepers Association. Forty–five beekeepers were interviewed which is a representative sample of beekeepers in Karlovacka county. Beekeepers were categorized as hobby beekeepers (<60, part–time (61–150 and professional beekeepers (>151 based on the number of beehives. There are 56 % of hobby beekeepers, 31 % of part–time beekeepers and 13 % are professional beekeepers. Fixed assets in beekeeping consist of equipment, beehives and vehicles used in beekeeping (trucks, trailers, personal car. Hobby beekeepers generate 5.031,55 € of total income per year with 52 average beehives per beekeeper. They achieve the highiest selling price an average of 3,20 € per kilo for their honey. Part–time beekeepers generate 9.875,74 € total income per year. The average number of beehives per part–time beekeeper is 110 and they achieve a selling price of 2,69 € per kilo. Professional beekeepers generate 26.681,36 € total income per year with an average number of 329 beehives per beekeeper. Their actual selling price, on average, is 2,07 €.

  13. Socio-economic status influences blood pressure control despite equal access to care

    DEFF Research Database (Denmark)

    Paulsen, M S; Andersen, M; Munck, A P;

    2012-01-01

    OBJECTIVE: Denmark has a health care system with free and equal access to care irrespective of age and socio-economic status (SES). We conducted a cross-sectional study to investigate a possible association between SES and blood pressure (BP) control of hypertensive patients treated in general pr...

  14. A Primer on Health Economic Evaluations in Thoracic Oncology.

    Science.gov (United States)

    Whittington, Melanie D; Atherly, Adam J; Bocsi, Gregary T; Camidge, D Ross

    2016-08-01

    There is growing interest for economic evaluation in oncology to illustrate the value of multiple new diagnostic and therapeutic interventions. As these analyses have started to move from specialist publications into mainstream medical literature, the wider medical audience consuming this information may need additional education to evaluate it appropriately. Here we review standard practices in economic evaluation, illustrating the different methods with thoracic oncology examples where possible. When interpreting and conducting health economic studies, it is important to appraise the method, perspective, time horizon, modeling technique, discount rate, and sensitivity analysis. Guidance on how to do this is provided. To provide a method to evaluate this literature, a literature search was conducted in spring 2015 to identify economic evaluations published in the Journal of Thoracic Oncology. Articles were reviewed for their study design, and areas for improvement were noted. Suggested improvements include using more rigorous sensitivity analyses, adopting a standard approach to reporting results, and conducting complete economic evaluations. Researchers should design high-quality studies to ensure the validity of the results, and consumers of this research should interpret these studies critically on the basis of a full understanding of the methodologies used before considering any of the conclusions. As advancements occur on both the research and consumer sides, this literature can be further developed to promote the best use of resources for this field.

  15. Socio-economic inequalities in the use of postnatal care in India.

    Directory of Open Access Journals (Sweden)

    Abhishek Singh

    Full Text Available OBJECTIVES: First, our objective was to estimate socio-economic inequalities in the use of postnatal care (PNC compared with those in the use of care at birth and antenatal care. Second, we wanted to compare inequalities in the use of PNC between facility births and home births and to determine inequalities in the use of PNC among mothers with high-risk births. METHODS AND FINDINGS: Rich-poor ratios and concentration indices for maternity care were estimated using the third round of the District Level Household Survey conducted in India in 2007-08. Binary logistic regression models were used to examine the socio-economic inequalities associated with use of PNC after adjusting for relevant socio-economic and demographic characteristics. PNC for both mothers and newborns was substantially lower than the care received during pregnancy and child birth. Only 44% of mothers in India at the time of survey received any care within 48 hours after birth. Likewise, only 45% of newborns received check-up within 24 hours of birth. Mothers who had home births were significantly less likely to have received PNC than those who had facility births, with significant differences across the socio-economic strata. Moreover, the rich-poor gap in PNC use was significantly wider for mothers with birth complications. CONCLUSIONS: PNC use has been unacceptably low in India given the risks of mortality for mothers and babies shortly after birth. However, there is evidence to suggest that effective use of pregnancy and childbirth care in health facilities led to better PNC. There are also significant socio-economic inequalities in access to PNC even for those accessing facility-based care. The coverage of essential PNC is inadequate, especially for mothers from economically disadvantaged households. The findings suggest the need for strengthening PNC services to keep pace with advances in coverage for care at birth and prenatal services in India through targeted policy

  16. [The effects of economic crises on health care].

    Science.gov (United States)

    Chang, Nai-Hsin; Huang, Chiu-Ling; Yang, Yu-O

    2010-08-01

    In September 2008, financial turmoil on Wall Street led to severe losses in that country's financial derivatives market and plunged the United States into the most severe financial crisis in over a decade. The backlash of this "financial tsunami" has affected countries around the world. The world economy, facing the most critical financial crisis since the 1930s, must deal with recession, severe unemployment and general fears of worse to come, which have, in turn, spawned a range of physical, psychological and spiritual problems. In this article we study the effects of the economic crisis on healthcare from several angles, including: decreasing incomes causing changing attitudes toward seeking healthcare; decreasing numbers of people covered by medical insurance; increasing impact on the job market of untreated illnesses; changing national healthcare policies in response to economic pressures; increasing physical, psychological and social problems resulting from economic problems; and the need for the nursing profession to respond to these and other rapid changes in the healthcare landscape. Nursing staff are sometimes unaware of social problems outside their profession. This article may, therefore, provide a general reference to medical and nursing staff on the effects of the economic crisis on healthcare.

  17. 多药耐药菌医疗相关感染经济损失评价%Evaluation of economic losses induced by multidrug-resistant bacteria health care-associated infections

    Institute of Scientific and Technical Information of China (English)

    孙吉花; 邢敏; 姜雪锦; 王琳; 邱会芬; 赵爱荣; 李卫光

    2015-01-01

    OBJECTIVE To observe the effect of multidrug‐resistant bacteria health care‐associated infections (HAIs) on length of hospital stay and hospitalization expenses and evaluate the economical losses induced by the multidrug‐resistant bacteria HAIs .METHODS In 2012 and 2013 ,a retrospective survey was conducted to collect the related data of the patients with multidrug‐resistant bacteria HAIs and the patients without multidrug‐resistant bacteria HAIs ,and the occurrence tendency of HAIs ,length of hospital stay ,and hospitalization expenses were statistically analyzed by using SPSS17 .0 software .RESULTS The detection rate of the multidrug‐resistant bacteria HAIs was 44 .16% in 2012 and dropped to 23 .68% in 2013 .The average length of hospital stay of the patients with multidrug‐resistant bacteria HAIs was 51 .48 days in 2012 ,significantly longer than 20 .67 days of the pa‐tients without multidrug‐resistant bacteria HAIs ;it was 45 .16 days in 2013 ,significantly longer than 21 .19 days of the patients without multidrug‐resistant bacteria HAIs .The total hospitalization expense of the patients with multidrug‐resistant bacteria HAI was 130 749 .80 yuan in 2012 ,significantly more than 20 919 .86 yuan of the pa‐tients without multidrug‐resistant bacteria infections ;it was 127 473 .29 yuan in 2013 ,significantly more than 29 225 .12 yuan of the patients without multidrug‐resistant bacteria infections .CONCLUSIONS The multidrug‐resist‐ant bacteria HAIs may increase the length of hospital stay and the economic losses ,and it is urgent to take effec‐tive prevention measures .%目的:了解多药耐药菌(MDROs)医疗相关感染(HAIs)对住院日及住院费用的影响,评价其导致的经济损失。方法回顾性调查2012及2013年多药耐药菌 H A Is及非多药耐药菌 H A Is患者的相关资料,采用SPSS17.0软件对 HAIs发生趋势、两组患者的住院日及住院费用进行统计

  18. Are economic evaluations an important tool in vaccine policy decisions?

    Science.gov (United States)

    Jacobs, Philip

    2011-10-01

    In the 1980s, drug prices began rising considerably worldwide, and in the 1990s, countries began incorporating health economics into the scientific review process. Rising prices in vaccines began around the year 2000 and national bodies began to use health economics to review vaccines in the next decade. Health economics is a discipline that evaluates alternative interventions, balancing costs and health outcomes. There are characteristics of infectious diseases that differ from other illnesses, most notably the herd effect. We reviewed the role of economics in conducting vaccine scientific reviews. We conclude that health economics can move some of the considerations in vaccine policy decision-making from the political to the scientific arena, but there are still many unresolved issues. Health economists will continue to address these issues in the coming years, but there will always be a need for a separate policy review.

  19. Solar energy system economic evaluation for Solaron Akron, Akron, Ohio

    Science.gov (United States)

    1980-01-01

    The economic analysis of the solar energy system that was installed at Akron, Ohio is developed for this and four other sites typical of a wide range of environmental and economic conditions. The analysis is accomplished based on the technical and economic models in the f chart design procedure with inputs based on the characteristics of the installed parameters of present worth of system cost over a projected twenty year life: life cycle savings, year of positive savings and year of payback for the optimized solar energy system at each of the analysis sites. The sensitivity of the economic evaluation to uncertainties in constituent system and economic variables is also investigated. Results show that only in Albuquerque, New Mexico, where insolation is 1828 Btu/sq ft/day and the conventional energy cost is high, is this solar energy system marginally profitable.

  20. Evaluating the economic impact of casino liberalization in Macao.

    Science.gov (United States)

    Zheng, Victor; Hung, Eva P W

    2012-09-01

    This paper aims to evaluate the economic impact after Macao decided to liberalize its gaming industry. By analysing both objective data of official statistics and subjective data of the perceptions of quality of life, we painted a picture of mixed blessings. Although objective indicators showed strong economic growth in terms of a rise in per capita GDP and public revenue as well as a decline in unemployment rate, subjective indicators revealed that local residents were less than optimistic about their own employment outlook and did not perceive any improvement in their overall economic situation. While casino liberalization brought forth tremendous economic gain, the general population did not subjectively feel the benefits. An integrative analysis of both objective and subjective indicators would therefore allow us to look closer how residents' lives in the micro-level could have been adversely affected by the prosperous economic outlook at the macro-level.

  1. Economic evaluation of information technology applications on dairy farms

    NARCIS (Netherlands)

    Asseldonk, van M.A.P.M.

    1999-01-01

    The research described in this thesis focused on the economic evaluation of information technology (IT) applications on dairy farms in order to support investment decisions. The evaluation included a normative (deductive) approach and an empirical (positive) approach. The normative approach predicte

  2. Comprehensive Evaluation of Circular Economic Development in North Anhui Province

    OpenAIRE

    Hu, Shuheng; Zhang, Simei; Chen, Guangzhou; Xu, Min

    2009-01-01

    In view of the characteristics of north Anhui Province, an index system was constructed for evaluating the development level of circular economy according to relevant principles, Principal Component Analysis and Analytic Hierarchy Process were adopted to evaluate the circular economic development in north Anhui Province, and corresponding measures were put forward to promote the circular economy in north Anhui Province.

  3. A Survey on Economic-driven Evaluations of Information Technology

    NARCIS (Netherlands)

    Mutschler, B.; Zarvić, N.; Reichert, M.U.

    2007-01-01

    The economic-driven evaluation of information technology (IT) has become an important instrument in the management of IT projects. Numerous approaches have been developed to quantify the costs of an IT investment and its assumed profit, to evaluate its impact on business process performance, and to

  4. Economic evaluations of hepatitis B vaccination for developing countries

    NARCIS (Netherlands)

    H.A.T. Tu; H.J. Woerdenbag; S. Kane; A. Riewpaiboon; M. van Hulst; M.J. Postma

    2009-01-01

    Economic evaluations, in particular cost-effectiveness, are important determinants for policy makers and stakeholders involved in decision-making for health interventions. Up until now, most evaluations of cost-effectiveness of hepatitis B vaccination have been performed in developed countries. Appr

  5. Intensive Care Nurses’ Belief Systems Regarding the Health Economics: A Focused Ethnography

    Science.gov (United States)

    Heydari, Abbas; Vafaee-Najar, Ali; Bakhshi, Mahmoud

    2016-01-01

    Background: Health care beliefs can have an effect on the efficiency and effectiveness of nursing practices. Nevertheless, how belief systems impact on the economic performance of intensive care unit (ICU) nurses is not known. This study aimed to explore the ICU nurses’ beliefs and their effect on nurse’s: practices and behavior patterns regarding the health economics. Methods: In this study, a focused ethnography method was used. Twenty-four informants from ICU nurses and other professional individuals were purposively selected and interviewed. As well, 400 hours of ethnographic observations were used for data collection. Data analysis was performed using the methods described by Miles and Huberman (1994). Findings: Eight beliefs were found that gave meaning to ICU nurse’s practices regarding the health economics. 1. The registration of medications and supplies disrupt the nursing care; 2. Monitoring and auditing improve consumption; 3. There is a fear of possible shortage in the future; 4. Supply and replacement of equipment is difficult; 5. Higher prices lead to more accurate consumption; 6. The quality of care precedes the costs; 7. Clinical Guidelines are abundant but useful; and 8. Patient economy has priority over hospital economy. Maintaining the quality of patient care with least attention to hospital costs was the main focus of the beliefs formed up in the ICU regarding the health economics. Conclusions: ICU nurses’ belief systems have significantly shaped in relation to providing a high-quality care. Although high quality of care can lead to a rise in the effectiveness of nursing care, cost control perspective should also be considered in planning for improve the quality of care. Therefore, it is necessary to involve the ICU nurses in decision-making about unit cost management. They must become familiar with the principles of heath care economics and productivity by applying an effective cost management program. It may be optimal to implement the

  6. Experiences of including costs of added life years in health economic evaluations in Sweden

    Directory of Open Access Journals (Sweden)

    Laura Pirhonen

    2014-06-01

    Full Text Available It is of importance to include the appropriate costs and outcomes when evaluating a health intervention. Sweden is the only country where the national guidelines of decisions on reimbursement explicitly state that costs of added life years should be accounted for when presenting health economic evaluations. The aim of this article is to, from a theoretical and empirical point of view, critically analyze the Swedish recommendations used by the Dental and Pharmaceutical Benefits Agency (TLV, when it comes to the use of costs of added life years in economic evaluations of health care. The aim is furthermore to analyze the numbers used in Sweden and discuss their impact on the incremental cost‑effectiveness ratios of assessed technologies. If following a societal perspective, based on welfare economics, there is strong support for the inclusion of costs of added life years in health economic evaluations. These costs have a large impact on the results. However this fact may be in conflict with ethical concerns of allocation of health care resources, such as favoring the younger part of the population over the older. It is important that the estimates of production and consumption reflect the true societal values, which is not the case with the values used in Sweden.http://dx.doi.org/10.7175/fe.v15i2.925

  7. Indonesia health care system and Asean economic community

    Directory of Open Access Journals (Sweden)

    Joko Gunawan

    2015-07-01

    However, AEC, by looking at this challenges, is expected to improve health care system and service in Indonesia, and close the gap by collaborating among ten ASEAN member countries through 4 modes of AEC consisting of cross border supply, consumption abroad, commercial presence, and movement of natural persons. [Int J Res Med Sci 2015; 3(7.000: 1571-1577

  8. Economic implications of neonatal intensive care unit collaborative quality improvement

    NARCIS (Netherlands)

    Rogowski, JA; Horbar, JD; Plsek, PE; Baker, LS; Deterding, J; Edwards, WH; Hocker, J; Kantak, AD; Lewallen, P; Lewis, W; Lewit, E; McCarroll, CJ; Mujsce, D; Payne, NR; Shiono, P; Soll, RF; Leahy, K

    2001-01-01

    Objective. To make measurable improvements in the quality and cost of neonatal intensive care using a multidisciplinary collaborative quality improvement model. Design. Interventional study. Data on treatment costs were collected for infants with birth weight 501 to 1500 g for the period of January

  9. Health economics evidence for medical nutrition: are these interventions value for money in integrated care?

    Directory of Open Access Journals (Sweden)

    Walzer S

    2014-05-01

    value for money of medical nutrition interventions. The evaluations were conducted by analyzing different medical nutrition according to their indications, the economic methodology or perspective adopted, the cost source and utility measures, selected efficiency measures, as well as the incremental cost-effectiveness ratio. Results: A total of 225 abstracts were identified for the detailed review, and the data were entered into a data extraction sheet. For the abstracts that finally met the predefined inclusion criteria (n=53, full-text publications were obtained via PubMed, subito, or directly via each journal's Webpage for further assessment. After a detailed review of the full text articles, 34 publications have been qualified for a thorough data extraction procedure. When differentiating the resulting articles in terms of their settings, 20 studies covered inpatients, whereas 14 articles covered outpatients, including patients in community centers. When reviewing the value-for-money evaluations, the indications showed that the different results were mostly impacted by the different perspectives adopted and the comparisons that were made. In order to draw comprehensive conclusions, the results were split according to the main indications and diseases. Discussion: The systematic literature search has shown that there is not only an interest in health economics and its application in medical nutrition, but that there is a lot of ongoing research in this area. Based on the underlying systematic analysis, it has been shown that medical nutrition interventions offer value for money in the different health care settings, particularly for the specific disease areas that have been pointed out. Conclusion: Based on the systematic literature search that was performed, it was shown that medical nutrition interventions offer value for money in the different health care settings. Although medical nutrition has been the topic of some health economic analyses, the usual willingness

  10. Conceptual Framework of Economic Evaluation on SMRs

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Jin Sam; Kim, Jee Young [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of); Kim, Chang Hoon [Stramo Co., Seoul (Korea, Republic of)

    2010-10-15

    Korea Atomic Energy Research Institute(KAERI) launched a project to develop an integral reactor in 1996. The reactor called as System Integrated Modular Advanced Reactor(SMART) which is a kind of small modular reactors (SMRs). Since the early 1990s, there has been renewed interest in the development and application of small and medium sized integral reactors. 2009 assessment by the IAEA under its Innovative Nuclear Power Reactor and Fuel Cycle (INPRO) program concluded that there could be 96 SMRs in operation around the world by 2030 in its 'high' case, and 43 units in the 'low' case, none of them in the USA. The reason of the increased demand mostly comes from the fact that SMRs are thought to be more suitable for developing countries with small electrical grid capacity, insufficient infrastructure and limited investment capability than developed ones. However, it has disadvantage in the point of scale of economy. So, it should be compared the amount of this advantage and disadvantage which differ from the circumstances of the countries. In this work, conceptual framework was built up for suitable evaluation model of SMRs to be utilized in the future detailed study

  11. Evaluation of Fragility of the Economic System in Poyang Lake Ecological Economic Zone

    Institute of Scientific and Technical Information of China (English)

    2012-01-01

    From two aspects,namely the sensitivity of regional economic system to internal and external interference,and its resilience,we establish the evaluation indicator system of fragility of the economic system in Poyang Lake Ecological Economic Zone,and evaluate the internal differences in fragility of the regional economic system,using set pair analysis method. The results show that there is a great difference in fragility of the economic system between different administrative units; the difference in resilience is the major factor responsible for difference in fragility of the economic system in various cities and counties within the region; according to the difference in fragility characteristics,we conduct classification as follows: Nanchang City is a low-sensitivity and high-resilience type; Jiujiang City is a high-sensitivity and high-resilience type; Jiujiang County,Xingzi County,Yongxiu County,Hukou County,Duchang County,Ruichang County,De’an Xian,Wuning County,Pengze County,Leping City, Dongxiang County,Fengcheng City and Gao’an City are a high-sensitivity and low-resilience type; other cities and counties are a low-sensitivity and low-resilience type.

  12. Economic aspect of health care systems. Advantage and disadvantage incentives in different systems.

    Science.gov (United States)

    Chen, G J; Feldman, S R

    2000-04-01

    European health care delivery systems illustrate the effect of economic incentives on health care delivery. Each country faces the issue of trying to balance the desire for economic efficiency with comprehensive, quality medical care. Without careful use of economic incentives achievable with central control, one gets to pick only two of the three desired goods--high quality, low cost, and comprehensive coverage. In the United States, payment approaches for health care have been undergoing tremendous changes since the early 1980s. These changes have escalated during the 1990s. The basic approach for reimbursing hospital care has been completely restructured by many payers for care, and payment approaches for physicians and long-term care providers also are being restructured. Financing approaches vary from provider to provider and payer to payer, and financing approaches will continue to evolve over time. In the traditional fee-for-service reimbursement system, the incentive to physicians is to do more because more services lead to more revenue. The use of incentives to influence health care practitioners' behavior is common. Incentives are generally financial in nature and expose health care providers to some risk or reward for certain patterns of behavior. Some common incentives used in managed care include capitation payment, in which a physician is paid a fixed fee, regardless of the number of services administered; bonus distribution; and withhold accounts, through which a practitioner stands to gain or lose some amount of money for overuse or underuse of medical resources against budget. In many countries, a strengthening of the position of primary care providers can be observed: Finland, Germany, Greece, Italy, the Netherlands, Norway, Sweden, the United Kingdom, and now the United States. General practitioners are assumed to function as a gatekeeper to second-line care, such as specialist care, prescription drugs, and hospital care. A further step is to

  13. Economic valuation of informal care: lessons from the application of the opportunity costs and proxy good methods.

    Science.gov (United States)

    van den Berg, Bernard; Brouwer, Werner; van Exel, Job; Koopmanschap, Marc; van den Bos, Geertrudis A M; Rutten, Frans

    2006-02-01

    This paper reports the results of the application of the opportunity costs and proxy good methods to determine a monetary value of informal care. We developed a survey in which we asked informal caregivers in The Netherlands to indicate the different types of time forgone (paid work, unpaid work and leisure) in order to be able to provide care. Moreover, we asked informal caregivers how much time they spent on a list of 16 informal care tasks during the week before the interview. Data were obtained from surveys in two different populations: informal caregivers and their care recipients with stroke and with rheumatoid arthritis (RA). A total of 218 care recipients with stroke and their primary informal caregivers completed a survey as well as 147 caregivers and their care recipients with RA. The measurement of care according to both methods is more problematic compared to the valuation. This is especially the case for the opportunity costs method and for the housework part in the proxy good method. More precise guidelines are necessary for the consistent application of both methods in order to ensure comparability of results and of economic evaluations of health care.

  14. Evaluation of the economic burden of Herpes Zoster (HZ) infection.

    Science.gov (United States)

    Panatto, Donatella; Bragazzi, Nicola Luigi; Rizzitelli, Emanuela; Bonanni, Paolo; Boccalini, Sara; Icardi, Giancarlo; Gasparini, Roberto; Amicizia, Daniela

    2015-01-01

    The main objective of this systematic review was to evaluate the economic burden of Herpes Zoster (HZ) infection.   The review was conducted in accordance with the standards of the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines. The following databases were accessed: ISI/Web of Knowledge (WoS), MEDLINE/PubMed, Scopus, ProQuest, the Cochrane Library and EconLit. Specific literature on health economics was also manually inspected. Thirty-three studies were included. The quality of the studies assessed in accordance with the Consolidated Health Economic Evaluation Reporting Standards checklist was good. All studies evaluated direct costs, apart from one which dealt only with indirect costs. Indirect costs were evaluated by 12 studies. The economic burden of HZ has increased over time. HZ management and drug prescriptions generate the highest direct costs. While increasing age, co-morbidities and drug treatment were found to predict higher direct costs, being employed was correlated with higher indirect costs, and thus with the onset age of the disease. Despite some differences among the selected studies, particularly with regard to indirect costs, all concur that HZ is a widespread disease which has a heavy social and economic burden.

  15. An exercise intervention to prevent falls in Parkinson’s: an economic evaluation

    Directory of Open Access Journals (Sweden)

    Fletcher Emily

    2012-11-01

    Full Text Available Abstract Background People with Parkinson’s (PwP experience frequent and recurrent falls. As these falls may have devastating consequences, there is an urgent need to identify cost-effective interventions with the potential to reduce falls in PwP. The purpose of this economic evaluation is to compare the costs and cost-effectiveness of a targeted exercise programme versus usual care for PwP who were at risk of falling. Methods One hundred and thirty participants were recruited through specialist clinics, primary care and Parkinson’s support groups and randomised to either an exercise intervention or usual care. Health and social care utilisation and health-related quality of life (EQ-5D were assessed over the 20 weeks of the study (ten-week intervention period and ten-week follow up period, and these data were complete for 93 participants. Incremental cost per quality adjusted life year (QALY was estimated. The uncertainty around costs and QALYs was represented using cost-effectiveness acceptability curves. Results The mean cost of the intervention was £76 per participant. Although in direction of favour of exercise intervention, there was no statistically significant differences between groups in total healthcare (−£128, 95% CI: -734 to 478, combined health and social care costs (£-35, 95% CI: -817 to 746 or QALYs (0.03, 95% CI: -0.02 to 0.03 at 20 weeks. Nevertheless, exploration of the uncertainty surrounding these estimates suggests there is more than 80% probability that the exercise intervention is a cost-effective strategy relative to usual care. Conclusion Whilst we found no difference between groups in total healthcare, total social care cost and QALYs, analyses indicate that there is high probability that the exercise intervention is cost-effective compared with usual care. These results require confirmation by larger trial-based economic evaluations and over the longer term.

  16. Stochastic techno-economic evaluation of cellulosic biofuel pathways.

    Science.gov (United States)

    Zhao, Xin; Brown, Tristan R; Tyner, Wallace E

    2015-12-01

    This study evaluates the economic feasibility and stochastic dominance rank of eight cellulosic biofuel production pathways (including gasification, pyrolysis, liquefaction, and fermentation) under technological and economic uncertainty. A techno-economic assessment based financial analysis is employed to derive net present values and breakeven prices for each pathway. Uncertainty is investigated and incorporated into fuel prices and techno-economic variables: capital cost, conversion technology yield, hydrogen cost, natural gas price and feedstock cost using @Risk, a Palisade Corporation software. The results indicate that none of the eight pathways would be profitable at expected values under projected energy prices. Fast pyrolysis and hydroprocessing (FPH) has the lowest breakeven fuel price at 3.11$/gallon of gasoline equivalent (0.82$/liter of gasoline equivalent). With the projected energy prices, FPH investors could expect a 59% probability of loss. Stochastic dominance is done based on return on investment. Most risk-averse decision makers would prefer FPH to other pathways.

  17. Productivity costs in economic evaluations: past, present, future.

    Science.gov (United States)

    Krol, Marieke; Brouwer, Werner; Rutten, Frans

    2013-07-01

    Productivity costs occur when the productivity of individuals is affected by illness, treatment, disability or premature death. The objective of this paper was to review past and current developments related to the inclusion, identification, measurement and valuation of productivity costs in economic evaluations. The main debates in the theory and practice of economic evaluations of health technologies described in this review have centred on the questions of whether and how to include productivity costs, especially productivity costs related to paid work. The past few decades have seen important progress in this area. There are important sources of productivity costs other than absenteeism (e.g. presenteeism and multiplier effects in co-workers), but their exact influence on costs remains unclear. Different measurement instruments have been developed over the years, but which instrument provides the most accurate estimates has not been established. Several valuation approaches have been proposed. While empirical research suggests that productivity costs are best included in the cost side of the cost-effectiveness ratio, the jury is still out regarding whether the human capital approach or the friction cost approach is the most appropriate valuation method to do so. Despite the progress and the substantial amount of scientific research, a consensus has not been reached on either the inclusion of productivity costs in economic evaluations or the methods used to produce productivity cost estimates. Such a lack of consensus has likely contributed to ignoring productivity costs in actual economic evaluations and is reflected in variations in national health economic guidelines. Further research is needed to lessen the controversy regarding the estimation of health-related productivity costs. More standardization would increase the comparability and credibility of economic evaluations taking a societal perspective.

  18. Political, cultural and economic foundations of primary care in Europe.

    Science.gov (United States)

    Kringos, Dionne S; Boerma, Wienke G W; van der Zee, Jouke; Groenewegen, Peter P

    2013-12-01

    This article explores various contributing factors to explain differences in the strength of the primary care (PC) structure and services delivery across Europe. Data on the strength of primary care in 31 European countries in 2009/10 were used. The results showed that the national political agenda, economy, prevailing values, and type of healthcare system are all important factors that influence the development of strong PC. Wealthier countries are associated with a weaker PC structure and lower PC accessibility, while Eastern European countries seemed to have used their growth in national income to strengthen the accessibility and continuity of PC. Countries governed by left-wing governments are associated with a stronger PC structure, accessibility and coordination of PC. Countries with a social-security based system are associated with a lower accessibility and continuity of PC; the opposite is true for transitional systems. Cultural values seemed to affect all aspects of PC. It can be concluded that strengthening PC means mobilising multiple leverage points, policy options, and political will in line with prevailing values in a country.

  19. Building bridges between health economics research and public policy evaluation.

    Science.gov (United States)

    Debrand, Thierry; Dourgnon, Paul

    2010-12-01

    The Institut de Recherche et Documentation en Economie de la Santé (IRDES) Workshop on Applied Health Economics and Policy Evaluation aims at disseminating health economic research's newest findings and enhancing the community's capacity to address issues that are relevant to public policy. The 2010 program consisted of 16 articles covering a vast range of topics, such as health insurance, social health inequalities and health services research. While most of the articles embedded theoretical material, all had to include empirical material in order to favor more applied and practical discussions and results. The 2010 workshop is to be the first of a series of annual workshops in Paris gathering together researchers on health economics and policy evaluation. The next workshop is to be held at IRDES in June 2011.

  20. Sustainability and economic evaluation of microalgae grown in brewery wastewater.

    Science.gov (United States)

    Mata, Teresa M; Mendes, Adélio M; Caetano, Nídia S; Martins, António A

    2014-09-01

    This article evaluates the sustainability and economic potential of microalgae grown in brewery wastewater for biodiesel and biomass production. Three sustainability and two economic indicators were considered in the evaluation within a life cycle perspective. For the production system the most efficient process units were selected. Results show that harvesting and oil separation are the main process bottlenecks. Microalgae with higher lipid content and productivity are desirable for biodiesel production, although comparable to other biofuel's feedstock concerning sustainability. However, improvements are still needed to reach the performance level of fossil diesel. Profitability reaches a limit for larger cultivation areas, being higher when extracted biomass is sold together with microalgae oil, in which case the influence of lipid content and areal productivity is smaller. The values of oil and/or biomass prices calculated to ensure that the process is economically sound are still very high compared with other fuel options, especially biodiesel.

  1. The use of modeling in the economic evaluation of vaccines

    NARCIS (Netherlands)

    Bos, Jasper M; Alphen, Loek van; Postma, Maarten J

    2002-01-01

    As a consequence of the increased role of pharmacoeconomics in policy-making, economic evaluations are performed at more and more early stages in the development of a therapeutic. This implies the development of models to assess the future impact of an intervention and to account for the level of un

  2. Economic evaluation in stratified medicine: methodological issues and challenges

    Directory of Open Access Journals (Sweden)

    Hans-Joerg eFugel

    2016-05-01

    Full Text Available Background: Stratified Medicine (SM is becoming a practical reality with the targeting of medicines by using a biomarker or genetic-based diagnostic to identify the eligible patient sub-population. Like any healthcare intervention, SM interventions have costs and consequences that must be considered by reimbursement authorities with limited resources. Methodological standards and guidelines exist for economic evaluations in clinical pharmacology and are an important component for health technology assessments (HTAs in many countries. However, these guidelines have initially been developed for traditional pharmaceuticals and not for complex interventions with multiple components. This raises the issue as to whether these guidelines are adequate to SM interventions or whether new specific guidance and methodology is needed to avoid inconsistencies and contradictory findings when assessing economic value in SM.Objective: This article describes specific methodological challenges when conducting health economic (HE evaluations for SM interventions and outlines potential modifications necessary to existing evaluation guidelines /principles that would promote consistent economic evaluations for SM.Results/Conclusions: Specific methodological aspects for SM comprise considerations on the choice of comparator, measuring effectiveness and outcomes, appropriate modelling structure and the scope of sensitivity analyses. Although current HE methodology can be applied for SM, greater complexity requires further methodology development and modifications in the guidelines.

  3. Economic evaluation of influenza vaccination : Assessment for The Netherlands

    NARCIS (Netherlands)

    Postma, Maarten J.; Bos, Jasper M.; Van Gennep, Mark; Jager, Johannes C.; Baltussen, Rob; Sprenger, Marc J.W.

    1999-01-01

    Objective: The objective of this study was to determine the costs associated with influenza and the cost effectiveness (net costs per life-year gained) of influenza vaccination in The Netherlands. Design and setting: The economic evaluation comprised a cost-of-illness assessment and a cost- effectiv

  4. Evaluating economic costs and benefits of climate resilient livelihood strategies

    Directory of Open Access Journals (Sweden)

    S. Liu

    2016-01-01

    Full Text Available A major challenge for international development is to assist the poorest regions to achieve development targets while taking climate change into account. Such ‘climate resilient development’ (CRD must identify and implement adaptation strategies for improving livelihoods while also being cost-effective. While the idea that climate resilience and development goals should be compatible is often discussed, empirical evaluations of the economic impacts of actual CRD investments are practically non-existent. This paper outlines a framework to evaluate economic returns to CRD and applies it in two adaptation strategies trialed in Nusa Tenggara Barat Province, eastern Indonesia. The evaluation framework is composed of three models: a household benefit cost model, a diffusion model, and a regional benefit cost model. The models draw upon the impact evaluation, technology diffusion, and risk assessment literatures, respectively. The analyzes are based on expert opinion and locally-derived information, and hence can be applied in data-poor situations typical of developing countries. Our results explore economic costs and benefits at the household and regional scale, and we identify key input variables that greatly influence the economic returns of the strategies. These variables should therefore be a focus of ongoing investment. We also discuss how the framework is more generally applicable, its limitations including challenges in accounting for less tangible social and ecosystem service benefits, potentially leading to the underestimation of impacts, and how the approach should be complemented by qualitative methods.

  5. The Citizens' Perspective in a socio-economic evaluation?

    NARCIS (Netherlands)

    Flinterman, M.; Glasius-Meier, A.

    2005-01-01

    The problem formulation of this quick scan is twofold: Is it possible to fully incorporate the citizens' perspective (for example in the form of experiential value) in a socio-economic evaluation? And does it serve a useful purpose? In this context, the concept of the citizen denotes the user of the

  6. Discounting in economic evaluations : Stepping forward towards optimal decision rules

    NARCIS (Netherlands)

    Gravelle, Hugh; Brouwer, Werner; Niessen, Louis; Postma, Maarten; Rutten, Frans

    2007-01-01

    The National Institute for Clinical Excellence has recently changed its guidelines on discounting costs and effects in economic evaluations. In common with most other regulatory bodies it now requires that health effects should be discounted at the same rate as costs. We show that the guideline lead

  7. Social, economic en ecological evaluation of the polder Breebaart

    NARCIS (Netherlands)

    ComCoast

    2006-01-01

    The aim of this evaluation is to gain insight in the social, economic en ecological impacts of an overtopping resistant dike compared to a traditional dike in combination with different forms of land use in the hinterland. At the same time this pilot study should provide support the decision makers

  8. Theoretical and methodological basis for the formation and evaluation of the level of the economic system's strategic economic potential

    Directory of Open Access Journals (Sweden)

    Kljushin Vladislav Vladimirovich

    2014-12-01

    Full Text Available The current level of business activity of socio-economic systems of different scale and insufficient to increase their overall potential. To solve this problem, the first priority is the effective management of their strategic and economic potential. Managerial decision-making about the use of economic resources strategic socio-economic systems requires the development of a methodology to identify and evaluate strategic and economic potential.

  9. Evaluating learning environments for interprofessional care.

    Science.gov (United States)

    Kvan, Thomas

    2013-09-01

    Many institutions have invested considerably in the provision of student facilities--lecture halls, tutorial rooms and classrooms--spaces we call collectively learning environments. In expending resources on such facilities, we have assumed that we have needed to create this range of spaces for such activities. However, how do we know we have invested wisely in support of learning for interprofessional care? In this article I review the literature to identify evidence in a range of fields, including health care, to consider the issues and difficulties of employing established approaches from practices of evidence-based design. Central in this article is the role of evidence in the assessment of learning environments. In particular, I argue that the evidence must include qualitative dimensions of the learning experience. To address the qualitative outcomes from education, with particular attention to the concerns of interprofessional education, a model is proposed to examine different levels of outcomes. By developing an interpretation of Kirkpatrick's model, four levels are described for the effective evaluation of interprofessional learning environments.

  10. [Is rehabilitation worth it? : Review of economic evaluations of rehabilitation in Germany].

    Science.gov (United States)

    Krauth, Christian; Bartling, Tim

    2017-04-01

    Because of demographic change, the rehabilitation sector in Germany is going to face increasing demands in the future. Limited budgets make the optimal allocation of resources a top priority. To support decisions about the optimal scope and design of rehabilitation, studies on health economics are of utmost importance. The aim of this article is to provide an overview of the evaluation of rehabilitation with regard to health economics in Germany.Based on a comprehensive literature research, 17 studies on the cost-effectiveness of rehabilitation in Germany were identified. The health economics evaluation focuses on four main topics: patient education (5 studies), the comparison of outpatient and inpatient rehabilitation (7 studies), medico-occupational rehabilitation programs (2 studies) and aftercare programs (3 studies). All four topics show that innovative rehabilitation technologies can be cost-effective. Significant potential savings in program costs of 25-35% are demonstrated in outpatient rehabilitation (with comparable effectiveness with inpatient care). Designated patient education programs often lead to significant savings with indirect costs, by reducing periods of unfitness to work and extending the long-term ability to work. This review article also points out that some relevant areas of rehabilitation, such as the flexibilization of rehabilitation programs or the efficient organization of access to rehabilitation, have not been evaluated sufficiently on the basis of health economics. This article ends with the requirement to carry out more economics-based rehabilitation studies.

  11. Willingness to pay in the context of an economic evaluation of healthcare programs: theory and practice.

    Science.gov (United States)

    Gafni, A

    1997-05-01

    Cost-benefit analysis (CBA) is defined in the methodology literature as a form of economic evaluation in which both costs and consequences are measured in monetary terms. In recent years we have witnessed renewed enthusiasm for CBA and the use of willingness to pay (WTP) as a method of measuring benefits from healthcare providers. Using the economics perspective, this paper assesses the usefulness of the WTP measure in a context of CBA analysis for economic evaluation of healthcare interventions. Starting from the welfarist approach as the foundation of the analysis, this paper evaluates the benefit and cost of using WTP as a measure of outcome compared mainly with the most commonly used measure of outcome (i.e., quality-adjusted life years) as well as a newly suggested measure of outcome (i.e., healthy-years equivalents). This paper studies this issue from both theoretical and practical aspects. The analysis starts with the premise that we want to use the discipline of economics as the mode of thinking and evaluate the methods suggested using economic criteria. A framework that includes five indicators (or criteria) to help identify the measures of outcome that are proper for use in the context of an economic evaluation are described. Following this framework, the paper argues that from a theoretic perspective the WTP approach is the best available measure, despite its limitations. This paper also describes a new instrument that can be used to measure individuals' WTP as well as a recent experience assessing the feasibility of using such an instrument in the context of evaluating a new pharmaceutical agent in a managed care setting. The conclusion of this study is that this technique holds promise as a method that can generate monetary values for program benefits for future use in CBA.

  12. Thermo economical evaluation of retrofitting strategies in air conditioning systems

    Energy Technology Data Exchange (ETDEWEB)

    Tribess, Arlindo; Fiorelli, Flavio Augusto Sanzogo; Hernandez Neto, Alberto [Sao Paulo Univ., SP (Brazil). Escola Politecnica. Dept. de Engenharia Mecanica]. E-mail: atribess@usp.br; fiorelli@usp.br; ahneto@usp.br

    2000-07-01

    In a building project, several subsystems are designed, among them the air conditioning system. Electrical energy consumption profiles show that this subsystem is responsible for 40 to 50% of total consumption in a commercial building. Besides the study of technical aspects that should be considered in order to assure the thermal comfort of the occupants as well the temperature and humidity conditions for an efficient equipment operation, an economical evaluation of this subsystem should be also made. In retrofit projects, the economical aspect is also critical for such projects in order to assure bigger efficiency in an economically attractive way. This paper analyses some strategies that might be adopted in retrofitting an air conditioning system installed in a commercial building with mixed occupation. By mixed we mean that some floors have a typical office occupation profile and other floors are mainly occupied by electronic equipment. This analysis includes both technical and economical evaluation. The proposed solutions performance are compared to the old system, which allows to verify the retrofitting impact in energy consumption reduction and its economical feasibility. (author)

  13. Comprehensive Evaluation of the Economic Development Level of Guanzhong-Tianshui Economic Zone Using Principal Component Cluster Analysis

    Institute of Scientific and Technical Information of China (English)

    Chunxiang; ZHAO; Xinrong; YAN; Xu; GUO

    2014-01-01

    Based on 10 years of statistics concerning economic development in Xi’an as the main part of Guanzhong- Tianshui Economic Zone, this article builds the main indicator system to reflect economic development. Using two mathematical methods( principal component analysis and cluster analysis),we carry out comprehensive evaluation analysis of the main economic indicators,point out the distribution differences in the economic development level in this region,and make classification,in order to provide a scientific basis for the decision- making body to lay down the relevant economic development strategies in accordance with the economic development level and geographical location.

  14. Economic Evaluation of Environmental Health Interventions to Support Decision Making

    Directory of Open Access Journals (Sweden)

    Guy Hutton

    2008-01-01

    Full Text Available Environmental burden of disease represents one quarter of overall disease burden, hence necessitating greater attention from decision makers both inside and outside the health sector. Economic evaluation techniques such as cost- effectiveness analysis and cost-benefit analysis provide key information to health decision makers on the efficiency of environmental health interventions, assisting them in choosing interventions which give the greatest social return on limited public budgets and private resources. The aim of this article is to review economic evaluation studies in three environmental health areas—water, sanitation, hygiene (WSH, vector control, and air pollution—and to critically examine the policy relevance and scientific quality of the studies for selecting and funding public programmers. A keyword search of Medline from 1990–2008 revealed 32 studies, and gathering of articles from other sources revealed a further 18 studies, giving a total of 50 economic evaluation studies (13 WSH interventions, 16 vector control and 21 air pollution. Overall, the economic evidence base on environmental health interventions remains relatively weak—too few studies per intervention, of variable scientific quality and from diverse locations which limits generalisability of findings. Importantly, there still exists a disconnect between economic research, decision making and programmer implementation. This can be explained by the lack of translation of research findings into accessible documentation for policy makers and limited relevance of research findings, and the often low importance of economic evidence in budgeting decisions. These findings underline the importance of involving policy makers in the defining of research agendas and commissioning of research, and improving the awareness of researchers of the policy environment into which their research feeds.

  15. Economic Evaluation of Intensive Growing of Selected Crops

    Directory of Open Access Journals (Sweden)

    J. Homolka

    2013-06-01

    Full Text Available The submitted paper on the topic: “Economic Evaluation of Intensive Growing of Selected Crops” deals with an economic evaluation of growing of selected crops – winter oilseed rape, winter wheat, and sugar beet in Agro Žlunice a.s. where intensive growing technologies are used. Reached results are compared with results in the framework of the Czech Republic which represent average values for the mentioned crops. Agro Žlutice a.s. is situated in sugar beet production area in district Jičín and it farms on 1902 ha of agricultural land of which 1742 ha is arable land. A decisive subject of business here is plant production, animal production, and fruit growing. In the paper, an intensity and economics of growing of winter oilseed rape, winter wheat, and sugar beet in 2010, 2011 and 2012 is evaluated. Winter oilseed rape from a market view-point is an important crop for the chosen enterprise and Czech agriculture. In suitable growing it significantly contributes to a positive economic result. In winter wheat growing, from a view-point of competitiveness, it is important to reduce technological inputs which does not lead to decrease in yield and has provable economic benefit in evaluation of costs per a production unit. A favourable economics of growing of this crop is reached both in the intensive growing technology in the given enterprise, and within average growing conditions. A basic presumption whether to grow sugar beet is a possibility of the enterprise to supply this raw-material for processing either for sugar or bio-ethanol production. This crop in the mentioned enterprise and in the nationwide framework shows a favourable profitability. The reached growing and economic results of the enterprise Agro Žlunice a.s. in use of intensive growing technologies are more favourable in comparison with average results over the whole sector of agriculture.Pieces of knowledge introduced in this paper resulted from solution of an

  16. Economic evaluations of childhood influenza vaccination: a critical review.

    Science.gov (United States)

    Newall, Anthony T; Jit, Mark; Beutels, Philippe

    2012-08-01

    The potential benefits of influenza vaccination programmes targeted at children have gained increasing attention in recent years. We conducted a literature search of economic evaluations of influenza vaccination in those aged ≤18 years. The search revealed 20 relevant articles, which were reviewed. The studies differed widely in terms of the costs and benefits that were included. The conclusions were generally favourable for vaccination, but often applied a wider perspective (i.e. including productivity losses) than the reference case for economic evaluations used in many countries. Several evaluations estimated outcomes from a single-year epidemiological study, which may limit their validity given the year-to-year variation in influenza transmissibility, virulence, vaccine match and prior immunity. Only one study used a dynamic transmission model able to fully incorporate the indirect herd protection to the wider community. The use of dynamic models offers great scope to capture the population-wide implications of seasonal vaccination efforts, particularly those targeted at children.

  17. The Economic Evaluation of Lighting Energy-saving Modification Program

    Directory of Open Access Journals (Sweden)

    ZHANG Xing-zheng

    2012-06-01

    Full Text Available Many lighting energy-saving modification programs have the embarrassment of uneconomical. This papertakes into account economic evaluation to solve the problem. According to illuminative equipments price, lifespan and power consumption, the optimal program will be found under the limited investment. Firstly, the benefit ratio will be used to evaluate on the equipments modification necessity, and get the modification sequence. If the biggest benefit ratio is in different equipment simultaneously, the better one will be selected in terms of relative investment recovery period. The relative remaining time is innovatively introduced into economic evaluation for determining the equipments modification locations. Then the system operation flowchart is to prove that the scheme is workable.

  18. Concepts of ‘personalization’ in personalized medicine: implications for economic evaluation

    Science.gov (United States)

    Rogowski, Wolf; Payne, Katherine; Schnell-Inderst, Petra; Manca, Andrea; Rochau, Ursula; Jahn, Beate; Alagoz, Oguzhan; Leidl, Reiner; Siebert, Uwe

    2015-01-01

    Context This paper assesses if, and how, existing methods for economic evaluation are applicable to the evaluation of PM and if not, where extension to methods may be required. Method Structured workshop with a pre-defined group of experts (n=47), run using a modified nominal group technique. Workshop findings were recorded using extensive note taking and summarised using thematic data analysis. The workshop was complemented by structured literature searches. Results The key finding emerging from the workshop, using an economic perspective, was that two distinct, but linked, interpretations of the concept of PM exist (personalization by ‘physiology’ or ‘preferences’). These interpretations involve specific challenges for the design and conduct of economic evaluations. Existing evaluative (extra-welfarist) frameworks were generally considered appropriate for evaluating PM. When ‘personalization’ is viewed as using physiological biomarkers, challenges include: representing complex care pathways; representing spill-over effects; meeting data requirements such as evidence on heterogeneity; choosing appropriate time horizons for the value of further research in uncertainty analysis. When viewed as tailoring medicine to patient preferences, further work is needed regarding: revealed preferences, e.g. treatment (non)adherence; stated preferences, e.g. risk interpretation and attitude; consideration of heterogeneity in preferences; and the appropriate framework (welfarism vs. extra-welfarism) to incorporate non-health benefits. Conclusion Ideally, economic evaluations should take account of both interpretations of PM and consider physiology and preferences. It is important for decision makers to be cognizant of the issues involved with the economic evaluation of PM to appropriately interpret the evidence and target future research funding. PMID:25249200

  19. Evaluation of care of dentoalveolar trauma

    Directory of Open Access Journals (Sweden)

    Luiz Fernando Fariniuk

    2010-08-01

    Full Text Available OBJECTIVES: The aim of this study was to evaluate cases of dental trauma treated at the specialized center of Pontifical Catholic University of Paraná, Curitiba, Brazil, during a period of 2 years. MATERIAL AND METHODS: A total of 647 patients were evaluated and treated between 2003 and 2005. Data obtained from each patient were tabulated and analyzed as to gender, age, etiology, time elapsed after the injury, diagnosis (type of trauma, and affected teeth. RESULTS: The results revealed that male individuals aged 7 to 13 years presented the highest prevalence of injury, and falling was the main causal factor. In most cases, the time elapsed between the accident and the first care ranged from 4 to 24 h. A total of 1,747 teeth were affected, with higher incidence of concussion/subluxation and coronal fracture, followed by lateral luxation and avulsion. The permanent maxillary central incisors were the most commonly affected teeth. CONCLUSION: The frequency and causes of dentoalveolar trauma should be investigated for identification of risk groups, treatment demands and costs in order to allow for the establishment of effective preventive measures that can reduce the treatment duration and costs for both patients and oral health services.

  20. Solar energy system economic evaluation: Contemporary Newman, Georgia

    Science.gov (United States)

    1980-01-01

    An economic evaluation of performance of the solar energy system (based on life cycle costs versus energy savings) for five cities considered to be representative of a broad range of environmental and economic conditions in the United States is discussed. The considered life cycle costs are: hardware, installation, maintenance, and operating costs for the solar unique components of the total system. The total system takes into consideration long term average environmental conditions, loads, fuel costs, and other economic factors applicable in each of five cities. Selection criteria are based on availability of long term weather data, heating degree days, cold water supply temperature, solar insolation, utility rates, market potential, and type of solar system.

  1. Evaluation of the economic and financial management in Mexican microenterprises

    Directory of Open Access Journals (Sweden)

    Malena Portal Boza

    2016-10-01

    Full Text Available The exhibit features Mexican microenterprises today give evidence of the problems that they face in terms of managing their activities, where the role of economic-financial elements is perceived. Although the issue has been addressed in previous studies the contribution of this study is to evaluate in an integrated manner the level of economic and financial management (GEF in micro and impact on business results. To do an index is constructed from indicators synthetic methodology using the principal components factor analysis, accompanied by linear regression exercises. The results confirm the presence of elements of GEF in micro studied. Moreover, it was found that the extent to which GEF elements are incorporated in its activities, the impact on their business results will be positive. These observations constitute the prelude to the creation of public policies seeking to establish improvement strategies for such companies, besides that fosters future research for analysis but by sectors of economic activity.

  2. Cross-border reproductive care : market forces in action or market failure? An economic perspective

    NARCIS (Netherlands)

    Connolly, Mark

    2011-01-01

    From an economist's perspective, cross-border reproductive care (CBRC) reflects a global market economy bringing together the needs of patients and skills of doctors at an agreed price. From this perspective CBRC is neither wrong nor right, rather it reflects rational economic behaviour of couples t

  3. The economic burden of the care and treatment for people with Alzheimer's disease: the outlook for the Czech Republic.

    Science.gov (United States)

    Marešová, Petra; Zahálková, Veronika

    2016-12-01

    The aim of this paper is to specify the cost of treatment and care for people with Alzheimer's disease (AD) in the Czech Republic and also with a view to the future. Data availability is evaluated as well as the quality of cost comparison with other developed countries. Data for the Czech Republic will include data from the health insurance company regarding medicines and treatment, as well as a selected home caring for people with dementia and, ultimately, the Social Security Administration. The basic methods include an analysis of data from publicly available sources, direct interviews with the representatives of nursing homes caring for people with dementia and the representative of the Social Security Administration of the Czech Republic. Items will be specified within the category of direct costs. For the study, the indirect costs related to the loss of patient as well as caring person productivity are not considered. Costs for treatment and care are based from the data on 4162 patients, the costs of a bed from data on 391 beds in homes for the elderly. The average annual cost per patient with AD in the Czech Republic was calculated and came to the amount of 12,783 EUR. These items include outpatient care, inpatient care in a medical facility, inpatient care in homes and medications. In terms of share of these items on the direct costs, the largest item are services provided by special homes which contributes to the direct costs by 94 %, medications create 1 % and treatment (both outpatient and inpatient) 5 %. In the case of home care the total costs are lower at 4698 EUR. The Czech Republic as well as other developed countries are faced with the problem of unified accounting cost of people suffering from Alzheimer's disease. This then causes the calculation of the economic burden to be very difficult and indicative values.

  4. On individual preferences and aggregation in economic evaluation in healthcare.

    Science.gov (United States)

    Liljas, B; Lindgren, B

    2001-01-01

    For practical reasons, in order to carry out economic evaluations of collective decisions, total costs will generally be compared with total benefits; hence, individuals' willingness to pay (WTP) or quality-adjusted life-years (QALYs) have to be estimated at an aggregate level. So far, aggregation has usually been done by taking the individuals' mean WTP or the unweighted number of QALYs. Since the aggregation process is closely related to the way that income, health and/or utility of different individuals are compared and weighted, it also has significant equity implications. Thus. the explicit (or, more often, implicit) assumptions behind the aggregation process will largely affect how health and welfare are distributed is society. The aggregation problem in economic evaluation is certainly not trivial, but is seldom addressed in current practice. This paper shows the underlying assumptions of aggregate cost-benefit analysis (CBA) and cost-effectiveness analysis/cost-utility analysis (CEA/CUA), and it emphasises the particularly strong assumptions which have to be made when QALYs are interpreted as utilities in the welfare economics sense. Naturally, the appropriate method to choose depends on what is to be maximised: welfare or health. If decisions of resource allocation are to be based on economic welfare theory, then CBA should be preferred. However, if QALYs are interpreted as measures of health, rather than as utilities, then CEA/CUA would be appropriate.

  5. CURRENT ECONOMIC AND MEDICAL REFORMS IN THE ROMANIAN HEALTH CARE SYSTEM

    Directory of Open Access Journals (Sweden)

    Dragoi Mihaela Cristina

    2011-12-01

    Full Text Available The issue of health has always been, both in social reality and in academia and research, a sensitive topic considering the relationship each individual has with his own health and the health care system as a public policy. At public opinion levels and not only, health care is the most important sector demanding the outmost attention, considering that individual health is the fundamental prerequisite for well-being, happiness and a satisfying life. The ever present research and practical question is on the optimal financing of the health care system. Any answer to this question is also a political decision, reflecting the social-economic value of health for a particular country. The size of the resource pool and the criteria and methods for resource allocation are the central economic problems for any health system. This paper takes into consideration the limited resources of the national health care system (the rationalization of health services, the common methods of health financing, the specificity of health services market (the health market being highly asymmetric, with health professionals knowing most if not all of the relevant information, such as diagnosis, treatment options and costs and consumers fully dependent on the information provided in each case and the performance of all hospitals in Romania, in order to assess the latest strategic decisions (introduction of co-payment and merging and reconversion of hospitals taken within the Romanian health care system and their social and economic implications. The main finding show that, even though the intention of reforming and transforming the Romanian health care system into a more efficient one is obvious, the lack of economic and demographic analysis may results into greater discrepancies nationwide. This paper is aimed to renew the necessity of joint collaboration between the economic and medical field, since the relationship between health and economic development runs both ways

  6. ECONOMIC EVALUATION OF Eucalyptus grandis PLANTATION FOR CELLULOSE PRODUCTION

    Directory of Open Access Journals (Sweden)

    Antonio Donizette de Oliveira

    2008-03-01

    Full Text Available The aims of this research were: to analyze the economic feasibility of planting eucalyptus for producing wood pulp,considering various site index and two spacings; to analyze the economic effects regarding the profitability of the forest activity indifferent distances from the industry and changes on discount rate, wood price, transportation costs, minimum profitable diameter oflogs and the length of the logs. A biometric model for making wood volume prognosis was developed, using data of a trial ofEucalyptus grandis stands 19 and 103 months old. The prognosis started at the age zero, considering logs of 2.5 and 6.0 m of lenghtand the minimum diameter varying from 4 to 10 cm, in intervals of 2 cm. Net Present Worth (NPW was used as the economic decisioncriterium, considering an infinite horizon. The main conclusions were: reducing the minimum profitable diameter and the length ofthe logs are good strategies to increase wood utilization and profit; plantations located in less productive lands are economicallyunfeasible; the cost of transportation has significant effect on the profitability of the forest activity and must be analyzed carefully atthe moment of defining the location of new plantations; small variations on wood sales price may cause big alterations on theprofitability of the forest activity, suggesting that the improvement of the wood quality together with other decisions that may increasewood price are alternatives that may render the plantations in less productive areas profitable.

  7. Economic evaluation of closure cap barrier materials study

    Energy Technology Data Exchange (ETDEWEB)

    Serrato, M.G.; Bhutani, J.S.; Mead, S.M.

    1993-09-01

    Volume II of the Economic Evaluation of the Closure Cap Barrier Materials, Revision I contains detailed cost estimates for closure cap barrier materials. The cost estimates incorporate the life cycle costs for a generic hazardous waste seepage basin closure cap under the RCRA Post Closure Period of thirty years. The economic evaluation assessed six barrier material categories. Each of these categories consists of several composite cover system configurations, which were used to develop individual cost estimates. The information contained in this report is not intended to be used as a cost estimating manual. This information provides the decision makers with the ability to screen barrier materials, cover system configurations, and identify cost-effective materials for further consideration.

  8. Superbugs II: how should economic evaluation be conducted for interventions which aim to contain antimicrobial resistance?

    Science.gov (United States)

    Coast, Joanna; Smith, Richard; Karcher, Anne-Marie; Wilton, Paula; Millar, Michael

    2002-10-01

    To date, there has been little examination of the problems associated with conducting economic evaluation for interventions designed to contain antimicrobial resistance. There are two quite different types of intervention aimed at containing antimicrobial resistance: interventions which are designed to avoid the emergence of resistant organisms; and interventions that are designed to avoid the transmission of resistance organisms. Four aspects of economic evaluation where the ease of assessment might be expected to differ across evaluations for these different types of intervention are examined: problems associated with the identification of diffuse impacts, problems associated with comparing current and future impacts, problems associated with uncertainty, and problems associated with difficulties in measurement and valuation. The paper suggests that it may be much easier to conduct rigorous economic evaluations for interventions designed to avoid transmission of resistance, than for those intended to avoid emergence. Unfortunately, the transmission policies, which are likely to be the easiest to evaluate, are not likely to produce an optimal long-term outcome given the apparent irreversibility of much resistance and the potentially severe harms which could be imposed as a result. Given the desirability of avoiding a scenario where, in the evidence-based medicine culture, the most rigorously evaluated policies are followed even though they may be less important, there is the need to consider carefully what, and how, economic evaluation should be conducted in the area of antimicrobial resistance. It is suggested that research should focus on the use of modelling as a means of evaluating optimal policy responses and on trying to resolve some of the difficulties associated with measurement and valuation.

  9. Maximizing Health or Sufficient Capability in Economic Evaluation? A Methodological Experiment of Treatment for Drug Addiction.

    Science.gov (United States)

    Goranitis, Ilias; Coast, Joanna; Day, Ed; Copello, Alex; Freemantle, Nick; Frew, Emma

    2016-11-17

    Conventional practice within the United Kingdom and beyond is to conduct economic evaluations with "health" as evaluative space and "health maximization" as the decision-making rule. However, there is increasing recognition that this evaluative framework may not always be appropriate, and this is particularly the case within public health and social care contexts. This article presents a methodological case study designed to explore the impact of changing the evaluative space within an economic evaluation from health to capability well-being and the decision-making rule from health maximization to the maximization of sufficient capability. Capability well-being is an evaluative space grounded on Amartya Sen's capability approach and assesses well-being based on individuals' ability to do and be the things they value in life. Sufficient capability is an egalitarian approach to decision making that aims to ensure everyone in society achieves a normatively sufficient level of capability well-being. The case study is treatment for drug addiction, and the cost-effectiveness of 2 psychological interventions relative to usual care is assessed using data from a pilot trial. Analyses are undertaken from a health care and a government perspective. For the purpose of the study, quality-adjusted life years (measured using the EQ-5D-5L) and years of full capability equivalent and years of sufficient capability equivalent (both measured using the ICECAP-A [ICEpop CAPability measure for Adults]) are estimated. The study concludes that different evaluative spaces and decision-making rules have the potential to offer opposing treatment recommendations. The implications for policy makers are discussed.

  10. Developing a web 2.0 diabetes care support system with evaluation from care provider perspectives.

    Science.gov (United States)

    Lin, Yung-Hsiu; Chen, Rong-Rong; Guo, Sophie Huey-Ming; Chang, Hui-Yu; Chang, Her-Kun

    2012-08-01

    Diabetes is a life-long illness condition that many diabetic patients end up with related complications resulted largely from lacking of proper supports. The success of diabetes care relies mainly on patient's daily self-care activities and care providers' continuous support. However, the self-care activities are socially bounded with patient's everyday schedules that can easily be forgotten or neglected and the care support from providers has yet been fully implemented. This study develops a Web 2.0 diabetes care support system for patients to integrate required self-care activities with different context in order to enhance patient's care knowledge and behavior adherence. The system also supports care managers in a health service center to conduct patient management through collecting patient's daily physiological information, sharing care information, and maintaining patient-provider relationships. After the development, we evaluate the acceptance of the system through a group of nursing staffs.

  11. Evaluation Study of Day-Care Centers in Israel.

    Science.gov (United States)

    Korazim, Malka; Trachtenberg, Silvia

    In recent years, day-care centers for the elderly have been playing an increasingly important role in the community service system for the elderly in Israel. ESHEL, one of the leading agencies in developing day-care services in Israel initiated a comprehensive evaluation study of day-care centers to identify variations among different types of…

  12. Exergy-Economic Criteria for Evaluating Heat Exchanger Performance

    Institute of Scientific and Technical Information of China (English)

    Wu Shuangying; Li Yourong

    2001-01-01

    Based on the exergy-economic analysis of heat exchanger heat transfer and flow process, two new exergyeconomic criteria which are defined as the total costs per unit heat transfer rate ηt t for heat transfer exchanger and the net profit per unit heat recovery rate ηr for heat recovery exchanger respectively are put forward.Furthermore, the application of criteria is illustrated by the evaluation of down-flow, counter-flow and cross-flow heat exchangers performance. The methods employed and results presented in this paper can serve as a guide for the performance evaluation of heat exchangers.

  13. Evaluation of Health Care System Reform in Hubei Province, China

    OpenAIRE

    2014-01-01

    This study established a set of indicators for and evaluated the effects of health care system reform in Hubei Province (China) from 2009 to 2011 with the purpose of providing guidance to policy-makers regarding health care system reform. The resulting indicators are based on the “Result Chain” logic model and include the following four domains: Inputs and Processes, Outputs, Outcomes and Impact. Health care system reform was evaluated using the weighted TOPSIS and weighted Rank Sum Ratio met...

  14. Influence of production circumstances and economic evaluation criteria on economic comparison of breeds and breed-crosses.

    NARCIS (Netherlands)

    Kahi, A.K.; Koskey, I.S.; Cardoso, V.L.; Arendonk, van J.A.M.

    1998-01-01

    The ranking of genotypes (i.e., breeds and breed crosses) for economic performance depends on the production circumstances of the herd and the criteria for economic evaluation. In this study, the effects of evaluation criteria and production circumstance are quantified using data from the literature

  15. Health economic evaluations of medical devices in the People's Republic of China: A systematic literature review

    Directory of Open Access Journals (Sweden)

    Zhang R

    2015-04-01

    Full Text Available Rongrong Zhang, Farhang Modaresi, Oleg Borisenko Synergus AB, Stockholm, Sweden Background: The objective of this study is to identify and review the methodological quality of health economic evaluations of medical devices performed in the People's Republic of China. To our knowledge, no such investigations have been performed to date. Methods: A systematic literature review involving searches of Medline, Medline In-Process, the National Health Service Economic Evaluation Database, the Cost-Effectiveness Analysis Registry of the Tufts Medical Center, and the Wanfang Database was performed. The search spanned the period from 1990 to 2013. Studies on health economic evaluations of medical devices, in-vitro diagnostics, procedures, and the use of medical devices in Chinese health care settings were included. Full-text articles and conference abstracts in English and Chinese were included. Results: Fifty-seven publications were included, 26 (46% of which were in English and 31 (54% of which were in Chinese. The included publications covered a wide range of clinical areas, such as surgery (n=23, 40%, screening (n=9, 16%, imaging use (n=6, 11%, kidney intervention (n=4, 7%, and nine other technological areas. Most of the studies (n=31, 54% were cost analyses. Among the others, 13 (50% studies used modeling, and another 13 (50% were within-trial evaluations. Among studies that used modeling, eleven (85% conducted sensitivity analyses, six of which had one-way sensitivity analysis, whereas one conducted both one-way and two-way sensitivity analyses; four of these eleven modeling-based analyses included probabilistic sensitivity analyses. The incremental cost-effectiveness ratio was reported in ten (18% studies, eight of which were screening studies. The remaining two modeling studies were in areas of imaging and oncology. Conclusion: This study indicates that there are major limitations and deficiencies in the health economic evaluations on medical

  16. Economical evaluation of damaged vacuum insulation panels in buildings

    Science.gov (United States)

    Kim, Y. M.; Lee, H. Y.; Choi, G. S.; Kang, J. S.

    2015-12-01

    In Korea, thermal insulation standard of buildings have been tightened annually to satisfy the passive house standard from the year 2009. The current domestic policies about disseminating green buildings are progressively conducted. All buildings should be the zero energy building in the year 2025, obligatorily. The method is applied to one of the key technologies for high-performance insulation for zero energy building. The vacuum insulation panel is an excellent high performance insulation. But thermal performance of damaged vacuum insulation panels is reduced significantly. In this paper, the thermal performance of damaged vacuum insulation panels was compared and analyzed. The measurement result of thermal performance depends on the core material type. The insulation of building envelope is usually selected by economic feasibility. To evaluate the economic feasibility of VIPs, the operation cost was analyzed by simulation according to the types and damaged ratio of VIPs

  17. ECOGEN - Soil ecological and economic evaluation of genetically modified crops

    DEFF Research Database (Denmark)

    Krogh, P. H

    2007-01-01

    ECOGEN is a project funded by the EU under the 6th Framework Programme. Based on results obtained from soil biodiversity studies and economic evaluations, ECOGEN assessed the impact on soil organisms of different agricultural management practices, including those involving genetically modified (GM...... where non-GM conventional maize (8 different varieties) was planted. In addition, economic assessments of the GM crop were performed by quantifying the differences in variable costs, revenues and external effects in comparison with the conventional variety. The implications for the EU Common Agriculture...... corn borer, was chosen as the model GM crop since it has been approved for planting in the EU and been available to growers in Europe since 2003 (introduced first in Spain), with commercial plantings being conducted in five Member States in 2006 on more than 63,000 ha. MON 810 maize was first...

  18. Economic Evaluation of Childhood Obesity Interventions: Reflections and Suggestions.

    Science.gov (United States)

    Frew, Emma

    2016-08-01

    Rising levels of childhood obesity present a serious global public health problem amounting to 7 % of GDP in developed countries and affecting 14 % of children. As such, many countries are investing increasingly large quantities of resource towards treatment and prevention. Whilst it is important to demonstrate the clinical effectiveness of any intervention, it is equally as important to demonstrate cost effectiveness as policy makers strive to get the best value for money from increasingly limited public resources. Economic evaluation assists with making these investment decisions and whilst it can offer considerable support in many healthcare contexts, applying it to a childhood obesity context is not straightforward. Childhood obesity is a complex disease with interventions being multi-component in nature. Furthermore, the interventions are implemented in a variety of settings such as schools, the community, and the home, and have costs and benefits that fall outside the health sector. This paper provides a reflection from a UK perspective on the application of the conventional approach to economic evaluation to childhood obesity. It offers suggestions for how evaluations should be designed to fit better within this context, and to meet the needs of local decision makers. An excellent example is the need to report costs using a micro-costing format and for benefit measurement to go beyond a health focus. This is critical as the organisation and commissioning of childhood obesity services is done from a Local Authority setting and this presents further challenges for what is the most appropriate economic evaluation approach to use. Given that adult obesity is now of epidemic proportions, the accurate assessment of childhood obesity interventions to support public health decision making is critical.

  19. A clinical-economic study of caspofungin use in the treatment of invasive candidiasis in intensive care units

    Directory of Open Access Journals (Sweden)

    A. S. Kolbin

    2010-01-01

    Full Text Available Candida spp. are the fourth on the list of sepsis pathogens in patients in intensive care units. Currently the physician’s armamentarium includes a whole range of antifungal medicines that have demonstrated high clinicalmycological effectiveness in clinical trials. The aim of this study to evaluate the clinical-economic usefulness of caspofungin therapy in the treatment of invasive candidiasis versus standard and alternative treatments in patients inintensive care units. The first time in the Russian clinical-economic analysis for targeted IC treatment in non-neutropenic patients in intensive care units who have not received primary prophylaxis with azole antimycotics, as well as in those with low (< 20% occurrence of in vitro Candida spp. resistance to fluconazole according to national or local study results, yielded the following findings: the best strategy is initial amphotericin B therapy with subsequent switching to caspofungin in patients with ineffective initial amphotericin B therapy or those with severe adverse events.

  20. Economic evaluation of agricultural pollution control options for China

    Institute of Scientific and Technical Information of China (English)

    David Abler

    2015-01-01

    Environmental sustainability has become a policy priority in China. In agriculture, China has had major success in reha-bilitating desertiifed lands through programs to convert steeply-sloped cropland to forest and limit grazing on sensitive grasslands. However, little has been done in terms of policies for agricultural nutrient management. Runoff and leaching of nutrients in chemical fertilizers and livestock manure are widely acknowledged as signiifcant problems in China. This paper presents an evaluation of agricultural nonpoint pol ution control options for China. Options analyzed include design standards (command&control), performance standards, and design and performance incentives. Evaluation criteria include economic efifciency and effectiveness, environmental impact and risk, and social criteria such as equity and food security. The evaluation indicates that the best options for China involve subsidies to farmers for changing production practices in order to reduce nonpoint emissions, combined with appropriate farmer education and technical assistance.

  1. Evaluation of the Economical and Intensive Use of Industrial Land in Chizhou Economic and Technological Development Zone

    Institute of Scientific and Technical Information of China (English)

    Rui; LIU

    2014-01-01

    Based on the subdivision of industrial land in Chizhou Economic and Technological Development Zone,this paper builds the evaluation indicator system for the economical and intensive use of industrial land in the development zone,to analyze the current situation of economical and intensive use of industrial land. The results show that the levels of economical and intensive use of industrial land vary in the development zone; the factors affecting the intensive degree of various industries also vary; the industry in Chizhou Economic and Technological Development Zone is still in the transition phase from inefficient use to low level of use to intensive use.

  2. Different Strategies for the Treatment of Age-Related Macular Degeneration in China: An Economic Evaluation

    Directory of Open Access Journals (Sweden)

    Bin Wu

    2016-01-01

    Full Text Available Purpose. To assess the cost-effectiveness of bevacizumab compared to ranibizumab, verteporfin photodynamic therapy (PDT, and usual care for the treatment of age-related macular degeneration (AMD in China. Methods. A Markov model was developed according to patient visual acuity (VA in the better-seeing eye (Snellen scale. Four cohorts of patients were treated with one of the following therapies: bevacizumab, ranibizumab, PDT, or usual care. Clinical data related to treatments were obtained from published randomized clinical trials. Direct medical costs and resource utilization in the Chinese health care setting were taken into account. Health and economic outcomes were evaluated over a lifetime horizon. Sensitivity analyses were performed. Results. Treatment with ranibizumab provided the greatest gains in quality-adjusted life-years (QALYs. The cost per marginal QALY gained with bevacizumab over usual care was $1,258, $3,803, and $2,066 for the predominantly classic, minimally classic, and occult lesions, respectively. One-way sensitivity analysis showed considerably influential factors, such as utility values and effectiveness data. Probabilistic sensitivity analysis indicated that, compared to usual care, PDT and ranibizumab most cases would be cost-effective in the bevacizumab arm at a threshold of $7,480/QALY. Conclusion. Bevacizumab can be a cost-effective option for the treatment of AMD in the Chinese setting.

  3. HIV treatment as prevention: issues in economic evaluation.

    Science.gov (United States)

    Bärnighausen, Till; Salomon, Joshua A; Sangrujee, Nalinee

    2012-01-01

    Meyer-Rath and Over assert in another article in the July 2012 PLoS Medicine Collection, "Investigating the Impact of Treatment on New HIV Infections", that economic evaluations of antiretroviral therapy (ART) in currently existing programs and in HIV treatment as prevention (TasP) programs should use cost functions that capture cost dependence on a number of factors, such as scale and scope of delivery, health states, ART regimens, health workers' experience, patients' time on treatment, and the distribution of delivery across public and private sectors. We argue that for particular evaluation purposes (e.g., to establish the social value of TasP) and from particular perspectives (e.g., national health policy makers) less detailed cost functions may be sufficient. We then extend the discussion of economic evaluation of TasP, describing why ART outcomes and costs assessed in currently existing programs are unlikely to be generalizable to TasP programs for several fundamental reasons. First, to achieve frequent, widespread HIV testing and high uptake of ART immediately following an HIV diagnosis, TasP programs will require components that are not present in current ART programs and whose costs are not included in current estimates. Second, the early initiation of ART under TasP will change not only patients' disease courses and treatment experiences--which can affect behaviors that determine clinical treatment success, such as ART adherence and retention--but also quality of life and economic outcomes for HIV-infected individuals. Third, the preventive effects of TasP are likely to alter the composition of the HIV-infected population over time, changing its biological and behavioral characteristics and leading to different costs and outcomes for ART.

  4. Improving the Methods for the Economic Evaluation of Medical Devices.

    Science.gov (United States)

    Tarricone, Rosanna; Callea, Giuditta; Ogorevc, Marko; Prevolnik Rupel, Valentina

    2017-02-01

    Medical devices (MDs) have distinctive features, such as incremental innovation, dynamic pricing, the learning curve and organisational impact, that need to be considered when they are evaluated. This paper investigates how MDs have been assessed in practice, in order to identify methodological gaps that need to be addressed to improve the decision-making process for their adoption. We used the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist supplemented by some additional categories to assess the quality of reporting and consideration of the distinctive features of MDs. Two case studies were considered: transcatheter aortic valve implantation (TAVI) representing an emerging technology and implantable cardioverter defibrillators (ICDs) representing a mature technology. Economic evaluation studies published as journal articles or within Health Technology Assessment reports were identified through a systematic literature review. A total of 19 studies on TAVI and 41 studies on ICDs were analysed. Learning curve was considered in only 16% of studies on TAVI. Incremental innovation was more frequently mentioned in the studies of ICDs, but its impact was considered in only 34% of the cases. Dynamic pricing was the most recognised feature but was empirically tested in less than half of studies of TAVI and only 32% of studies on ICDs. Finally, organisational impact was considered in only one study of ICDs and in almost all studies on TAVI, but none of them estimated its impact. By their very nature, most of the distinctive features of MDs cannot be fully assessed at market entry. However, their potential impact could be modelled, based on the experience with previous MDs, in order to make a preliminary recommendation. Then, well-designed post-market studies could help in reducing uncertainties and make policymakers more confident to achieve conclusive recommendations. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.

  5. HIV treatment as prevention: issues in economic evaluation.

    Directory of Open Access Journals (Sweden)

    Till Bärnighausen

    Full Text Available Meyer-Rath and Over assert in another article in the July 2012 PLoS Medicine Collection, "Investigating the Impact of Treatment on New HIV Infections", that economic evaluations of antiretroviral therapy (ART in currently existing programs and in HIV treatment as prevention (TasP programs should use cost functions that capture cost dependence on a number of factors, such as scale and scope of delivery, health states, ART regimens, health workers' experience, patients' time on treatment, and the distribution of delivery across public and private sectors. We argue that for particular evaluation purposes (e.g., to establish the social value of TasP and from particular perspectives (e.g., national health policy makers less detailed cost functions may be sufficient. We then extend the discussion of economic evaluation of TasP, describing why ART outcomes and costs assessed in currently existing programs are unlikely to be generalizable to TasP programs for several fundamental reasons. First, to achieve frequent, widespread HIV testing and high uptake of ART immediately following an HIV diagnosis, TasP programs will require components that are not present in current ART programs and whose costs are not included in current estimates. Second, the early initiation of ART under TasP will change not only patients' disease courses and treatment experiences--which can affect behaviors that determine clinical treatment success, such as ART adherence and retention--but also quality of life and economic outcomes for HIV-infected individuals. Third, the preventive effects of TasP are likely to alter the composition of the HIV-infected population over time, changing its biological and behavioral characteristics and leading to different costs and outcomes for ART.

  6. Economic Valuation of Health Care Services in Public Health Systems: A Study about Willingness to Pay (WTP) for Nursing Consultations

    Science.gov (United States)

    Martín-Fernández, Jesús; del Cura-González, Mª Isabel; Rodríguez-Martínez, Gemma; Ariza-Cardiel, Gloria; Zamora, Javier; Gómez-Gascón, Tomás; Polentinos-Castro, Elena; Pérez-Rivas, Francisco Javier; Domínguez-Bidagor, Julia; Beamud-Lagos, Milagros; Tello-Bernabé, Mª Eugenia; Conde-López, Juan Francisco; Aguado-Arroyo, Óscar; Bayona, Mª Teresa Sanz-; Gil-Lacruz, Ana Isabel

    2013-01-01

    Background Identifying the economic value assigned by users to a particular health service is of principal interest in planning the service. The aim of this study was to evaluate the perception of economic value of nursing consultation in primary care (PC) by its users. Methods and Results Economic study using contingent valuation methodology. A total of 662 users of nursing consultation from 23 health centers were included. Data on demographic and socioeconomic characteristics, health needs, pattern of usage, and satisfaction with provided service were compiled. The validity of the response was evaluated by an explanatory mixed-effects multilevel model in order to assess the factors associated with the response according to the welfare theory. Response reliability was also evaluated. Subjects included in the study indicated an average Willingness to Pay (WTP) of €14.4 (CI 95%: €13.2–15.5; median €10) and an average Willingness to Accept [Compensation] (WTA) of €20.9 (CI 95%: €19.6–22.2; median €20). Average area income, personal income, consultation duration, home visit, and education level correlated with greater WTP. Women and older subjects showed lower WTP. Fixed parameters explained 8.41% of the residual variability, and response clustering in different health centers explained 4–6% of the total variability. The influence of income on WTP was different in each center. The responses for WTP and WTA in a subgroup of subjects were consistent when reassessed after 2 weeks (intraclass correlation coefficients 0.952 and 0.893, respectively). Conclusions The economic value of nursing services provided within PC in a public health system is clearly perceived by its user. The perception of this value is influenced by socioeconomic and demographic characteristics of the subjects and their environment, and by the unique characteristics of the evaluated service. The method of contingent valuation is useful for making explicit this perception of value of

  7. Economic valuation of health care services in public health systems: a study about Willingness to Pay (WTP for nursing consultations.

    Directory of Open Access Journals (Sweden)

    Jesús Martín-Fernández

    Full Text Available BACKGROUND: Identifying the economic value assigned by users to a particular health service is of principal interest in planning the service. The aim of this study was to evaluate the perception of economic value of nursing consultation in primary care (PC by its users. METHODS AND RESULTS: Economic study using contingent valuation methodology. A total of 662 users of nursing consultation from 23 health centers were included. Data on demographic and socioeconomic characteristics, health needs, pattern of usage, and satisfaction with provided service were compiled. The validity of the response was evaluated by an explanatory mixed-effects multilevel model in order to assess the factors associated with the response according to the welfare theory. Response reliability was also evaluated. Subjects included in the study indicated an average Willingness to Pay (WTP of €14.4 (CI 95%: €13.2-15.5; median €10 and an average Willingness to Accept [Compensation] (WTA of €20.9 (CI 95%: €19.6-22.2; median €20. Average area income, personal income, consultation duration, home visit, and education level correlated with greater WTP. Women and older subjects showed lower WTP. Fixed parameters explained 8.41% of the residual variability, and response clustering in different health centers explained 4-6% of the total variability. The influence of income on WTP was different in each center. The responses for WTP and WTA in a subgroup of subjects were consistent when reassessed after 2 weeks (intraclass correlation coefficients 0.952 and 0.893, respectively. CONCLUSIONS: The economic value of nursing services provided within PC in a public health system is clearly perceived by its user. The perception of this value is influenced by socioeconomic and demographic characteristics of the subjects and their environment, and by the unique characteristics of the evaluated service. The method of contingent valuation is useful for making explicit this perception

  8. Community health workers and health care delivery: evaluation of a women's reproductive health care project in a developing country.

    Directory of Open Access Journals (Sweden)

    Abdul Wajid

    Full Text Available BACKGROUND: As part of the mid-term evaluation of a Women's Health Care Project, a study was conducted to compare the utilization of maternal and neonatal health (MNH services in two areas with different levels of service in Punjab, Pakistan. METHODS: A cross-sectional survey was conducted to interview Married Women of Reproductive Age (MWRA. Information was collected on MWRA knowledge regarding danger signs during pregnancy, delivery, postnatal periods, and MNH care seeking behavior. After comparing MNH service utilization, the two areas were compared using a logistic regression model, to identify the association of different factors with the intervention after controlling for socio-demographic, economic factors and distance of the MWRA residence to a health care facility. RESULTS: The demographic characteristics of women in the two areas were similar, although socioeconomic status as indicated by level of education and better household amenities, was higher in the intervention area. Consequently, on univariate analysis, utilization of MNH services: antenatal care, TT vaccination, institutional delivery and use of modern contraceptives were higher in the intervention than control area. Nonetheless, multivariable analysis controlling for confounders such as socioeconomic status revealed that utilization of antenatal care services at health centers and TT vaccination during pregnancy are significantly associated with the intervention. CONCLUSIONS: Our findings suggest positive changes in health care seeking behavior of women and families with respect to MNH. Some aspects of care still require attention, such as knowledge about danger signs and neonatal care, especially umbilical cord care. Despite overall success achieved so far in response to the Millennium Development Goals, over the past two decades decreases in maternal mortality are far from the 2015 target. This report identifies some of the key factors to improving MNH and serves as an

  9. The economic cost of pathways to care in first episode psychosis.

    LENUS (Irish Health Repository)

    Heslin, Margaret

    2011-01-01

    Few studies have examined the economic cost of psychoses other than schizophrenia and there have been no studies of the economic cost of pathways to care in patients with their first episode of psychosis. The aims of this study were to explore the economic cost of pathways to care in patients with a first episode of psychosis and to examine variation in costs. Data on pathways to care for first episode psychosis patients referred to specialist mental health services in south-east London and Nottingham between 1997-2000. Costs of pathway events were estimated and compared between diagnostic groups. The average costs for patients in south-east London were £54 (CI £33-£75) higher, compared to patients in Nottingham. Across both centres unemployed patients had £25 (CI £7-£43) higher average costs compared to employed patients. Higher costs were associated with being unemployed and living in south-east London and these differences could not be accounted for by any single factor. This should be considered when the National Health Service (NHS) is making decisions about funding.

  10. Care or custody? An evaluation of palliative care in prisons in North West England.

    Science.gov (United States)

    Turner, Mary; Payne, Sheila; Barbarachild, Zephyrine

    2011-06-01

    This study aimed to evaluate health professionals' views about palliative care provision in prisons in the counties of Cumbria and Lancashire in the North West of England. Seventeen prison healthcare staff and nine specialist palliative care staff participated in semi-structured interviews and 16 prison healthcare staff completed a questionnaire designed to measure knowledge, skills and confidence in relation to palliative care. The findings highlighted tensions between the philosophies of care and custody, and the many challenges in providing palliative care in a custodial setting. This paper presents two illustrative case study examples, and suggests ways in which some of these challenges can be overcome in practice.

  11. Comparing top-down and bottom-up costing approaches for economic evaluation within social welfare.

    Science.gov (United States)

    Olsson, Tina M

    2011-10-01

    This study compares two approaches to the estimation of social welfare intervention costs: one "top-down" and the other "bottom-up" for a group of social welfare clients with severe problem behavior participating in a randomized trial. Intervention costs ranging over a two-year period were compared by intervention category (foster care placement, institutional placement, mentorship services, individual support services and structured support services), estimation method (price, micro costing, average cost) and treatment group (intervention, control). Analyses are based upon 2007 costs for 156 individuals receiving 404 interventions. Overall, both approaches were found to produce reliable estimates of intervention costs at the group level but not at the individual level. As choice of approach can greatly impact the estimate of mean difference, adjustment based on estimation approach should be incorporated into sensitivity analyses. Analysts must take care in assessing the purpose and perspective of the analysis when choosing a costing approach for use within economic evaluation.

  12. Developing, implementing and evaluating an end of life care intervention.

    Science.gov (United States)

    Cox, Anna; Arber, Anne; Bailey, Fiona; Dargan, Sue; Gannon, Craig; Lisk, Radcliffe; Quinn, Barry; Samarasinghe, Jane; Wrigley, Martha; Gallagher, Ann

    2017-01-31

    Aim To develop, implement and evaluate a collaborative intervention in care homes seeking to increase the confidence and competence of staff in end of life care and enable more people to receive end of life care in their usual place of residence. Method A two-phase exploratory mixed methods design was used, evaluating the effect of an end of life care toolkit and associated training in care homes, facilitated by a specialist palliative care team. Six care homes in England were recruited to the intervention; 24 staff participated in discussion groups; 54 staff attended at least one training session; and pre- and post-intervention questionnaires were completed by 78 and 103 staff respectively. Results Staff confidence in receiving emotional and clinical support and managing end of life care symptoms increased post-intervention, but confidence in discussing death and dying with residents and relatives decreased. Audit data indicate greater reduction in the number of residents from participating care homes dying in hospital than those from comparison homes. Conclusion Collaborative end of life care interventions support care home staff to manage end of life and may enable residents to have choice about their place of death.

  13. Evaluating Health Care Financing Reforms in Africa

    NARCIS (Netherlands)

    I.E.J. Bonfrer (Igna)

    2015-01-01

    markdownabstract__Abstract__ Africa is on a steady economic growth path. Over the last decade, most Sub-Saharan African (SSA) countries outperformed European and North-American countries’ growth rates, as shown in Figure 1. A number of SSA countries are among the fastest growing economies in the wo

  14. Impoverishment of practice: analysis of effects of economic discourses in home care case management practice.

    Science.gov (United States)

    Ceci, Christine

    2006-03-01

    Home care is a health sector under increasing pressure. Demand is often said to be outstripping capacity, with constant change and retrenchment distinguishing features of the current context. This paper takes a reading of the current conditions of home care using data gathered during a field study of home care case management practices conducted in 2004. As economic discourses become increasingly influential in determining responses to client situations, case managers (and their managers) find themselves with limited capacity to exercise control over their practices. A growing gap between professionally influenced discourses--those presumably intended to guide practice--and organizational priorities creates a dissonance for case managers as the political-ethical dimensions of their practices are displaced by budget "realities." For front-line workers, such displacement cannot be sustained in their face-to-face encounters with clients, leading to a growing sense of frustration and powerlessness among these highly skilled practitioners.

  15. Economic evaluation guidelines in Latin America: a current snapshot.

    Science.gov (United States)

    Augustovski, Federico; Garay, Osvaldo Ulises; Pichon-Riviere, Andres; Rubinstein, Adolfo; Caporale, Joaquín E

    2010-10-01

    Economic evaluation guidelines are widespread in developed countries with fourth hurdle systems but as of yet not in Latin America. In the present article, a systematic search was conducted in order to retrieve regional guidelines in PubMed, Latin American and Caribbean Health Sciences Literature (LILACS) and the gray literature. Four national guidelines were found: Brazil, Colombia, Cuba and Mexico. We report a thorough review of these documents, as well as a comparison among them. We conclude that, despite some differences found, they are broadly similar, and are broadly in accordance with international documents. The existence of these documents, together with other experiences in the region that explicitly use economic evaluation information for health decision making clearly shows that this global tendency is gaining momentum in Latin America, although there is still a long way to go. In the near future we will be able to see if these documents were successfully used and applied for transparent and evidence-based decision making.

  16. [Fostering of health economics in Germany].

    Science.gov (United States)

    Ulrich, V

    2012-05-01

    Health economics is now well established in Germany with the aim to apply economic tools to answer problems in health and health care. After a short review of the international development of health economics and the development in Germany in particular, the article looks at selected recent topics of health economic analysis in Germany (economic evaluation, industrial economics, health and education).

  17. Economic evaluation of newborn hearing screening: modelling costs and outcomes

    Directory of Open Access Journals (Sweden)

    von Voß, Hubertus

    2003-12-01

    Full Text Available Objectives: The prevalence of newborn hearing disorders is 1-3 per 1,000. Crucial for later outcome are correct diagnosis and effective treatment as soon as possible. With BERA and TEOAE low-risk techniques for early detection are available. Universal screening is recommended but not realised in most European health care systems.Aim of the study was to examine the scientific evidence of newborn hearing screening and a comparison of medical outcome and costs of different programmes, differentiated by type of strategy (risk screening, universal screening, no systematical screening. Methods: In an interdisciplinary health technology assessment project all studies on newborn hearing screening detected in a standardized comprehensive literature search were identified and data on medical outcome, costs, and cost-effectiveness extracted. A Markov model was designed to calculate cost-effectiveness ratios. Results: Economic data were extracted from 20 relevant publications out of 39 publications found. In the model total costs for screening of 100,000 newborns with a time horizon of ten years were calculated: 2.0 Mio.€ for universal screening (U, 1.0 Mio.€ for risk screening (R, and 0.6 Mio.€ for no screening (N. The costs per child detected: 13,395€ (U respectively 6,715€ (R, and 4,125€ (N. At 6 months of life the following percentages of cases are detected: U 72%, R 43%, N 13%. Conclusions: A remarkable small number of economic publications mainly of low methodological quality was found. In our own model we found reasonable cost-effectiveness ratios also for universal screening. Considering the outcome advantages of higher numbers of detected cases a universal newborn hearing screening is recommended.

  18. Economic Evaluation of Coronary Heart Disease (CHD: Expectations and Challenges in UK and Iran

    Directory of Open Access Journals (Sweden)

    AD Parsa

    2005-10-01

    Full Text Available Introduction: Hearth disease is a major worldwide health problem with high incidence and prevalence in developed countries and rising incidence in developing countries. During last ten years, almost 20% of all acute hospital admissions are cardiac-related. More than 25,000 bypass procedures, about 40,000 angioplasty, and other coronary intervention procedures are carried out annually in the UK. CHD burdens the UK economy by £7.06 billion. Methods: Economic evaluation involves three basic steps of cost identification, cost valuation and cost measurement. The most accepted perspective is societal. Patient data are extracted from the patient file record or patients’ questionnaire or interview. Both quantitative and qualitative analyses are used. Discussion: Management is important clinically and from the economics viewpoint (e.g.; individuals and society must be considered. CHD management is becoming increasingly costly. Direct and indirect costs divert scarce resources (patient’s or family and society to medical care. Economic evaluation assesses the value of heart management in terms of their expected costs and expected benefits, if it includes an analysis of all direct and indirect cost and also all benefits forgone. Increasingly technical solutions are deployed and consideration must be given to which would better meet health sector objectives. Health care expectations: The basic principle is simple- comprehensive, high quality medical care should be available to all without financial barriers to access. However, in the face of increasing costs and ever more patients, this is under threat. In addition, sometimes, populations in greatest need are those least likely to receive it. It is expected economic evaluation aid to define choices on how best to use resources. The current distribution of resources leaves some high- priority demands unmet. The challenge of meeting the demand free public services is increasing. Demand for CHD treatment

  19. Dynamic Transmission Economic Evaluation of Infectious Disease Interventions in Low- and Middle-Income Countries: A Systematic Literature Review.

    Science.gov (United States)

    Drake, Tom L; Devine, Angela; Yeung, Shunmay; Day, Nicholas P J; White, Lisa J; Lubell, Yoel

    2016-02-01

    Economic evaluation using dynamic transmission models is important for capturing the indirect effects of infectious disease interventions. We examine the use of these methods in low- and middle-income countries, where infectious diseases constitute a major burden. This review is comprised of two parts: (1) a summary of dynamic transmission economic evaluations across all disease areas published between 2011 and mid-2014 and (2) an in-depth review of mosquito-borne disease studies focusing on health economic methods and reporting. Studies were identified through a systematic search of the MEDLINE database and supplemented by reference list screening. Fifty-seven studies were eligible for inclusion in the all-disease review. The most common subject disease was HIV/AIDS, followed by malaria. A diverse range of modelling methods, outcome metrics and sensitivity analyses were used, indicating little standardisation. Seventeen studies were included in the mosquito-borne disease review. With notable exceptions, most studies did not employ economic evaluation methods beyond calculating a cost-effectiveness ratio or net benefit. Many did not adhere to health care economic evaluations reporting guidelines, particularly with respect to full model reporting and uncertainty analysis. We present a summary of the state-of-the-art and offer recommendations for improved implementation and reporting of health economic methods in this crossover discipline.

  20. The environment of coal mining areas and the economic evaluation of the land reclamation

    Institute of Scientific and Technical Information of China (English)

    王志宏; 肖兴田; 何志强

    2001-01-01

    The environment impact of the coal resources mining was analyzed. The method of economic evaluation for the coal mining was established to analyze land destruction. The opportunity cost method was used to quantitatively analyze and estimate the economic loss of the land destruction by coal mining. At the same time, the dump land reclamation of the Yuanbaoshan. Open Pit was taken as an example to evaluate environmental and economical benefit with the method of economic evaluation for the coal mining areas land reclamation.

  1. Socio-economic and Demographic Determinants of Antenatal Care Services Utilization in Central Nepal

    Directory of Open Access Journals (Sweden)

    Srijana Pandey, PhD

    2014-09-01

    Full Text Available Background/Objective: The importance of maternal health services in lessening maternal mortality and morbidity as well as neonatal deaths has received substantial recognition in the past decade. The lack of antenatal care has been identified as a risk factor for maternal mortality and other adverse pregnancy outcomes. The purpose of this study was to determine the factors affecting attendance of antenatal care services in Nepal. Methods: This is a cross-sectional descriptive study carried out in Central Nepal. Using semi-structured questionnaire, interviews were conducted with married women aged between 15-49 years, who had delivered their babies within one year. Systematic random sampling method was used to select the sample. Results were obtained by frequency distribution and cross-tabulation of the variables. Results: More than half of the women were not aware of the consequences of lack of antenatal care. Age, education, income, type of family were strongly associated with the attendance at antenatal care service. Conclusions and Public Health Implications: In Nepal and in other developing countries, maternal mortality and morbidity continue to pose challenges to the health care delivery system. Variety of factors including socio-demographic, socio-economic, cultural and service availability as well as accessibility influences the use of maternal health services.

  2. The economics of choice: lessons from the U.S. health-care market.

    Science.gov (United States)

    Hanoch, Yaniv; Rice, Thomas

    2011-03-01

    The English health-care system is moving towards increasing consumers' choice. Following economic thinking, it is assumed that such a policy will improve quality, enhance patient satisfaction and reduce health disparities. Indeed, the English health-care system has already built the necessary infrastructure to increase patients' choice. Before expanding the range of choices further, however, it is important that policy makers be aware of the limitations and hurdles that such a policy contains. Here, we highlight these limitations by drawing on the influential work of Kenneth Arrow, who has argued that we cannot treat the health-care market as if it was just another market, and the ideas of Herbert Simon, who questioned whether people had sufficient cognitive abilities to make effective choices in an information-rich environment. In the light of these two strands of thought, we review evidence suggesting that many older adults have low (health) literacy levels, raising concerns over their ability to obtain, process and understand medical-related information, with its increasing complexity, associated risks and emotional involvement. We also discuss recent findings from the United States highlighting the difficulties older users of health-care face with a wide range of prescription drug insurance plans from which to choose. Thus, learning from the experience of health-care systems where choice is abundant could help any health system interested in extending patients' choice to better target the domains where more choice could be beneficial and possibly avoid those where it could be detrimental.

  3. Quixotic medicine: physical and economic laws perilously disregarded in health care and medical education.

    Science.gov (United States)

    Haburchak, David R; Mitchell, Bradford C; Boomer, Craig J

    2008-12-01

    Wise medical practice requires balancing the idealistic goals of medicine with the physical and economic realities of their application. Clinicians should know and employ the rules, maxims, and heuristics that summarize these goals and constraints. There has been little formal study of rules or laws pertaining to therapeutics and prognosis, so the authors postulate four physical and four economic laws that apply to health care: the laws of (1) finitude, (2) inertia, (3) entropy, and (4) the uncertainty principle; and the laws of (5) diminishing returns, (6) unintended consequences, (7) distribution, and (8) economizing. These laws manifest themselves in the absence of health, the pathogenesis of disease, prognosis, and the behaviors of participants in the health care enterprise. Physicians and the public perilously disregard these laws, frequently producing misdiagnoses, distraction, false expectations, unanticipated and undesirable outcomes, inequitable distribution of scarce resources, distrust, and cynicism: in short, quixotic medicine. The origins and public reinforcement of quixotic medicine make it deaf to calls for pragmatism. To achieve the Accreditation Council of Graduate Medical Education competency of systems-based practice, the authors recommend that premedical education return to a broader liberal arts curriculum and that medical education and training foster didactic and experiential knowledge of these eight laws.

  4. Networks for integrated care provision: an economic approach based on opportunism and trust.

    Science.gov (United States)

    Meijboom, Bert; de Haan, Job; Verheyen, Piet

    2004-07-01

    In this paper, we provide the economic rationale for an important issue in the health care sector, namely the network formation, e.g., in The Netherlands. The presence of such cooperation structures is hard to explain using the basic concept of the economic organization (EO) theory, i.e., the dichotomy of hierarchy versus market. However, acknowledging the aspect of trust renders the clan concept to be a powerful tool in understanding the viability of intra- and inter-organizational cooperation in the health sector. The main reason for this is the manner in which the professionals involved perform, as well as the importance of the tacit knowledge of the actors employed in the various health institutions. First, we address the conversion from supply towards demand orientation and the resulting pressure on multi-professional cooperation between health care providers. Then, relevant EO concepts will be reviewed, while introducing theory on knowledge, learning, and trust. Moreover, we offer conclusions for the health care sector on a concept-by-concept basis. Finally, we propose the notion of interclan, a clan-inspired notion for inter-organizational cooperation, and analyse the observed network formation.

  5. Future demand for dental care in Norway; a macro-economic perspective.

    Science.gov (United States)

    Grytten, J; Lund, E

    1999-10-01

    The future demand for dental care in Norway is discussed on the basis of economic theory. During the next 30 years gross national income will increase substantially due to a marked increase in national income from the sale of oil and gas. On the basis of the model we predict that this increase in income will lead to an increase in demand for dental services in the short run, say for the next 10-15 years. To a large extent this increase in demand is supported by evidence from dental epidemiology. In particular, an increasing proportion of elderly dentate people will demand more services. This picture is different in the long run, say from the year 2010-15 and onwards. Evidence from dental epidemiology indicates that at that stage there will be a fairly high proportion of disease-free individuals in the population who will demand less dental care. Such a trend is also supported by economic theory as long as disease-free individuals consume less dental care irrespective of their income.

  6. SERVQUAL: a tool for evaluating patient satisfaction with nursing care.

    Science.gov (United States)

    Scardina, S A

    1994-01-01

    Rising health care costs and competition among hospital facilities have resulted in the need to recognize patient satisfaction as an important indicator of quality care. Nurses provide the primary service to patients; therefore, their role is influential in overall satisfaction. Several instruments have been developed to measure patient satisfaction with nursing care; however, most of them focus only on patient perceptions. One such approach to evaluating patient satisfaction with nursing care involves an instrument, SERVQUAL, derived from a marketing service perspective. Adapting SERVQUAL for use in evaluating nursing care is the focus of this article. SERVQUAL assesses both patient perceptions and expectations of quality service and permits managers and clinicians to view the gaps between the two; thus, the overall areas of improvement in nursing services can be determined.

  7. The economics of dementia-care mapping in nursing homes: a cluster-randomised controlled trial.

    Directory of Open Access Journals (Sweden)

    Geertje van de Ven

    Full Text Available BACKGROUND: Dementia-care mapping (DCM is a cyclic intervention aiming at reducing neuropsychiatric symptoms in people with dementia in nursing homes. Alongside an 18-month cluster-randomized controlled trial in which we studied the effectiveness of DCM on residents and staff outcomes, we investigated differences in costs of care between DCM and usual care in nursing homes. METHODS: Dementia special care units were randomly assigned to DCM or usual care. Nurses from the intervention care homes received DCM training, a DCM organizational briefing day and conducted the 4-months DCM-intervention twice during the study. A single DCM cycle consists of observation, feedback to the staff, and action plans for the residents. We measured costs related to health care consumption, falls and psychotropic drug use at the resident level and absenteeism at the staff level. Data were extracted from resident files and the nursing home records. Prizes were determined using the Dutch manual of health care cost and the cost prices delivered by a pharmacy and a nursing home. Total costs were evaluated by means of linear mixed-effect models for longitudinal data, with the unit as a random effect to correct for dependencies within units. RESULTS: 34 units from 11 nursing homes, including 318 residents and 376 nursing staff members participated in the cost analyses. Analyses showed no difference in total costs. However certain changes within costs could be noticed. The intervention group showed lower costs associated with outpatient hospital appointments over time (p = 0.05 than the control group. In both groups, the number of falls, costs associated with the elderly-care physician and nurse practitioner increased equally during the study (p<0.02. CONCLUSIONS: DCM is a cost-neutral intervention. It effectively reduces outpatient hospital appointments compared to usual care. Other considerations than costs, such as nursing homes' preferences, may determine whether they

  8. Reported barriers to evaluation in chronic care

    DEFF Research Database (Denmark)

    Knai, Cécile; Nolte, Ellen; Brunn, Matthias

    2013-01-01

    The growing movement of innovative approaches to chronic disease management in Europe has not been matched by a corresponding effort to evaluate them. This paper discusses challenges to evaluation of chronic disease management as reported by experts in six European countries....

  9. Evaluation of Economic Education from Graduates’ Point of View

    Directory of Open Access Journals (Sweden)

    Hana Řezanková

    2012-03-01

    Full Text Available The labour market expects graduates with certain levels of competences, which reflect the quality of education. In this paper we present the results of the analyses of selected indicators concerning of the education quality obtained on the basis of answers of graduates of the University of Economics, Prague. The graduates were addressed four or five years after graduation within large REFLEX surveys realized in 2006 and 2010. We compare competence levels acquired by graduates with competence levels required by employers; both types of levels were evaluated by graduates. We investigate dependency, agreement and similarity of acquired and requiredcompetence levels by different coefficients and we compare their values in the 2006 and 2010 surveys.

  10. Process simulation and economical evaluation of enzymatic biodiesel production plant.

    Science.gov (United States)

    Sotoft, Lene Fjerbaek; Rong, Ben-Guang; Christensen, Knud V; Norddahl, Birgir

    2010-07-01

    Process simulation and economical evaluation of an enzymatic biodiesel production plant has been carried out. Enzymatic biodiesel production from high quality rapeseed oil and methanol has been investigated for solvent free and cosolvent production processes. Several scenarios have been investigated with different production scales (8 and 200 mio. kg biodiesel/year) and enzyme price. The cosolvent production process is found to be most expensive and is not a viable choice, while the solvent free process is viable for the larger scale production of 200 mio. kg biodiesel/year with the current enzyme price. With the suggested enzyme price of the future, both the small and large scale solvent free production proved viable. The product price was estimated to be 0.73-1.49 euro/kg biodiesel with the current enzyme price and 0.05-0.75 euro/kg with the enzyme price of the future for solvent free process.

  11. A Review of Economic Evaluations of Tobacco Control Programs

    Directory of Open Access Journals (Sweden)

    Jennifer W. Kahende

    2008-12-01

    Full Text Available Each year, an estimated 443,000 people die of smoking-related diseases in the United States. Cigarette smoking results in more than $193 billion in medical costs and productivity losses annually.In an effort to reduce this burden, many states, the federal government, and several national organizations fund tobacco control programs and policies. For this report we reviewed existing literature on economic evaluations of tobacco control interventions. We found that smoking cessation therapies, including nicotine replacement therapy (NRT and self-help are most commonly studied. There are far fewer studies on other important interventions, such as price and tax increases, media campaigns, smoke free air laws and workplace smoking interventions, quitlines, youth access enforcement, school-based programs, and community-based programs. Although there are obvious gaps in the literature, the existing studies show in almost every case that tobacco control programs and policies are either cost-saving or highly cost-effective.

  12. [Evaluation of the welcoming strategies in the Intensive Care Unit].

    Science.gov (United States)

    Maestri, Eleine; do Nascimento, Eliane Regina Pereira; Bertoncello, Kátia Cilene Godinho; de Jesus Martins, Josiane

    2012-02-01

    This qualitative study was performed at the adult Intensive Care Unit (ICU) of a public hospital in Southern Brazil with the objective to evaluate the implemented welcoming strategies. Participants included 13 patients and 23 relatives. Data collection was performed from July to October 2008, utilizing semi-structured interviews. All interviews were recorded. Data analysis was performed using the Collective Subject Discourse. The collected information yielded two discourses: the family recognized the welcoming strategies and the patients found the ICU team to be considerate. By including the family as a client of nursing care, relatives felt safe and confident. Results show that by committing to the responsibility of making changes in heath care practices, nurses experience a novel outlook towards ICU care, focused on human beings and associating the welcoming to the health care model that promotes the objectivity of care.

  13. Evaluation of wound care options in patients with recessive dystrophic epidermolysis bullosa: a costly necessity.

    Science.gov (United States)

    Kirkorian, Anna Yasmine; Weitz, Nicole A; Tlougan, Brook; Morel, Kimberly D

    2014-01-01

    Recessive dystrophic epidermolysis bullosa (RDEB) is a genetic disorder in which mutations in collagen VII, the main component of the anchoring fibril, lead to skin fragility and to the development of acute and chronic wounds. Wound care and dressing changes are an important part of the daily lives of individuals with RDEB. Ideal wound care should improve wound healing, minimize pain, and improve quality of life. The objective of the current study was to review wound care options that might be used in a patient with RDEB and calculate the cost of these various options based on publicly available pricing of wound care products. There is a wide range of costs for wound care options in patients with RDEB. For example, a 1-day supply of dressing for a neonate boy with RDEB ranges from $10.64 for the least expensive option to $127.54 for the most expensive option. Wound care in patients with severe, generalized RDEB has not only a significant economic effect, but also directly affects quality of life in this patient population. Although randomized controlled trials evaluating different wound care products in patients with RDEB are lacking, small studies and expert opinion support the use of specialized nonadherent dressings that minimize skin trauma and promote wound healing. Until there is a cure, prospective studies are needed to assess pain, quality of life, and wound healing associated with the use of specialized wound care products for this life-altering condition.

  14. Economic evaluations of health technologies: insights into the measurement and valuation of benefits

    NARCIS (Netherlands)

    A. Bobinac (Ana)

    2012-01-01

    textabstractEconomic evaluations have been applied in the field of healthcare for several decades with the principle aim of improving the economic efficiency of resource allocation, i.e., help maximizing benefits from available (and constrained) resources. Broadly speaking, “economic evaluation is t

  15. Impact of the east Asian economic crisis on health and health care: Malaysia's response.

    Science.gov (United States)

    Suleiman, A B; Lye, M S; Yon, R; Teoh, S C; Alias, M

    1998-01-01

    In the wake of the east Asian economic crisis, the health budget for the public sector in Malaysia was cut by 12%. The Ministry of Health responded swiftly with a series of broad-based and specific strategies. There was a careful examination of the operating expenditure and where possible measures were taken to minimise the effects of the budget constraints at the service interface. The MOH reprioritised the development of health projects. Important projects such as rural health projects and training facilities, and committed projects, were continued. In public health, population-based preventive and promotive activities were expected to experience some form of curtailment. There is a need to refocus priorities, maximise the utilisation of resources, and increase productivity at all levels and in all sectors, both public and private, in order to minimise the impact of the economic downturn on health.

  16. Evaluation of care of dentoalveolar trauma

    OpenAIRE

    2010-01-01

    OBJECTIVES: The aim of this study was to evaluate cases of dental trauma treated at the specialized center of Pontifical Catholic University of Paraná, Curitiba, Brazil, during a period of 2 years. MATERIAL AND METHODS: A total of 647 patients were evaluated and treated between 2003 and 2005. Data obtained from each patient were tabulated and analyzed as to gender, age, etiology, time elapsed after the injury, diagnosis (type of trauma), and affected teeth. RESULTS: The results revealed that ...

  17. Optimization Model for Economic Evaluation of Wind Farms - How to Optimize a Wind Energy Project Economically and Technically

    Directory of Open Access Journals (Sweden)

    Wagner Sousa de Oliveira

    2012-01-01

    Full Text Available This paper makes a review and systematize methods and techniques of economic evaluation applied to renewable energy projects, specific to wind energy projects. Both project and cost methodologies of economic evaluation are reviewed for a model optimization construction for a proposed optimization model with its objective function most appropriated. It is necessary to engage in different approaches, but complementary, microeconomic project evaluation methods and optimization methods applied to engineering solutions in wind energy converter systems. Optimization model for economic evaluation of wind farms can be as an efficient planning and resource management, which is the key to the success of an energy project. Wind energy is one of the most potent alternative energy resources; however the economics of wind energy is not yet universally favorable to place wind at a competitive platform with coal and natural gas (fossil fuels. Economic evaluation models of wind projects developed would allow investors to better plan their projects, as well as provide valuable insight into the areas that require further development to improve the overall economics of wind energy projects.

  18. Economic burden of Clostridium difficile in five hospitals of the Florence health care system in Italy

    Directory of Open Access Journals (Sweden)

    Poli A

    2015-11-01

    Full Text Available Anna Poli,1 Sergio Di Matteo,2 Giacomo M Bruno,2 Enrica Fornai,1 Maria Chiara Valentino,2 Giorgio L Colombo2,31Vigilanza e Controllo Infezioni Correlate all'Assistenza, Ospedale Piero Palagi, Azienda Sanitaria di Firenze, Firenze, Italy; 2SAVE Studi – Health Economics and Outcomes Research, Milan, Italy; 3Department of Drug Sciences, University of Pavia, Pavia, ItalyIntroduction: Despite the awareness about the increasing rates of Clostridium difficile infection (CDI and the economic burden arising from its management (prolonged hospitalization, laboratory tests, visits, surgical treatment, environmental sanitation, few studies are available in Italy on the economic costs directly attributable to the CDI. The Florence health care system has designed a study with the aim of describing the costs attributable to the CDI and defines the incremental economic burden associated with the management of this complication.Methods: We conducted a retrospective study in five hospitals of the Florence health care system. The enrolled population included all patients who were hospitalized during the year 2013 with a diagnosis of CDI. Of the 187 total cases reported in 2013, 69 patients were enrolled, for whom the main cause of hospitalization was directly attributable to CDI.Results: We enrolled 69 patients (19 males and 50 females, with a mean age of 82.16 years (minimum 46 to maximum 98. The total number of hospitalization days observed was 886 (12.8 per patient on average. The data from this study show that the mean total incremental cost for a patient with CDI was €3,270.52 per year. The hospital stay length is the most significant cost parameter, having the largest influence on the overall costs, with an impact of 87% on the total cost. The results confirm the costs for the management of CDI in five hospitals of the Florence health care system are in line with data from the international literature.Conclusion: The economic impact of CDI is most

  19. Solar energy system economic evaluation for Wormser Columbia, South Carolina

    Science.gov (United States)

    1980-01-01

    The Solar Energy System is not economically beneficial under the assumed economic conditions at the sites considered. Economic benefits from this system depend on decreasing the initial investment and the continued increase in the cost of conventional energy. Decreasing the cost depends on favorable tax treatment and continuing development of solar energy technology. Fuel cost would have to increase drastically while the cost of the system would have to remain constant or decrease for the system to become economically feasible.

  20. [Problems of evaluating regional integrated care using the example of "Gesundes Kinzigtal Integrated Care"].

    Science.gov (United States)

    Siegel, Achim; Stössel, Ulrich; Schubert, Ingrid; Erler, Antje

    2011-01-01

    "Gesundes Kinzigtal Integrated Care" (GKIC) is one of the few population-based integrated care systems in Germany. The external evaluation of GKIC has a modular design and is coordinated by the Department of Medical Sociology of Freiburg University. In this article we will outline the different evaluation modules and address typical problems arising in the evaluation of regional integrated health care systems. One of these problems is the small size of the intervention population in a recently established pilot care system which makes the use of epidemiologic measures (such as incidence figures) difficult. Total population surveys could alleviate this problem, but when the same intervention population is questioned repeatedly for different evaluation modules, the danger of 'over-surveying' arises. This may lead to decreasing participation in further studies. These problems may be managed by using short survey instruments, by conducting surveys successively (not simultaneously) using time shifts, and by analysing claims data from health insurers. Another problem in the evaluation of comparably small systems of care is how to attribute outcomes (effects) to certain health promotion or disease management programmes: Since participants usually take part in more than one programme, the intervention effect is contaminated by multiple programme effects. These will have to be adjusted for in the final evaluation of the data. Finally, randomised controlled study (RCT) designs frequently cannot be used in the evaluation of a region-wide pilot intervention, so the evidence generated by such a (non-randomised) study is weaker than the evidence generated by an RCT.

  1. Economic analysis of delivering primary health care services through community health workers in 3 North Indian states.

    Directory of Open Access Journals (Sweden)

    Shankar Prinja

    Full Text Available We assessed overall annual and unit cost of delivering package of services and specific services at sub-centre level by CHWs and cost effectiveness of Government of India's policy of introducing a second auxiliary nurse midwife (ANM at the sub-centre compared to scenario of single ANM sub-centre.We undertook an economic costing of health services delivered by CHWs, from a health system perspective. Bottom-up costing method was used to collect data on resources spent in 50 randomly selected sub-centres selected from 4 districts. Mean unit cost along with its 95% confidence intervals were estimated using bootstrap method. Multiple linear regression model was used to standardize cost and assess its determinants.Annually it costs INR 1.03 million (USD 19,381, or INR 187 (USD 3.5 per capita per year, to provide a package of preventive, curative and promotive services through community health workers. Unit costs for antenatal care, postnatal care, DOTS treatment and immunization were INR 525 (USD 10 per full ANC care, INR 767 (USD 14 per PNC case registered, INR 974 (USD 18 per DOTS treatment completed and INR 97 (USD 1.8 per child immunized in routine immunization respectively. A 10% increase in human resource costs results in 6% rise in per capita cost. Similarly, 10% increment in the ANC case registered per provider through-put results in a decline in unit cost ranging from 2% in the event of current capacity utilization to 3% reduction in case of full capacity utilization. Incremental cost of introducing 2nd ANM at sub-centre level per unit percent increase ANC coverage was INR 23,058 (USD 432.Our estimates would be useful in undertaking full economic evaluations or equity analysis of CHW programs. Government of India's policy of hiring 2nd ANM at sub-centre level is very cost effective from Indian health system perspective.

  2. Trial-based economic evaluations in occupational health: Principles, methods, and recommendations

    NARCIS (Netherlands)

    Dongen, J.M. van; Wier, M.F. van; Tompa, E.; Bongers, P.M.; Beek, A.J. van der; Tulder, M.W. van; Bosmans, J.E.

    2014-01-01

    To allocate available resources as efficiently as possible, decision makers need information on the relative economic merits of occupational health and safety (OHS) interventions. Economic evaluations can provide this information by comparing the costs and consequences of alternatives. Nevertheless,

  3. Spirituality and spiritual evaluation, their role in providing spiritual care

    Directory of Open Access Journals (Sweden)

    Tzounis E.

    2013-01-01

    Full Text Available Introduction: Spiritual evaluation is the procedure in which health professionals are able to recognize the spiritual needs of the patients with the use of the right “tools”. The specific models of spirituality and their correlation to health and sickness are more and more attached and applied to medical-nursing care. This is why spiritual care is recognized by the bibliography as a significant factor which affects the biological and psycho – emotional needs of the people. Aim: This specific review is conducted in order to define the influence of spirituality and spiritual evaluation in providing spiritual care by the healthcare professionals. Μaterial and method: A bibliographic search on the data bases Pubmed using the terms: spirituality, spiritual care, spiritual evaluation, spiritual needs, spiritual pain, teaching on spirituality. Results: The last few years, more and more healing interventions include the patients’ thoughts and those of the health care professional in relation to spirituality and spiritual care. The patients desire discussions of spiritual content with the health professionals considering spiritual health as important as physical health. In order to evaluate and diagnose, both doctors and nurses should evaluate whether spirituality is important for a patient and whether the spiritual factors can actually help or prevent healing procedure. Moreover, health professionals who actually recognize their own spiritual needs, formulate the most important healing relationships.Conclusion: The spiritual area of the clinical care is important. The health care professionals have access to emotionally loaded moments of their patients. This is the reason why, any possible tendency for intervention in their patients’ belief system needs attention and should be limited. Because awareness of spiritual needs is best achieved through education, should at least be provided in the curriculum of medical and nursing schools in Greece.

  4. [Clinical effectiveness and economical evaluation of preventive vaccination].

    Science.gov (United States)

    Vaz Carneiro, António; Belo, Ana Isabel; Gouveia, Miguel; Costa, João; Borges, Margarida

    2011-01-01

    The value of mass vaccination as a preventive measure for infectious diseases is one of the most important advances of modern Medicine. The impact on incidence of several infectious diseases, until recently responsible for significant morbidity and mortality at world level, is well proved in a series of high quality epidemiological studies. In this scientific review we aimed firstly to briefly resume the history of mass vaccination and its scientists, responsible for synthesis and marketing of these drugs. In second place we present a group of a few disease preventable by vaccines as well as the Portuguese National Vaccination Plan and its benefits. In third place we identified groups of subjects in which a well structured vaccination plan is particularly important, as well as the correspondent diseases to be covered by vaccination. Fourthly, we discussed the ethical considerations of vaccination, and its tensions between subject autonomy and society advantages in com pulsive programs. Fifthly, we analyzed clinical effectiveness of vaccines through the concept of herd immunity, clinical evaluation of immune response to vaccines and some examples of systematic reviews on three relevant diseases (influenza, meningococcal and pneumococcal infections). In sixth place we discussed vaccine safety presenting monitoring methods of vaccination risks, as well as discussing the public myths concerning vaccines. Finally we present a economic analysis of preventive vaccination with a review of some published literature on specific diseases. We conclude that mass vaccination is a efficacious preventive measure, as well as a economic rational choice, and that this public health intervention should be a pillar of a modern preventive system.

  5. A systematic review of economic evaluations of cardiac rehabilitation

    Directory of Open Access Journals (Sweden)

    Wong Wai

    2012-08-01

    Full Text Available Abstract Background Cardiac rehabilitation (CR, a multidisciplinary program consisting of exercise, risk factor modification and psychosocial intervention, forms an integral part of managing patients after myocardial infarction (MI, revascularization surgery and percutaneous coronary interventions, as well as patients with heart failure (HF. This systematic review seeks to examine the cost-effectiveness of CR for patients with MI or HF and inform policy makers in Singapore on published cost-effectiveness studies on CR. Methods Electronic databases (EMBASE, MEDLINE, NHS EED, PEDro, CINAHL were searched from inception to May 2010 for published economic studies. Additional references were identified through searching bibliographies of included studies. Two independent reviewers selected eligible publications based on the inclusion/exclusion criteria. Quality assessment of economic evaluations was undertaken using Drummond’s checklist. Results A total of 22 articles were selected for review. However five articles were further excluded because they were cost-minimization analyses, whilst one included patients with stroke. Of the final 16 articles, one article addressed both centre-based cardiac rehabilitation versus no rehabilitation, as well as home-based cardiac rehabilitation versus no rehabilitation. Therefore, nine studies compared cost-effectiveness between centre-based supervised CR and no CR; three studies examined that between centre- and home based CR; one between inpatient and outpatient CR; and four between home-based CR and no CR. These studies were characterized by differences in the study perspectives, economic study designs and time frames, as well as variability in clinical data and assumptions made on costs. Overall, the studies suggested that: (1 supervised centre-based CR was highly cost-effective and the dominant strategy when compared to no CR; (2 home-based CR was no different from centre-based CR; (3 no difference existed

  6. The Factors Influencing Economic Efficiency of the Hospital Bed Care in Terms of the Regional Allowance Organizations

    Directory of Open Access Journals (Sweden)

    Vaňková Ivana

    2014-09-01

    Full Text Available This paper aims to provide an efficiency evaluation of selected hospital bed care providers during years 2010 -2012 with respect to selected factors: The size of the hospital establishment according to number of beds, number of hospitalized patients, the average length of stay per a patient in care, total staff cost calculated per bed, total revenues calculated per bed, and total costs calculated per bed. For this purpose, hospitals providing primarily acute bed care were chosen. From the legal point of view, they are allowance organizations of a particular region. The evaluation concerns both allocative efficiency and technical efficiency. The allocative efficiency is treated from the proper algorithm point of view and it compares total costs calculated per bed with total revenues calculated per bed. A method denominated Data Envelopment Analysis was applied for the calculation of the technical efficiency of units. To be more specific, it was input-oriented model with constant returns to scale (CCR. The input parameters involve the number of beds, the average length of stay and costs per day of stay. Output parameters were as follows: Bed occupancy in days and the number of hospitalized patients. The data published by the Institute of Health Information and Statistic of the Czech Republic and by ÚFIS system (the Data Base of Ministry of Finance of the Czech Republic were used as the source of data. The evaluation implies that only three hospitals were economically-effective: Silesian Hospital in Opava, Hospital Jihlava, and TGM Hospital Hodonín. The most significant factor influencing the efficiency was determined - the average length of stay.

  7. Evaluating Documentation of Dietetic Care in Swedish Medical Records

    OpenAIRE

    Lövestam, Elin; Orrevall, Ylva; Koochek, Afsaneh; Karlström, Brita; Andersson, Agneta

    2013-01-01

    An adequate documentation in medical records is essential for patient safety and high quality care. The aim of this study was to evaluate documentation by dietitians in Swedish medical records. A retrospective audit of 147 dietetic notes in electronic medical records was performed. The audit focused at documentation of essential parts of the dietetic care, as well as other quality aspects such as lingual clarity and structure of the documentation. The nutrition intervention showed to be the m...

  8. Diagnostic evaluation of dementia in the secondary health care sector

    DEFF Research Database (Denmark)

    Phung, Thien Kieu Thi; Andersen, Birgitte Bo; Kessing, Lars Vedel;

    2009-01-01

    to clinical guidelines concerning dementia work-up is inadequate in the secondary health care sector. Our findings call for improvement in the organization of clinical dementia care, for education of specialists and for changes in attitude towards making a diagnosis of dementia.......BACKGROUND: We conducted a nationwide registry-based study of the quality of diagnostic evaluation for dementia in the secondary health care sector. METHOD: Two hundred patients were randomly selected from the patient population (4,682 patients) registered for the first time with a dementia...

  9. Economics.

    Science.gov (United States)

    Palley, Paul D; Parcero, Miriam E

    2016-10-01

    A review of literature in the calendar year 2015 dedicated to environmental policies and sustainable development, and economic policies. This review is divided into these sections: sustainable development, irrigation, ecosystems and water management, climate change and disaster risk management, economic growth, water supply policies, water consumption, water price regulation, and water price valuation.

  10. Guidelines for pharmaco-economic research in relation to published health-economics evaluations

    NARCIS (Netherlands)

    Postma, MJ; Kwik, JJ; Rutten, WJMJ; de Jong-van den Berg, LTW; Brouwers, JRBJ

    2002-01-01

    Objective. To investigate whether the health-economics research published in Dutch journals is in agreement with the guidelines for pharmaco-economic research as published in 1999 by the Dutch 'College voor zorgverzekeringen' [Healthcare Insurance Board]. Design. Descriptive. Method. A literature se

  11. Economic evaluation of noncontact normothermic wound therapy for treatment of pressure ulcers.

    Science.gov (United States)

    Macario, Alex

    2002-06-01

    New adjunctive treatments for pressure ulcers have become available to complement standard care. The economic benefits of new advanced wound care treatments like noncontact normothermic wound therapy are related to: the costs of adequately providing standard care treatment, the baseline probability of healing a pressure ulcer to closure with standard care, the relative improvement in healing rates with the advanced wound care treatment and the acquisition cost of the advanced treatment. Healing data from preliminary clinical trials suggest that pressure ulcer healing in long-term care patients is accelerated two-fold with noncontact normothermic wound therapy. At this healing rate, noncontact normothermic wound therapy for stage III and IV pressure ulcer is an economically attractive intervention. Additional well-controlled clinical trials are necessary.

  12. Comprehensive computerized medical imaging: interim hypothetical economic evaluation

    Science.gov (United States)

    Warburton, Rebecca N.; Fisher, Paul D.; Nosil, Josip

    1990-08-01

    The 422-bed Victoria General Hospital (VGH) and Siemens Electric Limited have since 1983 been piloting the implementation of comprehensive computerized medical imaging, including digital acquisition of diagnostic images, in British Columbia. Although full PACS is not yet in place at VGH, experience to date habeen used to project annual cost figures (including capital replacement) for a fully-computerized department. The resulting economic evaluation has been labelled hypothetical to emphasize that some key cost components were estimated rather than observed; this paper presents updated cost figures based on recent revisions to proposed departmental equipment configuration which raised the cost of conventional imaging equipment by 0.3 million* and lowered the cost of computerized imaging equipment by 0.8 million. Compared with conventional diagnostic imaging, computerized imaging appears to raise overall annual costs at VGH by nearly 0.7 million, or 11.6%; this is more favourable than the previous results, which indicated extra annual costs of 1 million (16.9%). Sensitivity analysis still indicates that all reasonable changes in the underlying assumptions result in higher costs for computerized imaging than for conventional imaging. Computerized imaging offers lower radiation exposure to patients, shorter waiting times, and other potential advantages, but as yet the price of obtaining these benefits remains substantial.

  13. The impact of health economic evaluations in Sweden.

    Science.gov (United States)

    Heintz, Emelie; Arnberg, Karl; Levin, Lars-Åke; Liliemark, Jan; Davidson, Thomas

    2014-01-01

    The responsibility for healthcare in Sweden is shared by the central government, county councils and municipalities. The counties and municipalities are free to make their own prioritizations within the framework of the state healthcare laws. To guide prioritization of healthcare resources in Sweden, there is consensus that cost-effectiveness constitutes one of the three principles. The objective of this paper is to describe how cost-effectiveness, and hence health economic evaluations (HEE), have a role in pricing decisions, reimbursement of pharmaceuticals as well as the overall prioritization and allocation of resources in the Swedish healthcare system. There are various organizations involved in the processes of implementing health technologies in the Swedish healthcare system, several of which consider or produce HEEs when assessing different technologies: the Dental and Pharmaceutical Benefits Agency (TLV), the county councils' group on new drug therapies (NLT), the National Board of Health and Welfare, the Swedish Council on Health Technology Assessment (SBU), regional HTA agencies and the Public Health Agency of Sweden. The only governmental agency that has official and mandatory guidelines for how to perform HEE is TLV (LFNAR 2003:2). Even though HEEs may seem to have a clear and explicit role in the decision-making processes in the Swedish healthcare system, there are various obstacles and challenges in the use and dissemination of the results.

  14. Solar energy system economic evaluation for Colt Pueblo, Pueblo, Colorado

    Science.gov (United States)

    1980-01-01

    The Solar Energy System is not economically beneficial under the assumed economic conditions at Pueblo, Colorado; Yosemite, California; Albuquerque, New Mexico; Fort Worth, Texas; and Washington, D.C. Economic benefits from this system depend on decreasing the initial investment and the continued increase in the cost of conventional energy. Decreasing the cost depends on favorable tax treatment and continuing development of solar energy technology. Fuel cost would have to increase drastically while the cost of the system would have to remain constant or decrease for the system to become economically feasible.

  15. Assessing the Quality of Medical Information Technology Economic Evaluations: Room for Improvement

    Science.gov (United States)

    Eisenstein, Eric L.; Ortiz, Maqui; Anstrom, Kevin J.; Crosslin, David R.; Lobach, David F.

    2006-01-01

    Medical information systems are being recognized for their ability to improve patient outcomes. While standards for the economic evaluation of medical technologies were instituted in the mid-1990s, little is known about their application in medical information technology studies. In a review of medical information technology evaluation studies published between 1982 and 2002, we found that the volume and variety of economic evaluations had increased; however, investigators routinely omitted key cost or effectiveness elements in their designs, resulting in publications with incomplete, and potentially biased, economic findings. Of the studies that made economic claims, 23% did not report any economic data, 40% failed to include any effectiveness measures, and more than 50% used a case study or pre- post- test design. Thus, during a time when health economic study methods in general have experienced significant development, there is little evidence of similar progress in medical information technology economic evaluations. PMID:17238338

  16. Medical supplies shortages and burnout among greek health care workers during economic crisis: a pilot study.

    Science.gov (United States)

    Rachiotis, George; Kourousis, Christos; Kamilaraki, Maria; Symvoulakis, Emmanouil K; Dounias, George; Hadjichristodoulou, Christos

    2014-01-01

    Greece has been seriously affected by the economic crisis. In 2011 there were reports of 40% reduction to public hospital budgets. Occasional shortages of medical supplies have been reported in mass media. We attempted to pivotally investigate the frequency of medical supplies shortages in two Greek hospital units of the National Health System and to also assess their possible impact on burnout risk of health care workers. We conducted a cross-sectional study (n=303) of health care workers in two Greek hospitals who were present at the workplace during a casually selected working day (morning shift work). The Maslach Burnout Inventory (MBI) was used as the measure of burnout. An additional questionnaire was used about demographics, and working conditions (duration of employment, cumulative night shifts, type of hospital including medical supplies shortages and their impact on quality of healthcare. The prevalence of emotional exhaustion, depersonalization and low personal accomplishment was 44.5%, 43.2% and 51.5%, respectively. Medical supply shortages were significantly associated with emotional exhaustion and depersonalization. This finding provides preliminary evidence that austerity has affected health care in Greece. Moreover, the medical supply shortages in Greek hospitals may reflect the unfolding humanitarian crisis of the country.

  17. Economic Evaluation in Medical Information Technology: Why the Numbers Don’t Add Up

    Science.gov (United States)

    Eisenstein, Eric L.; Ortiz, Maqui; Anstrom, Kevin J.; Crosslin, David R.; Lobach, David F.

    2006-01-01

    Standards for the economic evaluation of medical technologies were instituted in the mid-1990s, yet little is known about their application in medical information technology studies. In a review of evaluation studies published between 1982 and 2002, we found that the volume and variety of economic evaluations had increased. However, investigators routinely omitted key cost or effectiveness elements in their designs, resulting in publications with incomplete, and potentially biased, economic findings. PMID:17238533

  18. The diffusion of health economics knowledge in Europe : The EURONHEED (European Network of Health Economics Evaluation Database) project.

    Science.gov (United States)

    de Pouvourville, Gérard; Ulmann, Philippe; Nixon, John; Boulenger, Stéphanie; Glanville, Julie; Drummond, Michael

    2005-01-01

    This paper overviews the EURONHEED (EUROpean Network of Health Economics Evaluation Databases) project. Launched in 2003, this project is funded by the EU. Its aim is to create a network of national and international databases dedicated to health economic evaluation of health services and innovations. Seven centres (France, Germany, Italy, The Netherlands, Spain, Sweden and the UK) are involved covering 17 countries. The network is based on two existing databases, the French CODECS (COnnaissance et Decision en EConomie de la Sante) database, created in 2000 by the French Health Economists Association (College des Economistes de la Sante), and the UK NHS-EED (NHS Economic Electronic Database), run by the Centre for Reviews and Dissemination, University of York, York, England. The network will provide bibliographic records of published full health economic evaluation studies (cost-benefit, cost-utility and cost-effectiveness studies) as well as cost studies, methodological articles and review papers. Moreover, a structured abstract of full evaluation studies will be provided to users, allowing them access to a detailed description of each study and to a commentary stressing the implications and limits, for decision making, of the study. Access will be free of charge. The database features and its ease of access (via the internet: http://www.euronheed.org) should facilitate the diffusion of existing economic evidence on health services and the generalisation of common standards in the field at the European level, thereby improving the quality, generalisability and transferability of results across countries.

  19. What is the economic evidence for mHealth? A systematic review of economic evaluations of mHealth solutions

    Science.gov (United States)

    Cato, Kenrick; Falzon, Louise; Stone, Patricia W.

    2017-01-01

    Background Mobile health (mHealth) is often reputed to be cost-effective or cost-saving. Despite optimism, the strength of the evidence supporting this assertion has been limited. In this systematic review the body of evidence related to economic evaluations of mHealth interventions is assessed and summarized. Methods Seven electronic bibliographic databases, grey literature, and relevant references were searched. Eligibility criteria included original articles, comparison of costs and consequences of interventions (one categorized as a primary mHealth intervention or mHealth intervention as a component of other interventions), health and economic outcomes and published in English. Full economic evaluations were appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist and The PRISMA guidelines were followed. Results Searches identified 5902 results, of which 318 were examined at full text, and 39 were included in this review. The 39 studies spanned 19 countries, most of which were conducted in upper and upper-middle income countries (34, 87.2%). Primary mHealth interventions (35, 89.7%), behavior change communication type interventions (e.g., improve attendance rates, medication adherence) (27, 69.2%), and short messaging system (SMS) as the mHealth function (e.g., used to send reminders, information, provide support, conduct surveys or collect data) (22, 56.4%) were most frequent; the most frequent disease or condition focuses were outpatient clinic attendance, cardiovascular disease, and diabetes. The average percent of CHEERS checklist items reported was 79.6% (range 47.62–100, STD 14.18) and the top quartile reported 91.3–100%. In 29 studies (74.3%), researchers reported that the mHealth intervention was cost-effective, economically beneficial, or cost saving at base case. Conclusions Findings highlight a growing body of economic evidence for mHealth interventions. Although all studies included a comparison of

  20. Economic gains stimulate negative evaluations of corporate sustainability initiatives

    Science.gov (United States)

    Makov, Tamar; Newman, George E.

    2016-09-01

    In recent years, many organizations have sought to align their financial goals with environmental ones by identifying strategies that maximize profits while minimizing environmental impacts. Examples of this `win-win' approach can be found across a wide range of industries, from encouraging the reuse of hotel towels, to the construction of energy efficient buildings, to the large-scale initiatives of multi-national corporations. Although win-win strategies are generally thought to reflect positively on the organizations that employ them, here we find that people tend to respond negatively to the notion of profiting from environmental initiatives. In fact, observers may evaluate environmental win-wins less favourably than profit-seeking strategies that have no environmental benefits. The present studies suggest that how those initiatives are communicated to the general public may be of central importance. Therefore, organizations would benefit from carefully crafting the discourse around their win-win initiatives to ensure that they avoid this type of backlash.

  1. Models of economic geography : dynamics, estimation and policy evaluation

    NARCIS (Netherlands)

    Knaap, Thijs

    2004-01-01

    In this thesis we look at economic geography models from a number of angles. We started by placing the theory in a context of preceding theories, both earlier work on spatial economics and other children of the monopolistic competition ‘revolution.’ Next, we looked at the theoretical properties of t

  2. Economic evaluation of safety measures for transport companies

    NARCIS (Netherlands)

    Rietveld, Piet; Rienstra, Sytze A.

    1998-01-01

    Measures to reduce material damage within companies may both increase the business economic performance of the company and traffic safety in general. In this paper the notion of whether such measures are economically feasible is investigated. Results are presented of a series of interviews amongtran

  3. Economic Evaluation of Office Solar-Heating System

    Science.gov (United States)

    1982-01-01

    Solar-energy system at U.S. Department of Transportation Test Center at Pueblo, Colorado and five similar installations around the country is the subject of 109-page report. Objective of economic analysis is to report long-term economic performance of system at installation site and to extrapolate results to four other locations and an alternate site.

  4. Economism

    Directory of Open Access Journals (Sweden)

    P. Simons

    2010-07-01

    Full Text Available Modern society is characterised not only by a fascination with scientific technology as a means of solving all problems, especially those that stand in the way of material progress (technicism, but also by an obsessive interest in everything that has to do with money (economism or mammonism. The article discusses the relationship between technicism and economism, on the basis of their relationship to utilitarian thinking: the quest for the greatest happiness for the greatest number of people. Recent major studies of neo-liberalism (seen as an intensification of utilitarianism by Laval and Dardot are used as reference to the development of utilitarianism. It is suggested that the western view of the world, as expressed in economism and technicism, with a utilitarian ethics, features three absolutisations: those of theoretical thinking, technology and economics. In a second part, the article draws on the framework of reformational philosophy to suggest an approach that, in principle, is not marred by such absolutisations.

  5. Socio-economic evaluation of selected biogas technologies

    Energy Technology Data Exchange (ETDEWEB)

    Moeller, F.; Martinsen, L.

    2013-05-15

    Financial and welfare economic analyses are conducted of 15 different biogas production scenarios that vary in terms of plant size and type of input. All considered scenarios lead to welfare economic losses. Overall welfare economic GHG reduction costs seem to increase with increasing crop/crop material share of input, and although the costs vary significantly across scenarios they are quite high for all scenarios. The financial analyses suggest that biogas production generally will be financially profitable for the agricultural sector and local CHP facilities but unprofitable for the biogas plants and the State. Seen from a policy perspective the results highlights the importance of designing regulatory instruments in a way that create incentives for private actors to engage in welfare economically desirable biogas production activities while discouraging the expansion of welfare economically undesirable activities. (Author)

  6. Geographical, Ethnic and Socio-Economic Differences in Utilization of Obstetric Care in the Netherlands.

    Directory of Open Access Journals (Sweden)

    Anke G Posthumus

    Full Text Available All women in the Netherlands should have equal access to obstetric care. However, utilization of care is shaped by demand and supply factors. Demand is increased in high risk groups (non-Western women, low socio-economic status (SES, and supply is influenced by availability of hospital facilities (hospital density. To explore the dynamics of obstetric care utilization we investigated the joint association of hospital density and individual characteristics with prototype obstetric interventions.A logistic multi-level model was fitted on retrospective data from the Netherlands Perinatal Registry (years 2000-2008, 1.532.441 singleton pregnancies. In this analysis, the first level comprised individual maternal characteristics, the second of neighbourhood SES and hospital density. The four outcome variables were: referral during pregnancy, elective caesarean section (term and post-term breech pregnancies, induction of labour (term and post-term pregnancies, and birth setting in assumed low-risk pregnancies.Higher hospital density is not associated with more obstetric interventions. Adjusted for maternal characteristics and hospital density, living in low SES neighbourhoods, and non-Western ethnicity were generally associated with a lower probability of interventions. For example, non-Western women had considerably lower odds for induction of labour in all geographical areas, with strongest effects in the more rural areas (non-Western women: OR 0.78, 95% CI 0.77-0.80, p<0.001.Our results suggest inequalities in obstetric care utilization in the Netherlands, and more specifically a relative underservice to the deprived, independent of level of supply.

  7. 42 CFR 456.143 - Content of medical care evaluation studies.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Content of medical care evaluation studies. 456.143...: Medical Care Evaluation Studies § 456.143 Content of medical care evaluation studies. Each medical care evaluation study must— (a) Identify and analyze medical or administrative factors related to the...

  8. 42 CFR 456.243 - Content of medical care evaluation studies.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Content of medical care evaluation studies. 456.243... Ur Plan: Medical Care Evaluation Studies § 456.243 Content of medical care evaluation studies. Each medical care evaluation study must— (a) Identify and analyze medical or administrative factors related...

  9. Health care consumer reports: an evaluation of employer perspectives.

    Science.gov (United States)

    Longo, Daniel R

    2004-01-01

    The proliferation of health care consumer reports (also known as "consumer guides," "report cards," and "performance reports") designed to assist consumers in making more informed health care decisions makes it vital to understand the perspective of employers who provide the vast majority of health insurance to the working population regarding the use of these reports. There is little empirical evidence on how consumer reports are used by employers to make health care purchasing decisions. This study fills that gap by surveying 154 businesses in Boone County, Missouri, regarding their evaluation of a consumer guide. The majority of employers surveyed indicate that the report will not have a direct effect on their health care purchasing decisions. However, they indicate that the reports are "positive and worthwhile" and their responses reflect a favorable view of the health care organization that developed and disseminated the report. Additionally, findings indicate that employers generally prefer consumer reports as a means to compare local health care institutions, rather than reviewing national averages to locate the same information. Report developers should take precautions to determine the intent of such reports, as they may not achieve the objective of changing employers' health care purchasing behavior.

  10. QUALICOPC, a multi-country study evaluating quality, costs and equity in primary care.

    NARCIS (Netherlands)

    Salchev, P.; Schäfer, W.; Boerma, W.; Groenewegen, P.

    2011-01-01

    Today, strengthening primary care is worldwide probably higher than ever on the agenda of scientist and policy makers (1). Primary care is expected to be an effective response to effects of the current economic crisis on health and health care. The policy strategy towards primary care reinforcement

  11. An evaluation of four telemedicine systems for primary care.

    Science.gov (United States)

    Dunn, E V; Conrath, D W; Bloor, W G; Tranquada, B

    1977-01-01

    In an evaluation of the efficacy of four two-way telecommunication systems for use in primary care, more than 1,000 patients seeking care at a community health center received an additional remote examination by use of either color television, black and white television, still-frame black and white television, or hands-free telephone. The diagnosis, clinical tests and X rays requested, and proposed patient management were compared to the actual care received by the patients at the health center. There were no significant differences between any of the modes in relation to diagnostic accuracy, time for the diagnostic interview, tests requested, or referral rates. Furthermore, patient attitudes did not vary significantly. Thus the relatively inexpensive telephone proved to be as efficient and effective a means for delivery of remote physician care as did any of the visual communication systems. PMID:873812

  12. Introducing economic evaluation as a policy tool in Korea: will decision makers get quality information? : a critical review of published Korean economic evaluations.

    Science.gov (United States)

    Lee, Kun-Sei; Brouwer, Werner B F; Lee, Sang-Il; Koo, Hye-Won

    2005-01-01

    Interest in the use of economic evaluations in Korea as an aid for healthcare decision makers has been growing rapidly since the financial crisis of the Korean National Health Insurance fund and the separation in 2000 of the roles of prescribing and dispensing drugs. The Korean Health Insurance Review Agency (HIRA) is considering making it mandatory for pharmaceutical companies to submit the results of an economic evaluation when demanding reimbursement of new pharmaceuticals. The usefulness of the results of economic evaluations depends highly on the quality of the studies. The purpose of this paper, therefore, is to provide a critical review of economic evaluations of healthcare technologies published in the Korean context. Our results show that many studies did not meet international standards. Study designs were suboptimal, study perspectives and types were often stated incompletely, time periods were often too short, and outcome measures were often less than ideal. In addition, some articles did not distinguish between measurement and valuation of resource use. Capital, overhead and productivity costs were often omitted. Only half of the studies performed sensitivity analyses. In order to further rationalise resource allocation in the Korean healthcare sector, the quality of the information provided through economic evaluations needs to improve. Developing clear guidelines and educating and training researchers in performing economic evaluations is necessary.

  13. A study of the user's perception of economic value in nursing visits to primary care by the method of contingent valuation

    Directory of Open Access Journals (Sweden)

    Conde-López Juan

    2011-10-01

    Full Text Available Abstract Background The identification of the attribution of economic value that users of a health system assign to a health service could be useful in planning these services. The method of contingent valuation can provide information about the user's perception of value in monetary terms, and therefore comparable between services of a very different nature. This study attempts to extract the economic value that the subject, user of primary care nursing services in a public health system, attributes to this service by the method of contingent valuation, based on the perspectives of Willingness to Pay (WTP and Willingness to Accept [Compensation] (WTA. Methods/Design This is an economic study with a transversal design. The contingent valuation method will be used to estimate the user's willingness to pay (WTP for the care received from the primary care nurse and the willingness to accept [compensation] (WTA, were this service eliminated. A survey that meets the requisites of the contingent valuation method will be constructed and pilot-tested. Subsequently, 600 interviews will be performed with subjects chosen by systematic randomized sampling from among those who visit nursing at twenty health centers with different socioeconomic characteristics in the Community of Madrid. The characteristics of the subject and of the care received that can explain the variations in WTP, WTA and in the WTP/WTA ratio expressed will be studied. A theoretical validation of contingent valuation will be performed constructing two explanatory multivariate mixed models in which the dependent variable will be WTP, and the WTP/WTA relationship, respectively. Discussion The identification of the attribution of economic value to a health service that does not have a direct price at the time of use, such as a visit to primary care nursing, and the definition of a profile of "loss aversion" in reference to the service evaluated, can be relevant elements in planning

  14. [Assessing and evaluating physical activity during counseling in health care].

    Science.gov (United States)

    Hagströmer, Maria; Wisén, Anita; Hassmén, Peter

    2015-01-01

    To make individualized counseling possible, valid and reliable measures of physical activity are necessary. In health care, quality must be continuously secured and developed. Follow-up of life-style habits such as physical activity does not differ from monitoring of other treatment in the health care setting.  After counseling and appropriate period of time, evaluation should be done to assess if there has been any change in the physical activity level. For assessment and evaluation of physical activity in routine clinical practice the National Board for Health and Social Welfare indicator questions regarding physical activity are recommended. For a more detailed assessment and evaluation of physical activity and sedentary behavior comprehensive validated instruments/diaries should be used. For precise and objective assessment and evaluation of both physical activity and sedentary behavior, movement sensors are recommended.

  15. BUSINESS SURVEYS-EVALUATION INSTRUMENT OF THE EUROPEAN ECONOMIC CLIMATE

    Directory of Open Access Journals (Sweden)

    SECAREANU CONSTANTIN

    2010-07-01

    Full Text Available Business surveys or conjuncture surveys are specific statiostical researches, but complementary to traditional, official statistics.While official statistics provide quantitive information regardin the level,structure and evolution of varied economic process and phenomena, business surveys offer quality information, essential to the short term evolutional analysis of economic indicators: the diagnosis of the current situation, the timely detection of inflexion points within the economic cycle and the rapid estimation of short term tendencies of the main macroeconomic indicators (the dynamics of the gross domestic product, the index of industrial production, etc.

  16. Evaluation of Healthy Lifestyle Behaviors in Health Care Workers

    Directory of Open Access Journals (Sweden)

    Meltem Yalcinkaya

    2007-12-01

    Full Text Available This research was conducted as a descriptive study for the purpose of determining the healthy lifestyle behaviors of health care workers employed at university and state hospitals in Afyon and Denizli. There were 1779 health care personnel in the sample who were employed at university and state hospitals in Afyon and Denizli. It was planned conducted the research on the entire population however some health care workers did not want to participate a total of 316 health care workers were included in the study sample. Data were collected between 15 June-15 Agust 2006 using a demografik questionnaire form and the Healthy Lifestyle Behaviors Scale. In the evaluation data gained, Number-percentage calculations, t-test, One Way ANOVA, Kruskal-Wallis and Mann-Whitney U tests were used. This study was determined that 84.5% of the health care workers were nurses, 55.7% were in the 20-30 year old age group, 75.0% were married, 39.2% worked on surgical units, 69.6% ate regular meals, only 22.8% were interested in sports, 61.1% did not smoke cigarettes. A statistically significant difference was found health care workers between for age group, gender, educational level, years of employment, hospital unit where they worked, status of eating regular meals, status of being interested in sports, use of alcohol, hospital where employed and the health care workers' healthy lifestyle behaviors (p<0.05. For development health care behaviors lifestyle the main factor which is avoid risk behavior life. Healt care workers must play an important role on the issue. [TAF Prev Med Bull. 2007; 6(6: 409-420

  17. Evaluation of Healthy Lifestyle Behaviors in Health Care Workers

    Directory of Open Access Journals (Sweden)

    Meltem Yalcinkaya

    2007-12-01

    Full Text Available This research was conducted as a descriptive study for the purpose of determining the healthy lifestyle behaviors of health care workers employed at university and state hospitals in Afyon and Denizli. There were 1779 health care personnel in the sample who were employed at university and state hospitals in Afyon and Denizli. It was planned conducted the research on the entire population however some health care workers did not want to participate a total of 316 health care workers were included in the study sample. Data were collected between 15 June-15 Agust 2006 using a demografik questionnaire form and the Healthy Lifestyle Behaviors Scale. In the evaluation data gained, Number-percentage calculations, t-test, One Way ANOVA, Kruskal-Wallis and Mann-Whitney U tests were used. This study was determined that 84.5% of the health care workers were nurses, 55.7% were in the 20-30 year old age group, 75.0% were married, 39.2% worked on surgical units, 69.6% ate regular meals, only 22.8% were interested in sports, 61.1% did not smoke cigarettes. A statistically significant difference was found health care workers between for age group, gender, educational level, years of employment, hospital unit where they worked, status of eating regular meals, status of being interested in sports, use of alcohol, hospital where employed and the health care workers' healthy lifestyle behaviors (p<0.05. For development health care behaviors lifestyle the main factor which is avoid risk behavior life. Healt care workers must play an important role on the issue. [TAF Prev Med Bull 2007; 6(6.000: 409-420

  18. Evaluation of the Arizona health care cost-containment system

    OpenAIRE

    1985-01-01

    This article evaluates Arizona's alternative to the acute portion of Medicaid, the Arizona Health Care Cost-Containment System (AHCCCS), during its first 18 months of operation from October 1982 through March 1984. It focuses on the program's implementation and describes and evaluates the program's innovative features. The features of the program outlined in the original AHCCCS legislation included: Competitive bidding, prepaid capitation of providers, capitation of the State by the Health Ca...

  19. Evaluating the Quality of the Child Care in Finland

    Science.gov (United States)

    Hujala, Eeva; Fonsen, Elina; Elo, Janniina

    2012-01-01

    In this study we examine parents' and teachers' perceptions of the early childhood education and care (ECEC) quality in Finland. The study is based on the paradigm of inclusionary quality and the assessment is based on the quality evaluation model. The parents and teachers assess the quality to be good. The strength of the quality was the effect…

  20. Patients' Evaluation of the Quality of Diabetes Care (PEQD)

    DEFF Research Database (Denmark)

    Pouwer, F; Snoek, Frank J

    2002-01-01

    analysis comprised principal component analyses, Cronbach's alpha, t tests, Pearson's correlation, and linear regression analyses. RESULTS: Results in the literature were used to develop the 14 items of the Patients' Evaluation of the Quality of Diabetes Care (PEQD) scale, assessing the most important...

  1. Implementation and evaluation of Stanford Health Care direct-care teledermatology program

    Directory of Open Access Journals (Sweden)

    Akhilesh S Pathipati

    2016-07-01

    Full Text Available Introduction: Teledermatology has proven to be an effective means of providing dermatologic care. The existing research has primarily evaluated its usefulness in a consultative model. Few academic centers have evaluated a patient-initiated model, and direct-to-consumer services remain the subject of controversy. Stanford Health Care recently launched a direct-care, patient-initiated teledermatology pilot program. This article evaluates the viability and patient satisfaction with this service. Materials and Methods: During the pilot period, patients were able to seek remote dermatologic care using an eVisit tool in their MyHealth account. Patients initiated the consultation, answered questions regarding their complaint, and uploaded a picture if relevant. A Stanford dermatologist reviewed each eVisit and responded with an assessment and plan. The dermatologist noted whether they were able to make a diagnosis and their level of confidence in it. After the study, 10 patients participated in a focus group to provide feedback on the service. Results: In all, 38 patients sought care during the pilot period. A dermatologist was able to make a diagnosis in 36 of 38 (95% cases, with an average confidence level of 7.9 of 10. The average time to consultation was 0.8 days. Patients indicated high levels of satisfaction with the service although they had suggestions for improvement. Discussion: Patients provided clinically useful images and information in a direct-care teledermatology model. Such services allow dermatology providers to increase access while maintaining high-quality care in an academic medical center. Further research is needed on standalone services that cannot integrate encounters with the patient’s existing medical record.

  2. Economic evaluation of broadband distribution networks to the home

    Science.gov (United States)

    Merk, Charles A.

    1992-02-01

    Economic wideband, linear fiber optic transmitters and receivers pave the way for broadband to the home. The diamond network architecture (DNA) delivers 1 GHz bandwidth. This provides standard video, HDTV, and switched two-way broadband digital services to the home. An economic model is presented using the DNA that considers the impact of digital TV, HDTV, and the evolution of switched voice and data services on a CATV system.

  3. Models of economic geography: dynamics, estimation and policy evaluation

    OpenAIRE

    Knaap, Thijs

    2004-01-01

    In this thesis we look at economic geography models from a number of angles. We started by placing the theory in a context of preceding theories, both earlier work on spatial economics and other children of the monopolistic competition ‘revolution.’ Next, we looked at the theoretical properties of these models, especially when we allow firms to have different demand functions for intermediate goods. We estimated the model using a dataset on US states, and computed a number of counterfactuals....

  4. CareSearch: finding and evaluating Australia's missing palliative care literature

    Directory of Open Access Journals (Sweden)

    Abernethy Amy P

    2005-08-01

    Full Text Available Abstract Background Palliative care is an evolving specialty with a growing evidence base. However, evidence is less accessible than it could be with a lower than average conversion of conference abstracts to articles in peer-reviewed journals and the need for more accessible tools to support evidence-based practice (EBP in palliative care. The CareSearch project involved identifying, collecting and evaluating Australia's "grey" palliative care literature and identifying international published literature missing from the electronic indexing systems. The literature was then catalogued and made publicly available through the CareSearch website. Results To date over 2,500 items have been included in the CareSearch database and can be accessed and searched through a publicly available website. Nearly 2,000 items are conference abstracts and 178 are theses or government, organisational and planning documents. A further 410 items relate to articles from palliative journals that are not indexed on a major bibliographic database. The website also provides tools and facilities to support palliative care practice and research. Conclusion CareSearch is a new evidence resource for palliative practitioners, educators and researchers. The palliative community now has access to a more comprehensive literature base as well as a resource that supports the integration of knowledge into practice. This specialised data repository enables users to access information on the body of work that has shaped palliative care development and prevents the potential loss or duplication of research work. It also provides a template for other emerging disciplines to use in capturing their literature and evidence.

  5. The addition of E (Empowerment and Economics) to the ABCD algorithm in diabetes care.

    Science.gov (United States)

    Khazrai, Yeganeh Manon; Buzzetti, Raffaella; Del Prato, Stefano; Cahn, Avivit; Raz, Itamar; Pozzilli, Paolo

    2015-01-01

    The ABCD (Age, Body weight, Complications, Duration of disease) algorithm was proposed as a simple and practical tool to manage patients with type 2 diabetes. Diabetes treatment, as for all chronic diseases, relies on patients' ability to cope with daily problems concerning the management of their disease in accordance with medical recommendations. Thus, it is important that patients learn to manage and cope with their disease and gain greater control over actions and decisions affecting their health. Healthcare professionals should aim to encourage and increase patients' perception about their ability to take informed decisions about disease management and to improve patient self-esteem and feeling of self-efficacy to become agents of their own health. E for Empowerment is therefore an additional factor to take into account in the management of patients with type 2 diabetes. E stands also for Economics to be considered in diabetes care. Attention should be paid to public health policies as well as to the physician faced with the dilemma of delivering the best possible care within the problem of limited resources. The financial impact of the new treatment modalities for diabetes represents an issue that needs to be addressed at multiple strata both globally and nationally.

  6. New anticoagulant drugs versus warfarin in atrial fibrillation: economic evaluation and cost-effectiveness analysis

    Directory of Open Access Journals (Sweden)

    Mauro Silingardi

    2013-12-01

    Full Text Available Health care resources available for medical procedures, including pharmaceuticals, are limited worldwide. Health economic evidence is now accepted as an essential component of health technology appraisal, realizing the importance of value for money considerations for a more efficient (cost-effective prescribing. Regulatory agencies in more and more countries perform economic evaluation and cost-effectiveness analysis in order to decide about reimbursement of a new and almost always more expensive drug. Pharmacoeconomy is now acknowledged as a science. Cost-effective analysis is just one of its approaches, measuring cost in money and benefit in terms of Quality Adjusted Life Year, a new outcome measure which combines quantity/quality of additional life-years gained with the new drug/technology. A growing body of pharmacoeconomic evidence about new anticoagulant drugs (dabigatran, rivaroxaban, apixaban for stroke prevention in atrial fibrillation is now available. Most of this evidence comes from the National Institute of Health and Clinical Excellence (NICE in the United Kingdom, the most referenced regulatory agency in the world. Compared to current standard therapies (warfarin, dabigatran, rivaroxaban and apixaban are cost-effective treatments for the whole population of patients with atrial fibrillation, independently of poor/good international normalized ratio control (time in therapeutic range and risk stratification for stroke (CHADS2 score. Significant innovation and the lower rate of intracranial hemorrhage/hemorrhagic stroke coupled with the new drugs are the key drivers of these results.

  7. Bio-economic evaluation of implementing trawl fishing gear with different selectivity

    DEFF Research Database (Denmark)

    Kronbak, Lone Grønbæk; Nielsen, J. Rasmus; Jørgensen, Ole A.

    2009-01-01

    The paper develops a biological-economic evaluation tool to analyse the consequences for trawl fishers of implementing more selective fishing technologies. This is done by merging a dynamic biological population model and an economic cost-benefit evaluation framework to describe the consequences...

  8. Methodologies for environmental, micro- and macro-economic evaluation of bioenergy systems

    NARCIS (Netherlands)

    Broek, R. van den; Wijk, A. van

    2006-01-01

    An overview is given of methodologies used for evaluation of bioenergy systems on envoronmental, micro- and macro-economic spects. To evaluate micro-economic impacts net present value and annualised cost calculation are used. For environmental impacts, methods used are: qualitative studies, energy a

  9. Methodological issues and new developments in the economic evaluation of vaccines

    NARCIS (Netherlands)

    P. Beutels (Philippe); E.K.A. van Doorslaer (Eddy); P. van Damme (Damme); J. Hall (Jane)

    2003-01-01

    textabstractThe application of economic evaluation in healthcare, including vaccination programs, has increased exponentially since the 1980s. There are a number of aspects of economic evaluation of vaccine programs that present particular challenges to the analyst. These include the development of

  10. Cancer care coordination: building a platform for the development of care coordinator roles and ongoing evaluation.

    Science.gov (United States)

    Freijser, Louise; Naccarella, Lucio; McKenzie, Rosemary; Krishnasamy, Meinir

    2015-01-01

    Continuity of care is integral to the quality and safety of care provided to people with cancer and their carers. Further evidence is required to examine the contribution Nurse Cancer Care Coordinator (NCCC) roles make in improving the continuity. The aim of the present study was to clarify the assumptions underpinning the NCCC roles and provide a basis for ongoing evaluation. The project comprised a literature review and a qualitative study to develop program logic. The participants who were purposively sampled included policy makers, practitioners, patient advocates, and researchers. Both the literature and participant reports found that NCCC roles are diverse and responsive to contextual influences to coordinate care at the individual (patient), organisational, and systems levels. The application of the program logic for the development of NCCC roles was explored. The conceptualisation of NCCC roles was also examined in relation to Boundary Spanning and Relational Coordination theory. Further research is required to examine how NCCCs contribute to improving equity, safety, quality and coordination of care. The project has implications for research, policy and practice, and makes explicit existing assumptions to provide a platform for further development and evaluation of these roles.

  11. The impact of economic recession on health-care and the contribution by nurses to promote individuals' dignity.

    Science.gov (United States)

    Nunes, Sofia; Rego, Guilhermina; Nunes, Rui

    2015-12-01

    The health sector is facing many challenges, and there is a need to maintain the delivery of high-quality health-care. Issues related to equity and access to health-care have emerged in a context of an economic recession in which the sustainability of the health system depends on everyone, including the actions and decisions of professionals. Therefore, nurses and their skills may be the answer to ethical, professional and community health management, but this recession could lead to major problems in the education of nurses in daily health-care practice. Due to the limited availability of resources, nurses are increasingly taking leadership positions, continuing to develop their critical abilities and thinking skills, and considering sciences such as deontology and ethics. The main goals of this study were to reflect on the economic recession and its impact on health-care and to demonstrate the contribution of nursing to the sustainability of health-care and in the promotion of individuals' dignity. The authors conclude that health-care depends on economic redistribution and, in this context, needs to be equitable and fair. Nurses have the responsibility to develop their profession according to the underlying sciences and can therefore strategically help the healthcare system.

  12. Towards a social discount rate for the economic evaluation of health technologies in Germany: an exploratory analysis.

    Science.gov (United States)

    Schad, Mareike; John, Jürgen

    2012-04-01

    Over the last decades, methods for the economic evaluation of health care technologies were increasingly used to inform reimbursement decisions. For a short time, the German Statutory Health Insurance makes use of these methods to support reimbursement decisions on patented drugs. In this context, the discounting procedure emerges as a critical component of these methods, as discount rates can strongly affect the resulting incremental cost-effectiveness ratios. The aim of this paper is to identify the appropriate value of a social discount rate to be used by the German Statutory Health Insurance for the economic evaluation of health technologies. On theoretical grounds, we build on the widespread view of contemporary economists that the social rate of time preference (SRTP) is the adequate social discount rate. For quantifying the SRTP, we first apply the market behaviour approach, which assumes that the SRTP is reflected in observable market interest rates. As a second approach, we derive the SRTP from optimal growth theory by using the Ramsey equation. A major part of the paper is devoted to specify the parameters of this equation. Depending on various assumptions, our empirical findings result in the range of 1.75-4.2% for the SRTP. A reasonable base case discount rate for Germany, thus, would be about 3%. Furthermore, we deal with the much debated question whether a common discount rate for costs and health benefits or a lower rate for health should be applied in health economic evaluations. In the German social health insurance system, no exogenously fixed budget constraint does exist. When evaluating a new health technology, the health care decision maker is obliged to conduct an economic evaluation in order to examine whether there is an economically appropriate relation between the value of the health gains and the additional costs which are given by the value of the consumption losses due to the additional health care expenditures. Therefore, a discount

  13. Enviro-Economic Evaluation of Natural Water Resources: A Retrospect

    Directory of Open Access Journals (Sweden)

    Er.S.S.Kopekar

    2013-10-01

    Full Text Available Today, the threat to the environment is high on industrial agenda in many countries and there is every reason to believe that it will stay there for a long time to come, although local issues may still temporarily overshadow the long term impact on the environment as a result of human activity. The World Commission on Environment and Development (WECD foresaw the possibility for new areas of economic growth, based on policies that sustain the environmental resource base. A central finding of all country studies confirm that economic policies and environmental trends are closely linked but often in the ways that have not been widely recognized. Since economic policies must be designed increasingly in terms of their sustainability.

  14. Evaluating transfer capability of economic-driven power markets

    DEFF Research Database (Denmark)

    Xu, Zhao

    2007-01-01

    in the present economic-driven electricity markets. A mathematical model of a multi-objective optimization (MOOP) technique has been adopted and presented here for transfer capability studies; which can be helpful for power system planning and operation procedures. The newly-developed algorithm is being tested......The on-going restructuring of electric power utilities poses great challenges for power system engineers to plan and operate power systems as economical and reliable as possible. This paper discusses an important issue, which has been usually neglected, when quantifying active power transfer levels...

  15. Evaluation of patients with stroke monitored by home care programs

    Directory of Open Access Journals (Sweden)

    Ana Railka de Souza Oliveira

    2013-10-01

    Full Text Available The purpose of this study was to evaluate the patient with a stroke in home treatment, investigating physical capacity, mental status and anthropometric analysis. This was a cross-sectional study conducted in Fortaleza/CE, from January to April of 2010. Sixty-one individuals monitored by a home care program of three tertiary hospitals were investigated, through interviews and the application of scales. The majority of individuals encountered were female (59%, elderly, bedridden, with a low educational level, a history of other stroke, a high degree of dependence for basic (73.8% and instrumental (80.3 % activities of daily living, and a low cognitive level (95.1%. Individuals also presented with tracheostomy, gastric feeding and urinary catheter, difficulty hearing, speaking, chewing, swallowing, and those making daily use of various medications. It was concluded that home care by nurses is an alternative for care of those individuals with a stroke.

  16. Evaluation of patients with stroke monitored by home care programs

    Directory of Open Access Journals (Sweden)

    Ana Railka de Souza Oliveira

    Full Text Available The purpose of this study was to evaluate the patient with a stroke in home treatment, investigating physical capacity, mental status and anthropometric analysis. This was a cross-sectional study conducted in Fortaleza/CE, from January to April of 2010. Sixty-one individuals monitored by a home care program of three tertiary hospitals were investigated, through interviews and the application of scales. The majority of individuals encountered were female (59%, elderly, bedridden, with a low educational level, a history of other stroke, a high degree of dependence for basic (73.8% and instrumental (80.3 % activities of daily living, and a low cognitive level (95.1%. Individuals also presented with tracheostomy, gastric feeding and urinary catheter, difficulty hearing, speaking, chewing, swallowing, and those making daily use of various medications. It was concluded that home care by nurses is an alternative for care of those individuals with a stroke.

  17. An evaluation of gender equity in different models of primary care practices in Ontario

    Directory of Open Access Journals (Sweden)

    Russell Grant

    2010-03-01

    Full Text Available Abstract Background The World Health Organization calls for more work evaluating the effect of health care reforms on gender equity in developed countries. We performed this evaluation in Ontario, Canada where primary care models resulting from reforms co-exist. Methods This cross sectional study of primary care practices uses data collected in 2005-2006. Healthcare service models included in the study consist of fee for service (FFS based, salaried, and capitation based. We compared the quality of care delivered to women and men in practices of each model. We performed multi-level, multivariate regressions adjusting for patient socio-demographic and economic factors to evaluate vertical equity, and adjusting for these and health factors in evaluating horizontal equity. We measured seven dimensions of health service delivery (e.g. accessibility and continuity and three dimensions of quality of care using patient surveys (n = 5,361 and chart abstractions (n = 4,108. Results Health service delivery measures were comparable in women and men, with differences ≤ 2.2% in all seven dimensions and in all models. Significant gender differences in the health promotion subjects addressed were observed. Female specific preventive manoeuvres were more likely to be performed than other preventive care. Men attending FFS practices were more likely to receive influenza immunization than women (Adjusted odds ratio: 1.75, 95% confidence intervals (CI 1.05, 2.92. There was no difference in the other three prevention indicators. FFS practices were also more likely to provide recommended care for chronic diseases to men than women (Adjusted difference of -11.2%, CI -21.7, -0.8. A similar trend was observed in Community Health Centers (CHC. Conclusions The observed differences in the type of health promotion subjects discussed are likely an appropriate response to the differential healthcare needs between genders. Chronic disease care is non equitable in FFS but

  18. Economic evaluation of the efficiency of use of circulating assets

    Directory of Open Access Journals (Sweden)

    Svetlana Mullinova

    2015-06-01

    Full Text Available The article reviewed the status of inventory in the organization. The results of an economic study of current assets and their effect on the financial condition of the organization. The analysis of indicators of working capital and their efficiency. The recommendations to speed up inventory turnover may find practical application in the accounting and analytical activity of the agricultural organizations.

  19. Ex-ante environmental and economic evaluation of polymer photovoltaics

    NARCIS (Netherlands)

    Roes, A.L.; Alsema, E.A.; Blok, K.; Patel, M.K.

    2009-01-01

    The use of polymer materials for photovoltaic applications is expected to have several advantages over current crystalline silicon technology. In this paper, we perform an environmental and economic assessment of polymer-based thin film modules with a glass substrate and modules with a flexible subs

  20. Ecological and economic evaluation of Dutch egg production systems.

    NARCIS (Netherlands)

    Dekker, S.E.M.; Boer, de I.J.M.; Vermeij, I.; Aarnink, A.J.A.; Groot Koerkamp, P.W.G.

    2011-01-01

    The upcoming ban on battery cages in the European Union is expected to cause a shift in husbandry systems from predominantly battery cages to enriched cages and loose housing systems, such as barn, free range and organic systems. To gain insight into ecological and economic consequences of such a ba

  1. An Economic Evaluation Comparing Stroke Telemedicine to Conventional Stroke Medicine

    Science.gov (United States)

    Budhram, Stanley Chandra

    2011-01-01

    Stroke is not only a serious medical problem, but it also poses an enormous economic burden on society. Stroke ranks the third as the leading cause of death in the United States behind heart disease and cancer. The survivors of stroke suffer from various degrees of long-term disability which create a severe financial burden on society. University…

  2. Developing a Framework for Conducting Economic Evaluations of Community-Based Health Information Technology Interventions

    Science.gov (United States)

    Eisenstein, Eric L.; Anstrom, Kevin J.; Macri, Jennifer M.; Crosslin, David R.; Johnson, Frederick S.; Kawamoto, Kensaku; Lobach, David F.

    2005-01-01

    This study describes a framework for conducting economic analyses for health information technology (HIT) interventions, in the context of three interventions that are currently being implemented in a community-based health network caring for 17,779 Medicaid beneficiaries in Durham County, North Carolina. We show that if the HIT interventions were to redirect only 10% of low-severity emergency room encounters to outpatient care, it will result in $12,523 of monthly savings. PMID:16779235

  3. Subsidizing Early Childhood Education and Care for Parents on Low Income: Moving beyond the Individualized Economic Rationale of Neoliberalism

    Science.gov (United States)

    Simpson, Donald; Envy, Rose

    2015-01-01

    Neoliberalism and an associated "new politics of parenting" adopts a predominantly economic rationale which discursively positions early childhood education and care (ECEC) as essential to tackling several social ills by allowing individual parents (particularly young mothers) to improve their labour force participation, thus boosting…

  4. Cancer survival in the elderly: Effects of socio-economic factors and health care system features (ELDCARE project)

    NARCIS (Netherlands)

    M. Vercelli (Marina); R. Lillini (Roberto); R. Capocaccia (Riccardo); A. Micheli; J.W.W. Coebergh (Jan Willem); M.J. Quinn (M.); C. Martinez-Garcia (Carmen); A. Quaglia (Alberto); W. Oberaigner; J. Ajmová (J.); T. Aareleid (T.); J. Palo (Jukka); T. Hakulinen (Timo); P. Grosclaude (P.); H. Ziegler (H.); L. Tryggvadottir (Laufey); F. Langmark (F.); A. Andersen; M. Bielska-Lasota (Magdalena); M.A. Pinheiro (Magda Avelar); I. Pleško (I.); V. Pompe-Kirn (V.); P. Ecimovic (P.); T. Möller (Thomas); J.-M. Lutz (J.)

    2006-01-01

    textabstractThe purpose of the ELDCARE project is to study differences in cancer survival for elderly patients by country, taking into account the socio-economic conditions and the characteristics of health care systems at the ecological level. Fifty-three European cancer registries, from 19 countri

  5. Health gain and economic evaluation of breastfeeding policies : Model simulation

    NARCIS (Netherlands)

    Buchner FL; Hoekstra J; Rossum CTM van; CVG

    2007-01-01

    A policy aiming at increasing the percentage of breasted infants can be seen as a preventive measure, which can save health care costs.A literature review shows that breastfeeding has beneficial health effects in both the short en the longer term. Convincing evidence is found for a protective effec

  6. Evaluation of the OSCE in the primary health care situation

    Directory of Open Access Journals (Sweden)

    P.M. Garde

    1984-09-01

    Full Text Available The traditional methods of examination by long written questions, case presentations and orals have given rise to difficulties with both candidates and examiners, especially when they have been inexperienced and untrained. The new method of examination as described by the Medical School of the University of Cape Town, the Objective Structured Clinical Examination (OSCE, was therefore evaluated in the KwaZulu Primary Health Care (PHC nursing examinations in February, 1984.

  7. Indicators for Evaluating the Performance and Quality of Care of Ambulatory Care Nurses.

    Science.gov (United States)

    Rapin, Joachim; D'Amour, Danielle; Dubois, Carl-Ardy

    2015-01-01

    The quality and safety of nursing care vary from one service to another. We have only very limited information on the quality and safety of nursing care in outpatient settings, an expanding area of practice. Our aim in this study was to make available, from the scientific literature, indicators potentially sensitive to nursing that can be used to evaluate the performance of nursing care in outpatient settings and to integrate those indicators into the theoretical framework of Dubois et al. (2013). We conducted a scoping review in three databases (CINAHL, MEDLINE, and EMBASE) and the bibliographies of selected articles. From a total of 116 articles, we selected 22. The results of our study not only enable that framework to be extended to ambulatory nursing care but also enhance it with the addition of five new indicators. Our work offers nurses and managers in ambulatory nursing units indicators potentially sensitive to nursing that can be used to evaluate performance. For researchers, it presents the current state of knowledge on this construct and a framework with theoretical foundations for future research in ambulatory settings. This work opens an unexplored field for further research.

  8. Economic Evaluation of Obesity Prevention in Early Childhood: Methods, Limitations and Recommendations

    Science.gov (United States)

    Döring, Nora; Mayer, Susanne; Rasmussen, Finn; Sonntag, Diana

    2016-01-01

    Despite methodological advances in the field of economic evaluations of interventions, economic evaluations of obesity prevention programmes in early childhood are seldom conducted. The aim of the present study was to explore existing methods and applications of economic evaluations, examining their limitations and making recommendations for future cost-effectiveness assessments. A systematic literature search was conducted using PubMed, Cochrane Library, the British National Health Service Economic Evaluation Databases and EconLit. Eligible studies included trial-based or simulation-based cost-effectiveness analyses of obesity prevention programmes targeting preschool children and/or their parents. The quality of included studies was assessed. Of the six studies included, five were intervention studies and one was based on a simulation approach conducted on secondary data. We identified three main conceptual and methodological limitations of their economic evaluations: Insufficient conceptual approach considering the complexity of childhood obesity, inadequate measurement of effects of interventions, and lack of valid instruments to measure child-related quality of life and costs. Despite the need for economic evaluations of obesity prevention programmes in early childhood, only a few studies of varying quality have been conducted. Moreover, due to methodological and conceptual weaknesses, they offer only limited information for policy makers and intervention providers. We elaborate reasons for the limitations of these studies and offer guidance for designing better economic evaluations of early obesity prevention. PMID:27649218

  9. Economic Evaluation of Obesity Prevention in Early Childhood: Methods, Limitations and Recommendations

    Directory of Open Access Journals (Sweden)

    Nora Döring

    2016-09-01

    Full Text Available Despite methodological advances in the field of economic evaluations of interventions, economic evaluations of obesity prevention programmes in early childhood are seldom conducted. The aim of the present study was to explore existing methods and applications of economic evaluations, examining their limitations and making recommendations for future cost-effectiveness assessments. A systematic literature search was conducted using PubMed, Cochrane Library, the British National Health Service Economic Evaluation Databases and EconLit. Eligible studies included trial-based or simulation-based cost-effectiveness analyses of obesity prevention programmes targeting preschool children and/or their parents. The quality of included studies was assessed. Of the six studies included, five were intervention studies and one was based on a simulation approach conducted on secondary data. We identified three main conceptual and methodological limitations of their economic evaluations: Insufficient conceptual approach considering the complexity of childhood obesity, inadequate measurement of effects of interventions, and lack of valid instruments to measure child-related quality of life and costs. Despite the need for economic evaluations of obesity prevention programmes in early childhood, only a few studies of varying quality have been conducted. Moreover, due to methodological and conceptual weaknesses, they offer only limited information for policy makers and intervention providers. We elaborate reasons for the limitations of these studies and offer guidance for designing better economic evaluations of early obesity prevention.

  10. The economic evaluation of a participatory ergonomics programme to prevent low back and neck pain.

    Science.gov (United States)

    Driessen, Maurice; Bosmans, Judith; Proper, Karin; Anema, Johannes; Bongers, Paulien; van der Beek, Allard

    2012-01-01

    This study was an economic evaluation conducted alongside a cluster randomised controlled trial with a follow-up of 12 months. The aim was to evaluate the cost-effectiveness and cost-benefit of the Stay@Work Participatory Ergonomics programme (PE) compared to a control group (no PE). In total, 37 departments (n=3047 workers) were randomised into either the intervention (PE) or control group (no PE). During a meeting, working groups followed the steps of PE, and composed and prioritized ergonomic measures aimed to prevent low back pain (LBP) and neck pain (NP). Working groups had to implement the ergonomic measures within three months in their department. Cost data included those directly related to LBP and NP. Cost-effectiveness analyses (CEA) and cost-benefit analyses (CBA) were performed. After 12 months, health care costs and costs of productivity losses were higher in the intervention group than in the control group (the mean total cost difference was $/euro$127; 95% CI $/euro$-164 - $/euro$418). From a societal perspective, the CEA showed that PE was not cost-effective compared to control for LBP and NP prevalence, work performance, and sick leave. The CBA from a company perspective showed a monetary loss of $/euro$78 per worker. The PE programme was neither cost-effective nor cost-beneficial on any of the effect measures.

  11. Evaluation of a system of structured, pro-active care for chronic depression in primary care: a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Beecham Jennifer

    2010-08-01

    Full Text Available Abstract Background People with chronic depression are frequently lost from effective care, with resulting psychological, physical and social morbidity and considerable social and financial societal costs. This randomised controlled trial will evaluate whether regular structured practice nurse reviews lead to better mental health and social outcomes for these patients and will assess the cost-effectiveness of the structured reviews compared to usual care. The hypothesis is that structured, pro-active care of patients with chronic depression in primary care will lead to a cost-effective improvement in medical and social outcomes when compared with usual general practitioner (GP care. Methods/Design Participants were recruited from 42 general practices throughout the United Kingdom. Eligible participants had to have a history of chronic major depression, recurrent major depression or chronic dsythymia confirmed using the Composite International Diagnostic Interview (CIDI. They also needed to score 14 or above on the Beck Depression Inventory (BDI-II at recruitment. Once consented, participants were randomised to treatment as usual from their general practice (controls or the practice nurse led intervention. The intervention includes a specially prepared education booklet and a comprehensive baseline assessment of participants' mood and any associated physical and psycho-social factors, followed by regular 3 monthly reviews by the nurse over the 2 year study period. At these appointments intervention participants' mood will be reviewed, together with their current pharmacological and psychological treatments and any relevant social factors, with the nurse suggesting possible amendments according to evidence based guidelines. This is a chronic disease management model, similar to that used for other long-term conditions in primary care. The primary outcome is the BDI-II, measured at baseline and 6 monthly by self-complete postal questionnaire

  12. Analytic Support for Washington Citizens' Work Group on Health Care: Evaluation of Health Care Reform Proposals.

    OpenAIRE

    Deborah Chollet; Jeffrey Ballou; Alison Wellington; Thomas Bell; Allison Barrett; Gregory Peterson; Stephanie Peterson

    2009-01-01

    Mathematica evaluated five health care reform proposals for the state of Washington in 2008. The proposals featured, respectively: reduced regulation in the current market; Massachusetts-style insurance reforms with a health insurance connector; a health partnership program similar to the current state employee health plan; a state-operated single payer plan; and a program that would guarantee catastrophic coverage for all residents. This report provides estimates of the changes in coverage a...

  13. The role and importance of economic evaluation of traditional herbal medicine use for chronic non-communicable diseases

    Directory of Open Access Journals (Sweden)

    Hughes GD

    2015-07-01

    Full Text Available Gail D Hughes,1 Oluwaseyi M Aboyade,1 John D Hill,2 Rafia S Rasu3 1South African Herbal Science and Medicine Institute, University of the Western Cape, Western Cape, South Africa; 2Department of Pharmacy, Cleveland Clinic, Cleveland, OH, 3School of Pharmacy, University of Kansas, Lawrence, KS, USA Background: Non-communicable diseases (NCD constitute major public health problems globally, with an impact on morbidity and mortality ranking high and second to HIV/AIDS. Existing studies conducted in South Africa have demonstrated that people living with NCD rely on traditional herbal medicine (THM primarily or in combination with conventional drugs. The primary research focus has been on the clinical and experimental aspects of THM use for NCD, with limited data on the economic impact of health care delivery. Therefore, the purpose of this study will be to determine the cost and utilization of resources on THM in South Africa for NCD. Materials and methods: Study describes the methods toward incorporating cost estimations and economic evaluation illustrated with the Prospective Urban and rural Epidemiological (PURE study in South Africa. The South African PURE cohort is investigating the geographic and socioeconomic influence of THM spending and utilization, variations in spending based on perceived health status, marital status, and whether spending patterns have any impact on hospitalizations and disability. Data collection and evaluation plan: Since the individual costs of THM are not regulated nor do they have a standardized price value, information obtained through this study can be utilized to assess differences and determine underlying factors contributing to spending. This insight into THM spending patterns can aid in the development and implementation of guidelines or standardized legislation governing THM use and distribution. An economic evaluation and cost estimation model has been proposed, while the data collection is still ongoing

  14. Solar energy system economic evaluation for IBM System 3, Glendo, Wyoming

    Science.gov (United States)

    1980-01-01

    This analysis was based on the technical and economic models in f-chart design procedures with inputs based on the characteristics of the parameters of present worth of system cost over a projected twenty year life: life cycle savings, year of positive savings, and year of payback for the optimized solar energy system at each of the analysis sites. The sensitivity of the economic evaluation to uncertainties in constituent system and economic variables was also investigated.

  15. The environment of coal mining areas and the economic evaluation of the land reclamation

    Institute of Scientific and Technical Information of China (English)

    WANG Zhi-hong; XIAO Xing-tian; HE Zhi-qiang

    2001-01-01

    The environment impact of the coal resources mining was analyzed. The method of economic evaluation for the coal mining was established to analyze lan d destruction. The opportunity cost method was used to quantitatively analyze an d estimate the economic loss of the land destruction by coal mining. At the same time, the dump land reclamation of the Yuanbaoshan Open Pit was taken as an exa mple to evaluate environmental and economical benefit with the method of economi c evaluation for the coal mining areas land reclamation.

  16. African Primary Care Research: Performing a programme evaluation

    Directory of Open Access Journals (Sweden)

    Lilian Dudley

    2014-06-01

    Full Text Available This article is part of a series on Primary Care Research in the African context and focuses on programme evaluation. Different types of programme evaluation are outlined: developmental, process, outcome and impact. Eight steps to follow in designing your programme evaluation are then described in some detail: engage stakeholders; establish what is known; describe the programme; define the evaluation and select a study design; define the indicators; plan and manage data collection and analysis; make judgements and recommendations; and disseminate the findings. Other articles in the series cover related topics such as writing your research proposal, performing a literature review, conducting surveys with questionnaires, qualitative interviewing and approaches to quantitative and qualitative data analysis.

  17. Convergent innovation for sustainable economic growth and affordable universal health care: innovating the way we innovate.

    Science.gov (United States)

    Dubé, Laurette; Jha, Srivardhini; Faber, Aida; Struben, Jeroen; London, Ted; Mohapatra, Archisman; Drager, Nick; Lannon, Chris; Joshi, P K; McDermott, John

    2014-12-01

    This paper introduces convergent innovation (CI) as a form of meta-innovation-an innovation in the way we innovate. CI integrates human and economic development outcomes, through behavioral and ecosystem transformation at scale, for sustainable prosperity and affordable universal health care within a whole-of-society paradigm. To this end, CI combines technological and social innovation (including organizational, social process, financial, and institutional), with a special focus on the most underserved populations. CI takes a modular approach that convenes around roadmaps for real world change-a portfolio of loosely coupled complementary partners from the business community, civil society, and the public sector. Roadmaps serve as collaborative platforms for focused, achievable, and time-bound projects to provide scalable, sustainable, and resilient solutions to complex challenges, with benefits both to participating partners and to society. In this paper, we first briefly review the literature on technological innovation that sets the foundations of CI and motivates its feasibility. We then describe CI, its building blocks, and enabling conditions for deployment and scaling up, illustrating its operational forms through examples of existing CI-sensitive innovation.

  18. Health Care Workers’ Knowledge, Attitudes and Practices on Tobacco Use in Economically Disadvantaged Dominican Republic Communities

    Directory of Open Access Journals (Sweden)

    Michael G. Prucha

    2015-04-01

    Full Text Available Tobacco use is increasing globally, particularly in low and middle-income countries like the Dominican Republic (DR where data have been lacking. Health care worker (HCW interventions improve quit rates; asking patients about tobacco use at each visit is an evidence-based first step. This study provides the first quantitative examination of knowledge, attitudes and practices of DR HCWs regarding tobacco use. All HCWs (N = 153 in 7 economically disadvantaged DR communities were targeted with anonymous surveys. Approximately 70% (N = 107 completed the primary outcome item, asking about tobacco use at each encounter. Despite >85% strongly agreeing that they should ask about tobacco use at each encounter, only 48.6% reported doing so. While most (94.39% strongly agreed that smoking is harmful, knowledge of specific health consequences varied from 98.13% for lung cancer to 41.12% for otitis media. Few received training in tobacco intervention (38.32%. Exploratory analyses revealed that always asking even if patients are healthy, strongly agreeing that tobacco causes cardiac disease, and always advising smoke-free homes were associated with always asking. Overall, results demonstrate a disconnect between HCW belief and practice. Though most agreed that always asking about tobacco was important, fewer than half did so. Gaps in HCW knowledge and practices suggest a need for education and policy/infrastructure support. To our knowledge, this is the first reported survey of DR HCWs regarding tobacco, and provides a foundation for future tobacco control in the DR.

  19. Understanding the care.data conundrum: New information flows for economic growth

    Directory of Open Access Journals (Sweden)

    Paraskevas Vezyridis

    2017-01-01

    Full Text Available The analysis of data from electronic health records aspires to facilitate healthcare efficiencies and biomedical innovation. There are also ethical, legal and social implications from the handling of sensitive patient information. The paper explores the concerns, expectations and implications of the National Health Service (NHS England care.data programme: a national data sharing initiative of linked electronic health records for healthcare and other research purposes. Using Nissenbaum’s contextual integrity of privacy framework through a critical Science and Technology Studies (STS lens, it examines the way technologies and policies are developed to promote sustainability, governance and economic growth as the de facto social values, while reducing privacy to an individualistic preference. The state, acting as a new, central data broker reappropriates public ownership rights and establishes those information flows and transmission principles that facilitate the assetisation of NHS datasets for the knowledge economy. Various actors and processes from other contexts attempt to erode the public healthcare sector and privilege new information recipients. However, such data sharing initiatives in healthcare will be resisted if we continue to focus only on the monetary and scientific values of these datasets and keep ignoring their equally important social and ethical values.

  20. Five Years of HHS Home Health Care Evaluations: Using Evaluation to Change National Policy

    Science.gov (United States)

    Brandon, Paul R.; Smith, Nick L.; Grob, George F.

    2012-01-01

    In 1997, American Evaluation Association member George Grob, now retired from the U.S. Department of Health and Human Services (HHS) and currently President of the Center for Public Program Evaluation, made a testimony on Medicare home health care fraud and abuse before the U.S. Senate Special Committee on Aging. The occasion was to announce the…

  1. THE ORGANIZATION WORKS TO IMPROVE THE CLINICAL AND ECONOMIC OUTCOMES OF CARE FOR PROSTATE CANCER

    Directory of Open Access Journals (Sweden)

    O. I. Apolikhin

    2015-01-01

    Programme on the territory of theVoronezh region they deployed 7 Interdistrict (ITC and 1 regional centre. The most difficult clinical cases were sent to the Federal urology center - research Institute of urology. They humiliated 140 experts from the region, with 80 of them they studied using remote sensing technology. For the realisation of the Program it was established an Advisory portal NetHealth.ru, which considered 498 clinical cases of prostate cancer, with 28 of specialists in various stages of the region took an active part in distance counseling.      From 2009 to 2013 an improvement of a number of indicators was marked: increase in the absolute number of patients with newly diagnosed prostate cancer from 451 to 603 cases, a localized increase in the share stages with 60.3% to 71.2 %, a decrease of deaths within one year from the date of diagnosis for prostate cancer from 14.6% to 6.5% and deaths among all registered patients with prostate cancer from 10.4% to 5.5%, reducing the proportion of clinically insignificant PCA from 36.4 to 14.1%.Conclusions. "PC module" of integrated phased standardized program "Urology" is a universal tool for solving the problems of improving the organization of medical care for prostate cancer, as well as the principles of operation can be used in other diseases of urology and other medical fields. Clinical and economic efficiency and the versatility of the basis for its recommendations as a priority in the organization of medical care at a cancer on the entire territory of the Russian Federation.

  2. Multi-centred mixed-methods PEPFAR HIV care & support public health evaluation: study protocol

    Directory of Open Access Journals (Sweden)

    Fayers Peter

    2010-09-01

    Full Text Available Abstract Background A public health response is essential to meet the multidimensional needs of patients and families affected by HIV disease in sub-Saharan Africa. In order to appraise curret provision of HIV care and support in East Africa, and to provide evidence-based direction to future care programming, and Public Health Evaluation was commissioned by the PEPFAR programme of the US Government. Methods/Design This paper described the 2-Phase international mixed methods study protocol utilising longitudinal outcome measurement, surveys, patient and family qualitative interviews and focus groups, staff qualitative interviews, health economics and document analysis. Aim 1 To describe the nature and scope of HIV care and support in two African countries, including the types of facilities available, clients seen, and availability of specific components of care [Study Phase 1]. Aim 2 To determine patient health outcomes over time and principle cost drivers [Study Phase 2]. The study objectives are as follows. 1 To undertake a cross-sectional survey of service configuration and activity by sampling 10% of the facilities being funded by PEPFAR to provide HIV care and support in Kenya and Uganda (Phase 1 in order to describe care currently provided, including pharmacy drug reviews to determine availability and supply of essential drugs in HIV management. 2 To conduct patient focus group discussions at each of these (Phase 1 to determine care received. 3 To undertake a longitudinal prospective study of 1200 patients who are newly diagnosed with HIV or patients with HIV who present with a new problem attending PEPFAR care and support services. Data collection includes self-reported quality of life, core palliative outcomes and components of care received (Phase 2. 4 To conduct qualitative interviews with staff, patients and carers in order to explore and understand service issues and care provision in more depth (Phase 2. 5 To undertake document

  3. 42 CFR 456.242 - UR plan requirements for medical care evaluation studies.

    Science.gov (United States)

    2010-10-01

    ...: Mental Hospitals Ur Plan: Medical Care Evaluation Studies § 456.242 UR plan requirements for medical care... medical care evaluation studies under paragraph (b)(1) of this section. (b) The UR plan must provide that... 42 Public Health 4 2010-10-01 2010-10-01 false UR plan requirements for medical care...

  4. 42 CFR 456.142 - UR plan requirements for medical care evaluation studies.

    Science.gov (United States)

    2010-10-01

    ...: Hospitals Ur Plan: Medical Care Evaluation Studies § 456.142 UR plan requirements for medical care... medical care evaluation studies under paragraph (b)(1) of this section. (b) The UR plan must provide that... 42 Public Health 4 2010-10-01 2010-10-01 false UR plan requirements for medical care...

  5. A decision chart for assessing and improving the transferability of economic evaluation results between countries

    NARCIS (Netherlands)

    Welte, Robert; Feenstra, Talitha; Jager, Hans; Leidl, Reiner

    2004-01-01

    OBJECTIVE: To develop a user-friendly tool for managing the transfer of economic evaluation results. METHODS: Factors that may influence the transfer of health economic study results were systematically identified and the way they impact on transferability was investigated. A transferability decisio

  6. Outpatient Marijuana Treatment for Adolescents: Economic Evaluation of a Multisite Field Experiment.

    Science.gov (United States)

    French, Michael T.; Roebuck, M. Christopher; Dennis, Michael L.; Godley, Susan H.; Liddle, Howard A.; Tims, Frank M.

    2003-01-01

    Conducted an economic evaluation of five outpatient adolescent treatment approaches (12 total site-by-conditions) to identify average economic costs to society. Results suggest that some types of substance-abuse intervention for adolescents can reduce social costs immediately after treatment. (SLD)

  7. STATISTICAL EVALUATION OF THE IMPACT OF ECONOMIC FACTORS ON SOCIO-DEMOGRAPHICS OF THE COUNTRY

    Directory of Open Access Journals (Sweden)

    O. Evseenko

    2014-04-01

    Full Text Available In theory made a case the necessity of modeling economic and demographic indicators. The influences of economic, social and environmental indicators on social and demographic factors of development country are researeched. Given statistical evaluation of relationships based on correlation and regression analysis method.

  8. The role (or not) of economic evaluation at the micro level: can Bourdieu's theory provide a way forward for clinical decision-making?

    Science.gov (United States)

    Lessard, Chantale; Contandriopoulos, André-Pierre; Beaulieu, Marie-Dominique

    2010-06-01

    Despite increasing interest in health economic evaluation, investigations have shown limited use by micro (clinical) level decision-makers. A considerable amount of health decisions take place daily at the point of the clinical encounter; especially in primary care. Since every decision has an opportunity cost, ignoring economic information in family physicians' (FPs) decision-making may have a broad impact on health care efficiency. Knowledge translation of economic evaluation is often based on taken-for-granted assumptions about actors' interests and interactions, neglecting much of the complexity of social reality. Health economics literature frequently assumes a rational and linear decision-making process. Clinical decision-making is in fact a complex social, dynamic, multifaceted process, involving relationships and contextual embeddedness. FPs are embedded in complex social networks that have a significant impact on skills, attitudes, knowledge, practices, and on the information being used. Because of their socially constructed nature, understanding preferences, professional culture, practices, and knowledge translation requires serious attention to social reality. There has been little exploration by health economists of whether the problem may be more fundamental and reside in a misunderstanding of the process of decision-making. There is a need to enhance our understanding of the role of economic evaluation in decision-making from a disciplinary perspective different than health economics. This paper argues for a different conceptualization of the role of economic evaluation in FPs' decision-making, and proposes Bourdieu's sociological theory as a research framework. Bourdieu's theory of practice illustrates how the context-sensitive nature of practice must be understood as a socially constituted practical knowledge. The proposed approach could substantially contribute to a more complex understanding of the role of economic evaluation in FPs' decision-making.

  9. An Optimization Study on Syngas Production and Economic Evaluation

    Directory of Open Access Journals (Sweden)

    Qasim Faraz

    2016-01-01

    Full Text Available Syngas production in Gas-to-liquid (GTL process is focused in past by several researchers to increase the production with minimal capital and operating costs. In this study, syngas production process is simulated and optimized to increase its production and the economic analysis is studied for the proposed optimized process. Aspen HYSYS v8.4 is used for all process simulation work in this article. A new configuration is rigorously simulated while using auto-thermal reforming. Results exhibit a tremendous rise in production of syngas.

  10. Economic evaluation of geothermal power generation, heating, and cooling

    Energy Technology Data Exchange (ETDEWEB)

    Kanoglu, Mehmet; Cengel, Yunus A. [Nevada Univ., Dept. of Mechanical Engineering, Reno, NV (United States)

    1999-06-01

    Economic analysis of a typical geothermal resource shows that potential revenues from geothermal heating or cooling can be much larger than those from power generation alone. Geothermal heating may generate up to about 3.1 times and geothermal absorption cooling 2.9 times as much revenue as power generation alone. Similarly, combined power generation and heating may generate about 2.1 times and combined power generation and cooling about 1.2 times as much revenue as power generation alone. Cost and payback period comparison appear to favor power generation, followed by district heating. (Author)

  11. ECONOMIC EVALUATION OF GOLD-ORE DUMP REPROCESSING EFFICIENCY

    Directory of Open Access Journals (Sweden)

    N. Y. Samsonov

    2010-06-01

    Full Text Available An economic projection is presented in the paper on the heap leaching technology for extracting a residual gold from the gold-ore dumps accumulated at the exploited or closed gold mines. A brief analysis is performed on the legal status of use this source of raw materials, availability and efficiency of the heap leaching method are reviewed, and the potential users of this method are assessed. An investment plan is created for involving anthropogenic dumps of gold-raw materials at one of the ore deposits in Siberia (heap complex of the North-Western flank of the Sovetskoye minefield, Krasnoyarsk region, North-Yenisey area.

  12. Economic valuation of informal care in Asia: a case study of care for disabled stroke survivors in Thailand.

    Science.gov (United States)

    Riewpaiboon, Arthorn; Riewpaiboon, Wachara; Ponsoongnern, Kanyarat; Van den Berg, Bernard

    2009-08-01

    This study values informal care for disabled stroke survivors in Thailand. It applies the conventional recommended opportunity cost method to value informal care in monetary terms. Data were collected by means of face-to-face interviews conducted during 2006. The sample consisted of 101 disabled persons who had suffered a stroke at least six months prior to the interview, and who had a functional status score of less than 95 as measured by the Barthel Index. Average monthly time spent on informal care was 94.6 hours, and the major source of opportunity cost was forgone unpaid work (43.5%). The average monthly monetary value of informal care was 4642.6 baht, based on 2006 prices. This study shows that providing informal care involves a substantial opportunity cost, implying a hidden value to Thai society.

  13. Health Care Marketing: Opinions of Providers. North Dakota Economic Studies, Number 46.

    Science.gov (United States)

    Anderson, Donald G.; And Others

    The health care industry in the United States has undergone tremendous change. Health care providers must view their health care delivery organizations as businesses and must use the tools of business, including marketing. Most research on health care marketing has focused on the practices of large, urban facilities. Little work has been…

  14. Evaluation of the Efficiency of Economic and Medical Activities in Romanian Hospitals

    Directory of Open Access Journals (Sweden)

    Tudor C. DRUGAN

    2012-03-01

    Full Text Available Medical work in public hospitals in Romania has a double subordination: strictly speaking the Health Care Directives is coordinated by the Ministry of Health and in terms of economics the activity is funded by the National Health Insurance through its county subsidiaries. This separation of the two fields, medical and economical, has generated problems in many cases of hospital activity in our country.Economic and financial parameters of 39 hospitals were extracted from their economic balance sheets for 2009-2010 and were entered into a multi-criteria analysis to generate an overall score. Then this was checked for possible relationships with the hospitals’ competence (established by the Ministry of Health with the help of a national program.The aim of this study was to assess the relationship between hospital medical competency and economical parameters in the Romanian Health Care System. The lack of correlation of the economic and financial parameters with the health parameters observed by our study reflects the current problems in the Romanian health system, where the impossibility of generating practical management solutions is the consequence of multiple subordination of hospital units, separate assessment of competence and administrative skills.

  15. An economic evaluation of Columbia River anadromous fish programs: A preliminary study

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This paper evaluates the economics of the Columbia River anadromous fish programs. The paper begins with a description of the Columbia River watershed and discusses...

  16. Evaluation of the feasibility, economic impact, and effectiveness of underground nuclear power plants. Final technical report

    Energy Technology Data Exchange (ETDEWEB)

    1978-05-01

    Information on underground nuclear power plants is presented concerning underground nuclear power plant concepts; public health impacts; technical feasibility of underground concepts; economic impacts of underground construction; and evaluation of related issues.

  17. Introducing economic evaluation as a policy tool in Korea: Will decision makers get quality information? A critical review of published Korean economic evaluations

    NARCIS (Netherlands)

    K.-S. Lee (Kun-Sei); W.B.F. Brouwer (Werner); S.-I. Lee (Sang-Il); H.-W. Koo (Hye-Won)

    2005-01-01

    textabstractInterest in the use of economic evaluations in Korea as an aid for healthcare decision makers has been growing rapidly since the financial crisis of the Korean National Health Insurance fund and the separation in 2000 of the roles of prescribing and dispensing drugs. The Korean Health In

  18. Evaluation of the integrated community based home care model

    Directory of Open Access Journals (Sweden)

    LR Uys

    2001-09-01

    Full Text Available In 1999-2000 the Integrated Community-Based Home Care model for the care of people with AIDS in communities were implemented in seven sites across the country. The post-implementation evaluation showed that most respondents felt that the model could be replicated if a functioning and informed network including all partners, and a strong management team were in place. The effects of the project were mainly positive for all stakeholders (hospice, clinic, hospital, PWA and their carers, professionals and other community members. Hospitals and community- based services became more aware of and involved in the needs of PWA and felt that the model enabled them to address these needs. PWA and their carers felt supported and respected.

  19. Creation of minimum standard tool for palliative care in India and self-evaluation of palliative care programs using it

    Directory of Open Access Journals (Sweden)

    M R Rajagopal

    2014-01-01

    Full Text Available Background: It is important to ensure that minimum standards for palliative care based on available resources are clearly defined and achieved. Aims: (1 Creation of minimum National Standards for Palliative Care for India. (2 Development of a tool for self-evaluation of palliative care organizations. (3 Evaluation of the tool in India. In 2006, Pallium India assembled a working group at the national level to develop minimum standards. The standards were to be evaluated by palliative care services in the country. Materials and Methods: The working group prepared a "standards" document, which had two parts - the first composed of eight "essential" components and the second, 22 "desirable" components. The working group sent the document to 86 hospice and palliative care providers nationwide, requesting them to self-evaluate their palliative care services based on the standards document, on a modified Likert scale. Results: Forty-nine (57% palliative care organizations responded, and their self-evaluation of services based on the standards tool was analyzed. The majority of the palliative care providers met most of the standards identified as essential by the working group. A variable percentage of organizations had satisfied the desirable components of the standards. Conclusions: We demonstrated that the "standards tool" could be applied effectively in practice for self-evaluation of quality of palliative care services.

  20. ECONOMIC EVALUATION: LIFE CYCLE OF THE NATIONAL GAMES ROAD

    Directory of Open Access Journals (Sweden)

    MRS. VIDYA NITIN PATIL

    2012-03-01

    Full Text Available In response to the growing importance of sustainable undertaking, purchasing and building, designers, consultants and pavement managers now tend to make more rational decisions than before when comparing the pros and cons of the construction, maintenance and management of various types of road pavements. Asphalt and concrete pavements offer specific advantages that need to be compared when selecting the most favorable option for long-life pavements. Financial decisions can be based on life cycle cost. Life Cycle Cost analysis is to arrive at such an economic equitable assessment of competing design alternatives and it further useful for budget planning. The paper describes life cycle cost analysis of the assets of road pavement byusing present worth method. The information regarding the user cost and vehicle operating cost as per IRC recommendation is also discussed in detail.

  1. An economic model for evaluating high-speed aircraft designs

    Science.gov (United States)

    Vandervelden, Alexander J. M.

    1989-01-01

    A Class 1 method for determining whether further development of a new aircraft design is desirable from all viewpoints is presented. For the manufacturer the model gives an estimate of the total cost of research and development from the preliminary design to the first production aircraft. Using Wright's law of production, one can derive the average cost per aircraft produced for a given break-even number. The model will also provide the airline with a good estimate of the direct and indirect operating costs. From the viewpoint of the passenger, the model proposes a tradeoff between ticket price and cruise speed. Finally all of these viewpoints are combined in a Comparative Aircraft Seat-kilometer Economic Index.

  2. Evaluation of Sustainable Development (Economic Indicators in Parand New City

    Directory of Open Access Journals (Sweden)

    Fatemeh Razavian

    2016-06-01

    Full Text Available Introduction: Sustainable development has been an important part of urban management and lack of attention to this issue can seriously threaten the life of the city and its citizens in long-term. Large cities confront high population growth and frame development, and lack of attention to sustainable development has made the cities to face issues and problems such as the separation of workplace from the residential areas, being away from nature, reducing recreational areas and spending leisure time, reducing open space and finally confront lack of liveliness. Attitude of sustainable development, in practice, can be raised in terms of sustainable development of natural resources (renewable and non-renewable, efficient use of resources, less pollution for the environment and sustainable society.Purpose: The aim of this study is to determine the economic factors affecting the sustainable development indicators in the industrial city of Parand and investigating the status of sustainable development in this industrial city.Methodology: This is an applied descriptive-survey. The study population consists all residents of Parand city whose number is unknown and unlimited. The sample population was obtained as 384 through simple random sampling and Krejcieand Morgan Table. The collected data was analyzed through descriptive and inferential statistics such as mean, median and chi-square test.Findings: As the results indicated, the economic indicators of sustainable development in the new industrial city of Parand are in a very good situation.Conclusion:It is necessary for the city managers and practitioners to attend more to promote the developmental indicators in this city regarding the mentioned indicators.

  3. Systematic review of studies evaluating the broader economic impact of vaccination in low and middle income countries

    Directory of Open Access Journals (Sweden)

    Deogaonkar Rohan

    2012-10-01

    with other health economic evaluations. In addition, more country level evidence is needed from low and middle income countries to justify future investments in vaccines and immunization programs. Finally, the proposed broader economic impact framework may contribute towards better communication of the economic arguments surrounding vaccine uptake, leading to investments in immunization by stakeholders outside of the traditional health care sector such as ministries of finance and national treasuries.

  4. Summary of the SWOT panel's evaluation of the organisation and financing of the Danish health care system.

    Science.gov (United States)

    Christiansen, Terkel

    2002-02-01

    The organisation and financing of the Danish health care system was evaluated within a framework of a SWOT analysis (analysis of strengths, weaknesses, opportunities and threats) by a panel of five members with a background in health economics. This paper systematically summarises the panel's assessments, within the framework of the triangular model of health care. The members of the panel are in agreement on a number of aspects, while their views on other aspects differ. In general they find many strength in the way the system is organised and financed more so in the primary sector than in the hospital sector.

  5. An Evaluation of the Economic Theoretical Potential of the Rural Environment Mismanged During 1956-2010

    Directory of Open Access Journals (Sweden)

    Florentin Gabriel Niculescu

    2015-09-01

    Full Text Available Under the context of the essential role and growing importance of the rural environment in the development of a country, we focus on evaluating the economic theoretical potential of the rural environment that we consider to have been mismanaged during 1956-2010. For this purpose, in this paper we define, describe and explain the main concepts, as to be able to evaluate the economic potential of the rural development and further contribute to its improvement. The study focuses on the correlations between the population of working age, occupancy, unemployment and the wasted economic potential, putting forward a new concept, statistically valid, demographic named the absolute able overpopulation.

  6. Care for the Caregiver: Evaluation of Mind-Body Self-Care for Accelerated Nursing Students.

    Science.gov (United States)

    Drew, Barbara L; Motter, Tracey; Ross, Ratchneewan; Goliat, Laura M; Sharpnack, Patricia A; Govoni, Amy L; Bozeman, Michelle C; Rababah, Jehad

    2016-01-01

    Stress affects the well-being of both nursing students and the individuals with whom they work. With the theory of cognitive appraisal as a framework for this study, it is proposed that mind-body self-care strategies promote stress management by stabilization of emotions. Outcomes will be a perception of less stress and more mindful engagement with the environment. Objective of the study was to describe an evaluation of student perceived stress and mindfulness to 1-hour per week of class time dedicated to mind-body self-care (yoga, mindful breathing, Reiki, and essential oil therapy). It was a quasi-experimental study; data collection took place at 4 time points. Participants were entry-level accelerated nursing students from 3 US universities: 50 in the treatment group, 64 in the comparison group. Data included health-promoting practices using Health-Promoting Promotion Lifestyle Profile II as a control variable, stress and mindfulness (Perceived Stress Scale [PSS] and Mindful Attention Awareness Scale [MAAS]), and demographic information; analysis using mixed-design repeated-measures analysis of variances. There was a statistically significant interaction between intervention and time on PSS scores, F(3, 264) = 3.95, P = .009, partial η(2) = 0.043, with PSS scores of the intervention group decreasing from baseline to T3 when intervention ended whereas PSS scores of the comparison group increased from baseline. The average scores on the MAAS did not differ significantly. Evaluation of an embedded mind-body self-care module in the first nursing course demonstrated promising improvements in stress management. The findings support the appropriateness of integrating mind-body self-care content into nursing curricula to enhance students' ability to regulate stress.

  7. How do patients with a Turkish background evaluate their medical care in Germany? An observational study in primary care

    Directory of Open Access Journals (Sweden)

    Goetz K

    2015-11-01

    Full Text Available Katja Goetz,1 Jessica Bungartz,2 Joachim Szecsenyi,1 Jost Steinhaeuser3 1Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany; 2Praxis Medizin im Zentrum, München, Germany; 3Institute of Family Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany Background: Patients’ evaluation of medical care is an essential dimension of quality of care and an important aspect of the feedback cycle for health care providers. The aim of this study was to document how patients with a Turkish background evaluate primary care in Germany and determine which aspects of care are associated with language abilities.Methods: The study was based on an observational design. Patients with a Turkish background from German primary care practices completed the EUROPEP (European Project on Patient Evaluation of General Practice Care questionnaire consisting of 23 items. Seventeen primary care practices were involved with either German (n=8 or Turkish (n=9 general practitioners (GPs.Results: A convenience sample of 472 patients with a Turkish background from 17 practices participated in the study (response rate 39.9%. Practices with a German GP had a lower response rate (19.6% than those with a Turkish GP (57.5%. Items evaluated the highest were “keeping data confidential” (73.4% and “quick services for urgent health problems” (69.9%. Subgroup analysis showed lower evaluation scores from patients with good or excellent German language abilities. Patients who consulted a Turkish GP had higher evaluation scores.Conclusion: The evaluation from patients with a Turkish background living in Germany with either Turkish or German GPs showed lower scores than patients in other studies in Europe using EUROPEP. However, our results had higher evaluation scores than those of Turkish patients evaluating GPs in Turkey. Therefore, different explanation models for these findings should be explored in future studies

  8. Evaluation of economic loss from energy-related environmental pollution: a case study of Beijing

    Science.gov (United States)

    Chen, Chen; Su, Meirong; Liu, Gengyuan; Yang, Zhifeng

    2013-09-01

    With the growth of energy consumption, energy-related environmental pollution has become increasingly serious, which in turn causes enormous economic loss because of public health damage, corrosion of materials, crop yield reduction, and other factors. Evaluating economic loss caused by energy-related environmental pollution can contribute to decision making in energy management. A framework for evaluating economic loss from environmental pollution produced during energy production, transportation, and consumption is proposed in this paper. Regarding SO2, PM10, and solid waste as the main pollutants, economic losses from health damage, materials corrosion, crop yield reduction, and solid waste pollution are estimated based on multiple concentration-response relationships and dose-response functions. The proposed framework and evaluation methods are applied to Beijing, China. It is evident that total economic loss attributable to energy-related environmental pollution fluctuated during 2000-2011 but had a general growth trend, with the highest value reaching 2.3 × 108 CNY (China Yuan) in 2006. Economic loss caused by health damage contributes most to the total loss among the four measured damage types. The total economic loss strongly correlates with the amount of energy consumption, especially for oil and electricity. Our evaluation framework and methods can be used widely to measure the potential impact of environmental pollution in the energy lifecycle.

  9. Protocol for economic evaluation alongside the IMPLEMENT cluster randomised controlled trial

    Directory of Open Access Journals (Sweden)

    McKenzie Joanne E

    2008-02-01

    Full Text Available Abstract Background The recent development and publication of evidence-based clinical practice guidelines (CPGs for acute low back pain (LBP has resulted in evidence-based recommendations that, if implemented, have the potential to improve the quality and safety of care for acute LBP. While a strategy has been specified for dissemination of the CPG for acute LBP in Australia, there is no accompanying plan for active implementation. Evidence regarding the cost-effectiveness of active implementation of CPGs for acute LBP is sparse. The IMPLEMENT study will consider the incremental benefits and costs of progressing beyond development and dissemination to implementation. Methods/design Cost-effectiveness and cost-utility analyses alongside the IMPLEMENT cluster randomised controlled trial (CRCT from a societal perspective to quantify the additional costs (savings and health gains associated with a targeted implementation strategy as compared with access to the CPG via dissemination only. Discussion The protocol provided here registers our intent to conduct an economic evaluation alongside the IMPLEMENT study, facilitates peer-review of proposed methods and provides a transparent statement of planned analyses. Trial registration Australian New Zealand Clinical Trials Registry ACTRN012606000098538

  10. Economic evaluation of eribulin as second-line treatment for metastatic breast cancer in South Korea

    Science.gov (United States)

    Tremblay, Gabriel; Majethia, Unnati; Breeze, Janis L; Kontoudis, Ilias; Park, Jeongae

    2016-01-01

    Background Metastatic breast cancer (MBC) is associated with poor prognosis, particularly for those patients with human epidermal growth factor receptor (HER2)-negative tumor. Similar to the rest of the world, treatment options are limited in South Korea following first-line chemotherapy with anthracyclines and/or taxanes. This study examined the cost-effectiveness and cost-utility of eribulin in South Korean patients with HER2-negative MBC who have progressed after usage of at least one chemotherapeutic regimen for advanced disease (second-line therapy). Methods A partition survival model was developed from the perspective of the South Korean health care system. The economic impact of introducing eribulin as second-line therapy for HER2-negative MBC was compared to that of capecitabine and vinorelbine. The analysis estimated incremental cost per life-year (LY), that is, cost-effectiveness, and cost per quality-adjusted life-year (QALY), that is, cost-utility, of eribulin for management of HER2-negative MBC in South Korea. The model accounted for overall survival, progression-free survival, drug costs, grade 3/4 adverse events, and health care utilization. Deterministic and probabilistic sensitivity analyses were performed to identify uncertainty in the results of the economic evaluation. Results Second-line eribulin was associated with greater benefits in terms of LY and QALY, compared to capecitabine and vinorelbine. The incremental cost-effectiveness ratio was ₩10.5M (approximately USD 9,200) per LY, and the incremental cost-utility ratio was ₩17M (approximately USD 14,800) per QALY in the basecase analysis. The incremental cost-utility ratio ranged from ₩12M (USD 10,461) to ₩27M (USD 23,538) per QALY in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis, >99% of the simulations were below ₩50M (USD 42,300), and the lower and upper 95% confidence intervals were ₩3M (USD 2,600) and ₩24M (USD 20,900) per QALY

  11. Agricultural Foods Economic Efficiency Evaluation Based on DEA

    Directory of Open Access Journals (Sweden)

    Su Ling Guo

    2015-06-01

    Full Text Available On the basis of evaluation index system about the efficiency of agricultural product circular economy, this study quantitatively evaluates the efficiency of agricultural food circular economy in 11 districts and cities of Henan Province by DEA analysis. This study shows the efficiency of agricultural food circular economy has obvious differences in Henan Province. Therefore, improving the efficiency of agricultural food circular economy should adapt different measure according to local conditions, increase agricultural scientific and technological input and improve the quality of workers.

  12. Economic evaluation of stall stocking density of lactating dairy cows.

    Science.gov (United States)

    De Vries, Albert; Dechassa, Hailegziabher; Hogeveen, Henk

    2016-05-01

    conclusion, overstocking was profitable under plausible economic conditions in the United States. The 3 metamodels accurately captured the results for a wide range of values of the input variables. A tradeoff will occur between economically optimal SSD and animal welfare in some situations.

  13. Performance Evaluation of Rural Cooperative Economic Organizations in Hunan Province Based on Structural Equation

    Institute of Scientific and Technical Information of China (English)

    Naman; YANG

    2015-01-01

    Using the method of structural equation and balanced scorecard,this paper establishes the evaluation indicators and evaluation model for the performance of 21 rural cooperative economic organizations in X City of Hunan Province,and analyzes the relationship between indicators and dimensions of performance evaluation indicators,in order to find the influencing factors,obstacles and successful experience concerning the development of rural cooperative economic organizations. According to model analysis and conclusions,this paper sets forth the recommendations for promoting the development of rural cooperative economic organizations in Hunan Province,in order to provide a scientific basis for the institutional design and mechanism innovation of rural cooperative economic organizations in Hunan Province.

  14. THE SHADOW ECONOMY AS AN ECONOMIC CATEGORY AND OBJECT EVALUATION

    Directory of Open Access Journals (Sweden)

    А. Khodzhaian

    2014-12-01

    Full Text Available The article considers the existing scientific approaches to the formulation of the concept of nature and the structural elements of the shadow economy. Contains definitions of the shadow economy as an object of evaluation. Disclosed manifestations shadow relations in the context of the institutional sectors. Characterized by methods of assessment of the informal sector in terms of their object of study.

  15. Techno-economic evaluation of broadband access technologies

    DEFF Research Database (Denmark)

    Sigurdsson, Halldór Matthias; Skouby, Knud Erik

    2005-01-01

    Broadband for all is an essential element in the EU policy concerning the future of ICT-based society. The overall purpose of this paper is to present a model for evaluation of different broadband access technologies and to present some preliminary results based on the model that has been carried...

  16. A systematic review of economic evaluations of health and health-related interventions in Bangladesh

    Directory of Open Access Journals (Sweden)

    Koehlmoos Tracey P

    2011-07-01

    Full Text Available Abstract Background Economic evaluation is used for effective resource allocation in health sector. Accumulated knowledge about economic evaluation of health programs in Bangladesh is not currently available. While a number of economic evaluation studies have been performed in Bangladesh, no systematic investigation of the studies has been done to our knowledge. The aim of this current study is to systematically review the published articles in peer-reviewed journals on economic evaluation of health and health-related interventions in Bangladesh. Methods Literature searches was carried out during November-December 2008 with a combination of key words, MeSH terms and other free text terms as suitable for the purpose. A comprehensive search strategy was developed to search Medline by the PubMed interface. The first specific interest was mapping the articles considering the areas of exploration by economic evaluation and the second interest was to scrutiny the methodological quality of studies. The methodological quality of economic evaluation of all articles has been scrutinized against the checklist developed by Evers Silvia and associates. Result Of 1784 potential articles 12 were accepted for inclusion. Ten studies described the competing alternatives clearly and only two articles stated the perspective of their articles clearly. All studies included direct cost, incurred by the providers. Only one study included the cost of community donated resources and volunteer costs. Two studies calculated the incremental cost effectiveness ratio (ICER. Six of the studies applied some sort of sensitivity analysis. Two of the studies discussed financial affordability of expected implementers and four studies discussed the issue of generalizability for application in different context. Conclusion Very few economic evaluation studies in Bangladesh are found in different areas of health and health-related interventions, which does not provide a strong basis

  17. Does socio-economic status explain use of modern and traditional health care services?

    Science.gov (United States)

    Sato, Azusa

    2012-10-01

    Although socioeconomic status is acknowledged to be an important determinant of modern health care utilisation, most analyses to date have failed to include traditional systems as alternative, or joint, providers of care. In developing countries, where pluralistic care systems are common, individuals are likely to be using multiple sources of health care, and the order in which systems are chosen is likely to vary according to income. This paper uses self-collected data from households in Ghana and econometric techniques (biprobit modelling and ordered logit) to show that rising income is associated with modern care use whilst decreasing income is associated with traditional care use. When utilisation is analysed in order, results show rising income to have a positive effect on choice of modern care as a first provider, whilst choosing it second, third or never is associated with decreasing income. The effects of income on utilisation patterns of traditional care are stronger: as income rises, utilisation of traditional care as a first choice decreases. Policy should incorporate traditional care into the general utilisation framework and recognise that strategies which increase income may encourage wider utilisation of modern over traditional care, whilst high levels of poverty will see continued use of traditional care.

  18. Health: A Key Factor in the Evaluation of Day Care.

    Science.gov (United States)

    Bollin, Gail G.

    Research has inadequately examined why health has become a problem in the day care setting. Health regulations for day care have not been researched in the day care setting per se but have been imposed on day care by the medical community working from a hospital model. Day care research has presumed that having antecedent health regulations in…

  19. The economic benefits of negative pressure wound therapy in community-based wound care in the NHS.

    Science.gov (United States)

    Dowsett, Caroline; Davis, Lynn; Henderson, Valerie; Searle, Richard

    2012-10-01

    The human and economic costs of wounds are of major concern within today's National Health Service. Advances in wound care technology have been shown to be beneficial both in healing and in relation to patient quality of life. Negative pressure has often been associated with high-cost care and restricted to use in the secondary care setting. There is growing use of negative pressure within the community, and this has the potential to benefit the patient and the service by providing quality care in the patient's home setting. Three community sites were chosen to monitor their use of negative pressure wound therapy (NPWT) over a period of 2 years, and this paper presents some of the key findings of this work. The data generated has been used to help target resources and prevent misuse of therapy. Cost per patient episode has been calculated, and this can be compared to similar costs in secondary care, showing significant savings if patients are discharged earlier from secondary care. There is also an increased demand for more patients with complex wounds to be cared for in the community, and in the future, it is likely that community initiated NPWT may become more common. Early analysis of the data showed that the average cost of dressing complex wounds would be significantly less than using traditional dressings, where increased nursing visits could increase costs. There is a compelling argument for more negative pressure to be used and initiated in the community, based not only on improved quality of life for patients but also on the economic benefits of the therapy.

  20. A review of typhoid fever transmission dynamic models and economic evaluations of vaccination.

    Science.gov (United States)

    Watson, Conall H; Edmunds, W John

    2015-06-19

    Despite a recommendation by the World Health Organization (WHO) that typhoid vaccines be considered for the control of endemic disease and outbreaks, programmatic use remains limited. Transmission models and economic evaluation may be informative in decision making about vaccine programme introductions and their role alongside other control measures. A literature search found few typhoid transmission models or economic evaluations relative to analyses of other infectious diseases of similar or lower health burden. Modelling suggests vaccines alone are unlikely to eliminate endemic disease in the short to medium term without measures to reduce transmission from asymptomatic carriage. The single identified data-fitted transmission model of typhoid vaccination suggests vaccines can reduce disease burden substantially when introduced programmatically but that indirect protection depends on the relative contribution of carriage to transmission in a given setting. This is an important source of epidemiological uncertainty, alongside the extent and nature of natural immunity. Economic evaluations suggest that typhoid vaccination can be cost-saving to health services if incidence is extremely high and cost-effective in other high-incidence situations, when compared to WHO norms. Targeting vaccination to the highest incidence age-groups is likely to improve cost-effectiveness substantially. Economic perspective and vaccine costs substantially affect estimates, with disease incidence, case-fatality rates, and vaccine efficacy over time also important determinants of cost-effectiveness and sources of uncertainty. Static economic models may under-estimate benefits of typhoid vaccination by omitting indirect protection. Typhoid fever transmission models currently require per-setting epidemiological parameterisation to inform their use in economic evaluation, which may limit their generalisability. We found no economic evaluation based on transmission dynamic modelling, and no

  1. Study protocol of an economic evaluation of an enhanced implementation strategy for the treatment of low back pain in general practice

    DEFF Research Database (Denmark)

    Jensen, Cathrine; Riis, Allan; Pedersen, Kjeld Møller

    2014-01-01

    Background: In Denmark, guidelines on low back pain management are currently being implemented; in association with this, a clinical trial is conducted. A health economic evaluation is carried out alongside the clinical trial to assess the cost-effectiveness of an extended implementation strategy...... will be enrolled. The economic evaluation comprises both a cost-effectiveness analyses and a cost-utility analysis. Effectiveness measures include referral to secondary care, health-related quality of life measured by EQ-5D-5L, and disability measured by the Roland Morris disability questionnaire. Cost measures...... include all relevant additional costs of the extended implementation strategy compared to usual implementation. The economic evaluation will be performed from both a societal perspective and a health sector perspective with a 12-month time horizon. Discussion: It is expected that the extended...

  2. Economic Evaluation of a General Hospital Unit for Older People with Delirium and Dementia (TEAM Randomised Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Lukasz Tanajewski

    Full Text Available One in three hospital acute medical admissions is of an older person with cognitive impairment. Their outcomes are poor and the quality of their care in hospital has been criticised. A specialist unit to care for older people with delirium and dementia (the Medical and Mental Health Unit, MMHU was developed and then tested in a randomised controlled trial where it delivered significantly higher quality of, and satisfaction with, care, but no significant benefits in terms of health status outcomes at three months.To examine the cost-effectiveness of the MMHU for older people with delirium and dementia in general hospitals, compared with standard care.Six hundred participants aged over 65 admitted for acute medical care, identified on admission as cognitively impaired, were randomised to the MMHU or to standard care on acute geriatric or general medical wards. Cost per quality adjusted life year (QALY gained, at 3-month follow-up, was assessed in trial-based economic evaluation (599/600 participants, intervention: 309. Multiple imputation and complete-case sample analyses were employed to deal with missing QALY data (55%.The total adjusted health and social care costs, including direct costs of the intervention, at 3 months was £7714 and £7862 for MMHU and standard care groups, respectively (difference -£149 (95% confidence interval [CI]: -298, 4. The difference in QALYs gained was 0.001 (95% CI: -0.006, 0.008. The probability that the intervention was dominant was 58%, and the probability that it was cost-saving with QALY loss was 39%. At £20,000/QALY threshold, the probability of cost-effectiveness was 94%, falling to 59% when cost-saving QALY loss cases were excluded.The MMHU was strongly cost-effective using usual criteria, although considerably less so when the less acceptable situation with QALY loss and cost savings were excluded. Nevertheless, this model of care is worthy of further evaluation.ClinicalTrials.gov NCT01136148.

  3. An evaluation of teamwork within a specialist palliative care unit.

    Science.gov (United States)

    Donaghy, Kevin; Devlin, Breige

    2002-11-01

    This small-scale 10-month study evaluated teamworking within a specialist palliative care team. The study aims were to: collect, analyse and summarize information on how team members perceive teamworking; compare team members' perceptions after a teambuilding workshop; and to evaluate the longer term effect of this training on the team. A group of practitioners from a local Marie Curie Cancer Care Centre was selected and included members from all available disciplines. A piloted questionnaire was used to obtain qualitative and quantitative input. The team as a whole scored themselves above average on almost all counts. Following the teambuilding workshop significant improvement was seen in areas such as role appreciation and communication but not all improvements were long lasting. A perception of understaffing was noted as being one of the largest negative influences on teamwork whereas the setting and maintaining of agreed team objectives and having sufficient education opportunity were positive influences. Although teambuilding sessions appear to have the potential to produce the desired benefits, they should not be initiated at a time when staff already feel anxiety over their workload.

  4. The methodological quality of economic evaluation studies in obstetrics and gynecology: a systematic review.

    Science.gov (United States)

    Vijgen, Sylvia M C; Opmeer, Brent C; Mol, Ben Willem J

    2013-04-01

    We evaluated the methodological quality of economic evaluation studies in the field of obstetrics and gynecology published in the last decade. A MEDLINE search was performed to find economic evaluation studies in obstetrics and gynecology from the years 1997 through 2009. We included full economic evaluation studies concerning tests or interventions in the field of obstetrics or gynecology. Each included study was evaluated by two reviewers using a quality checklist that was based on international guidelines for medical economic evaluation studies and a checklist used in a previous review. The mean number of quality criteria adhered to was 23 of 30 items, whereas five articles (3%) met all 30 criteria. Compliance was low for the description of the perspective (40%), the completeness of costs looking at the perspective (48%) or time horizon (48%), and reporting of quantities of resources (47%). Furthermore, if no discounting was applied, an explanation was infrequently given (14%). A comparison of study quality to that reported by Smith and Blackmore showed a considerable improvement in the following criteria: presentation perspective (from 19 to 40%), statement of primary outcome measure (from 72 to 81%), completeness costs looking at the time horizon (from 14 to 48%), the presentation of discount rates (from 10 to 54%), details of sensitivity analyses (from 21 to 61%), reporting incremental results (from 17 to 70%), and reporting a summary measure (from 57 to 74%). The quality of economic studies in obstetrics and gynecology has considerably improved in the last decade, but room for further improvement is present.

  5. ECONOMIC EVALUATION OF CO2 STORAGE AND SINK ENHANCEMENT OPTIONS

    Energy Technology Data Exchange (ETDEWEB)

    Bert Bock; Richard Rhudy; Howard Herzog; Michael Klett; John Davison; Danial G. De La Torre Ugarte; Dale Simbeck

    2003-02-01

    This project developed life-cycle costs for the major technologies and practices under development for CO{sub 2} storage and sink enhancement. The technologies evaluated included options for storing captured CO{sub 2} in active oil reservoirs, depleted oil and gas reservoirs, deep aquifers, coal beds, and oceans, as well as the enhancement of carbon sequestration in forests and croplands. The capture costs for a nominal 500 MW{sub e} integrated gasification combined cycle plant from an earlier study were combined with the storage costs from this study to allow comparison among capture and storage approaches as well as sink enhancements.

  6. Development and psychometric evaluation of a measure to evaluate the quality of integrated care : the Patient Assessment of Integrated Elderly Care

    NARCIS (Netherlands)

    Uittenbroek, Ronald J; Reijneveld, Sijmen A; Stewart, Roy E; Spoorenberg, Sophie L W; Kremer, Hubertus P H; Wynia, Klaske

    2016-01-01

    BACKGROUND: Novel population-based integrated care services are being developed to adequately serve the growing number of elderly people. Suitable, reliable and valid measurement instruments are needed to evaluate the quality of care delivered. OBJECTIVE: To develop a measure to evaluate the quality

  7. Evaluation of economic impact of climatic change on agro-forestry systems

    Directory of Open Access Journals (Sweden)

    Vittorio Gallerani

    Full Text Available Climate change has a strong influence on agro-forestry systems. Present estimations evisage that changes in climate patterns and extreme events connected to climate change will have greater impacts in the future. This paper seeks to illustrate the articulation of the problems concerning the economic evaluation of climate change, with particularly attention to open problems and future lines of research. Research on this topic, though using methods and approaches consolidated in the disciplines of resource economics and evaluation, still have several open problems, particularly in the field of multidisciplinary studies of the man-environmental relations, policy evaluation and development of decision support systems for decision makers.

  8. The economic evaluation of a Participatory Ergonomics programme to prevent low back and neck pain

    NARCIS (Netherlands)

    Driessen, M.; Bosmans, J.; Proper, K.; Anema, J.; Bongers, P.; Beek, A. van der

    2012-01-01

    This study was an economic evaluation conducted alongside a cluster randomised controlled trial with a follow-up of 12 months. The aim was to evaluate the cost-effectiveness and cost-benefit of the Stay@Work Participatory Ergonomics programme (PE) compared to a control group (no PE). In total, 37 de

  9. Integrated Emergy and Economic Evaluation of Tea Production Chains in Anxi, China

    Science.gov (United States)

    Emergy and economic methods were used to evaluate and compare tea production systems in Anxi, China. Tea production was classified into three phases, i.e., the nursery, the plantation and tea processing, and each phase was evaluated. The results showed that the nursery subsystems...

  10. The energy-saving modification program of lighting equipment based on the economic evaluation

    Directory of Open Access Journals (Sweden)

    Yuan Yang

    2011-02-01

    Full Text Available Considering many lighting energy-saving modification programs have the phenomenon of diseconomy; this paper takes into account economic evaluation to solve this problem. The optimal program of total energy-saving benefit will be found under the limited investment according to economic evaluation of the price, life span and power consumption of lighting equipments. Firstly, the benefit ratio will be used to evaluate on the necessity of modification, and get the order. If the biggest benefit ratio exists in different equipments simultaneously, the better one will be selected in terms of relative payback period of investment. And on the basis, the relative remaining time is innovatively introduced into economic evaluation to determine the locations of modification. Then an example from a factory can prove that the program is workable.

  11. [Evaluation of quality of care in a general surgery department].

    Science.gov (United States)

    Visset, J; Paineau, J; Letessier, E; Hamelin, E; Hamy, A; Courant, O

    A permanent evaluation of a department's activity and the quality of health care it provides is needed to avoid inappropriate use resulting from a wide range of causes. The activity of a general surgery department treating and average of 1,500 patients per year and performing 1,200 operations was analyzed over the period 1986 to 1992. Post-operative hospital follow-up was noted for each patient and any complications were analyzed on discharge day by the surgeons, the anaesthesiologists and the nursing staff. A year-end sum up was conducted each year by homogeneous groups. Examples are presented: surgery for cancer of the oesophagus (122 cases), surgery for gastro-oesophageal reflux (120 cases), thyroid surgery (1,314 cases from 1988 to 1992). Complications, hospital stay and former pathologies were evaluated in order to determine the indications, prevent complications and evaluate more rapidly the advantages of modifications in techniques. The results were compared between surgeons. This daily evaluation allowed a better analysis than a retrospective study compared with data in the literature. Permanent personal reevaluation was one of the practical consequences of the study considered to be and enriching experience.

  12. Autologous chondrocyte implantation in the knee: systematic review and economic evaluation.

    Science.gov (United States)

    Mistry, Hema; Connock, Martin; Pink, Joshua; Shyangdan, Deepson; Clar, Christine; Royle, Pamela; Court, Rachel; Biant, Leela C; Metcalfe, Andrew; Waugh, Norman

    2017-01-01

    BACKGROUND The surfaces of the bones in the knee are covered with articular cartilage, a rubber-like substance that is very smooth, allowing frictionless movement in the joint and acting as a shock absorber. The cells that form the cartilage are called chondrocytes. Natural cartilage is called hyaline cartilage. Articular cartilage has very little capacity for self-repair, so damage may be permanent. Various methods have been used to try to repair cartilage. Autologous chondrocyte implantation (ACI) involves laboratory culture of cartilage-producing cells from the knee and then implanting them into the chondral defect. OBJECTIVE To assess the clinical effectiveness and cost-effectiveness of ACI in chondral defects in the knee, compared with microfracture (MF). DATA SOURCES A broad search was done in MEDLINE, EMBASE, The Cochrane Library, NHS Economic Evaluation Database and Web of Science, for studies published since the last Health Technology Assessment review. REVIEW METHODS Systematic review of recent reviews, trials, long-term observational studies and economic evaluations of the use of ACI and MF for repairing symptomatic articular cartilage defects of the knee. A new economic model was constructed. Submissions from two manufacturers and the ACTIVE (Autologous Chondrocyte Transplantation/Implantation Versus Existing Treatment) trial group were reviewed. Survival analysis was based on long-term observational studies. RESULTS Four randomised controlled trials (RCTs) published since the last appraisal provided evidence on the efficacy of ACI. The SUMMIT (Superiority of Matrix-induced autologous chondrocyte implant versus Microfracture for Treatment of symptomatic articular cartilage defects) trial compared matrix-applied chondrocyte implantation (MACI(®)) against MF. The TIG/ACT/01/2000 (TIG/ACT) trial compared ACI with characterised chondrocytes against MF. The ACTIVE trial compared several forms of ACI against standard treatments, mainly MF. In the SUMMIT

  13. A systematic review of economic evaluations of treatments for borderline personality disorder.

    Directory of Open Access Journals (Sweden)

    Christian Brettschneider

    Full Text Available PURPOSE: The borderline personality disorder is a common mental disorder. It is frequently associated with various mental co-morbidities and a fundamental loss of functioning. The borderline personality disorder causes high costs to society. The aim of this study was to perform a systematic literature review of existing economic evaluations of treatments for borderline personality disorder. MATERIALS AND METHODS: We performed a systematic literature search in MEDLINE, EMBASE, PsycINFO and NHSEED for partial and full economic evaluations regarding borderline personality disorder. Reported cost data were inflated to the year 2012 and converted into US-$ using purchasing power parities to allow for comparability. Quality assessment of the studies was performed by means of the Consensus on Health Economic Criteria checklist, a checklist developed by a Delphi method in cooperation with 23 international experts. RESULTS: We identified 6 partial and 9 full economic evaluations. The methodical quality was moderate (fulfilled quality criteria: 79.2% [SD: 15.4%] in partial economic evaluations, 77.3% [SD: 8.5%] in full economic evaluations. Most evaluations analysed psychotherapeutic interventions. Although ambiguous, most evidence exists on dialectical-behavioural therapy. Cognitive behavioural therapy and schema-focused therapy are cost-saving. Evidence on other interventions is scarce. CONCLUSION: The economic evidence is not sufficient to draw robust conclusions for all treatments. It is possible that some treatments are cost-effective. Most evidence exists on dialectical-behavioural therapy. Yet, it is ambiguous. Further research concerning the cost-effectiveness of treatments is necessary as well as the identification of relevant cost categories and the validation of effect measures.

  14. The European Network of Health Economic Evaluation Databases (EURO NHEED) Project.

    Science.gov (United States)

    Nixon, John; Ulmann, Philippe; Glanville, Julie; Boulenger, Stéphanie; Drummond, Michael; de Pouvourville, Gérard

    2004-06-01

    This paper provides a first outline of the European Network of Health Economic Evaluation Databases (EURO NHEED) project. The project is funded by the European Commission and will implement, in 7 European centres based in France, Germany, Italy, The Netherlands, Spain, Sweden and the United Kingdom, databases on the economic evaluation of healthcare interventions. The network will be based on two existing and well-established resources, namely the UK's NHS Economic Evaluation Database (NHS EED), and France's Connaissances et Décision en EConomie de la Santé (CODECS) database. EURO NHEED will initially cover 17 European countries and will provide its users with bibliographic records, detailing the main characteristics of all included studies. In addition, structured abstracts will be provided for articles identified as full economic evaluations (cost-benefit, cost-effectiveness or cost-utility), which will offer a detailed critique of the findings and the methodology used. These databases will be accessible free of charge on the Internet. The EURO NHEED project is the first attempt to develop such a resource on a multi-national basis. The project will bring together Health Economists and Information Scientists from the European Union and beyond and is anticipated to facilitate a number of benefits and advances in the field of Health Economics. These include harmonisation and increased understanding of the theory and methodology of economic evaluation in healthcare, the interpretation of the generalisability of studies to target settings, and the influence of healthcare system variations among the European countries. The project will therefore advance the state of the art in collecting, summarising, critiquing and disseminating economic evaluations of healthcare conducted within Europe.

  15. International care models for chronic kidney disease: methods and economics--United States.

    Science.gov (United States)

    Crooks, Peter

    2004-01-01

    In the United States, there is a major chronic kidney disease (CKD) problem with over 8 million adults having stage 3 or 4 CKD. There is good medical evidence that many of these patients can benefit from focused interventions. And while there are strong theoretical reasons to believe these interventions are cost-effective, there are little published data to back up this assertion. However, despite the lack of financial data proving cost-effectiveness and against the background of a disorganized health care system in the US, some models of CKD care are being employed. At the present time, the most comprehensive models of care in the US are emerging in vertically integrated health care programs. Other models of care are developing in the setting of managed care health plans that employ CKD disease management programs, either developed internally or in partnership with renal disease management companies.

  16. For profit versus non-profit: does economic sector make a difference in child-care?

    Science.gov (United States)

    Gelles, E

    1999-01-01

    The child-care industry in a large, southeastern community serves as this study's vehicle for comparing non-profit with for profit dependent care in areas not easily observable to clients. The cross-sectional analysis compares child-care centers on marketed and actual staff-to-child ratio; staff salary; consistency in the child's group environment; staff stability; and extent of parental involvement. Findings are based on self-reports of directors and support hypotheses derived from the theory that for profit day care centers will use their discretionary authority to vary the care environment to achieve profit goals despite the potential effect on the quality of the child's environment. Further, despite potential cost economies and enhanced quality of care achievable as a non-profit entity, few for profit center directors consider becoming non-profit centers.

  17. Bio-economic evaluation of implementing trawl fishing gear with different selectivity

    DEFF Research Database (Denmark)

    Grønbæk Kronbak, Lone; Nielsen, J. Rasmus; Jørgensen, Ole A.;

    2009-01-01

    with a baseline. The results from the evaluation are indicators for the consequences on ecological and economic levels. The results show that implementation of different selective fishing gear in the Kattegat and Skagerrak mixed trawl fisheries generally implies a trade off over time between rebuilding the stocks...... and economic loss. Moreover, the analysis shows that implementation of more selective gear is not always beneficial. (C) 2009 Elsevier Ltd. All rights reserved....

  18. Long-term socio-economic consequences and health care costs of poliomyelitis: a historical cohort study involving 3606 polio patients.

    Science.gov (United States)

    Nielsen, Nete Munk; Kay, Lise; Wanscher, Benedikte; Ibsen, Rikke; Kjellberg, Jakob; Jennum, Poul

    2016-06-01

    Worldwide 10-20 million individuals are living with disabilities after acute poliomyelitis. However, very little is known about the socio-economic consequences and health care costs of poliomyelitis. We carried out a historical register-based study including 3606 individuals hospitalised for poliomyelitis in Copenhagen, Denmark 1940-1954, and 13,795 age and gender-matched Danes. Participants were followed from 1980 until 2012, and family, socio-economic conditions and health care costs were evaluated in different age groups using chi-squared tests, boot-strapped t tests or hazard ratios (HR) calculated in Cox-regression models. The analyses were performed separately for paralytic and non-paralytic polio survivors and their controls, respectively. Compared with controls a higher percentage of paralytic polio survivors remained childless, whereas no difference was observed for non-paralytic polio survivors. The educational level among paralytic as well as non-paralytic polio survivors was higher than that among their controls, employment rate at the ages of 40, 50 and 60 years was slightly lower, whereas total income in the age intervals of 31-40, 41-50 and 51-60 years were similar to controls. Paralytic and non-paralytic polio survivors had a 2.5 [HR = 2.52 (95 % confidence interval (CI); 2.29-2.77)] and 1.4 [HR = 1.35 (95 % CI; 1.23-1.49)]-fold higher risk, respectively, of receiving disability pension compared with controls. Personal health care costs were considerably higher in all age groups in both groups of polio survivors. Individuals with a history of poliomyelitis are well educated, have a slightly lower employment rate, an income similar to controls, but a considerably higher cost in the health care system.

  19. Respiratory Distress in Neonatal Intensive Care Unit: A Retrospective Evaluation

    Directory of Open Access Journals (Sweden)

    Ali Annagur

    2012-04-01

    Full Text Available Purpose: To determine the demographic characteristics of the newborns with respiratory difficulties, frequency of neonatal disease, analyze of the prognostic factors and effectiveness of treatment who were hospitalized in neonatal intensive care unit (NICU. Methods: In this study, file records of the newborns who were hospitalized in NICU of Meram Medical School were analyzed retrospectively. Results: Of the 771 newborns, 225 who admitted due to respiratory distress in 2008 and of the 692 newborns, 282 who admitted due to respiratory distress in 2009. Mean birth weight was 1954±972 gr in 2008, and 2140±1009 gr in 2009. Mean pregnancy weeks were 32,4±5,0 in 2008 and 33,4±4,9 in 2009. Diagnosis of patients were sepsis (77,8%, respiratory distress syndrome (RDS (40,4%, pneumothorax (20,9%, patent ductus arteriosus (PDA (12,4%, meconium aspiration syndrome (MAS (6,2%, intraventricular hemorrhage (IVH (5,3%, pneumonia (3,6%, retinopathy of prematurely (ROP (3,1%, bronchopulmonary dysplasia (BPD (2,7% and transient tachypne of newborn (TTN (2,2% in 2008. In 2009, percentage of the diagnosis was 69,5% sepsis, 33,3% RDS, 17,0% PDA, 16,0% pneumothorax, 10,3% pneumonia, 8,2% IVH, 6% TTN, 5,3% BPD, 3,2% MAS and 3,2% ROP. 33.7% of the patients were died in 2009 and 43,6% of them in 2008. Conclusion: The newborns with respiratory distress who admitted to the hospital must be evaluated according to the pregnancy week, way of birth and accompanying problems during first examination and convenient transportation of the ones who need to be cared in advanced center where an intensive care support can be applied to decrease mortality and morbidity of newborns distress. [Cukurova Med J 2012; 37(2.000: 90-97

  20. Regulating the economic evaluation of pharmaceuticals and medical devices: a European perspective.

    Science.gov (United States)

    Cookson, Richard; Hutton, John

    2003-02-01

    Throughout the developed world, economic evaluation of costly new pharmaceuticals and medical devices became increasingly widespread and systematic during the 1990s. However, serious concerns remain about the validity and relevance of this economic evidence, and about the transparency and accountability of its use in public sector reimbursement decisions. In this article, we summarise current concerns in Europe, based on interviews with European health economists from industry, universities, research institutes and consulting firms. We identify five challenges for European policy-makers, and conclude that there is considerable scope for improving decision-making without damaging incentives to innovate. The challenges are: (1). full publication of the economic evidence used in reimbursement decisions; (2). the redesign of licensing laws to improve the relevance of economic data available at product launch; (3). harmonisation of economic evaluation methodologies; (4). development of methodologies for evaluation of health inequality impacts; and (5). negotiation of price-performance deals to facilitate the use of economic evidence in post-launch pricing review decisions, as information is gathered from studies of product performance in routine use.

  1. Do economic evaluation studies inform effective healthcare resource allocation in Iran? A critical review of the literature.

    Science.gov (United States)

    Haghparast-Bidgoli, Hassan; Kiadaliri, Aliasghar Ahmad; Skordis-Worrall, Jolene

    2014-01-01

    To aid informed health sector decision-making, data from sufficient high quality economic evaluations must be available to policy makers. To date, no known study has analysed the quantity and quality of available Iranian economic evaluation studies. This study aimed to assess the quantity, quality and targeting of economic evaluation studies conducted in the Iranian context. The study systematically reviewed full economic evaluation studies (n = 30) published between 1999 and 2012 in international and local journals. The findings of the review indicate that although the literature on economic evaluation in Iran is growing, these evaluations were of poor quality and suffer from several major methodological flaws. Furthermore, the review reveals that economic evaluation studies have not addressed the major health problems in Iran. While the availability of evidence is no guarantee that it will be used to aid decision-making, the absence of evidence will certainly preclude its use. Considering the deficiencies in the data identified by this review, current economic evaluations cannot be a useful source of information for decision makers in Iran. To improve the quality and overall usefulness of economic evaluations we would recommend; 1) developing clear national guidelines for the conduct of economic evaluations, 2) highlighting priority areas where information from such studies would be most useful and 3) training researchers and policy makers in the calculation and use of economic evaluation data.

  2. Economic Evaluation for Energy Business Using Real Options Pricing Method

    Energy Technology Data Exchange (ETDEWEB)

    Yun, W.C. [Korea Energy Economics Institute, Euiwang (Korea)

    2001-11-01

    Recently, facing the new era of restructuring, privatization, and liberalization the energy industry in the world is changing rapidly, and thus the uncertain factors tend to increase. This would imply that energy-related business is now confronted with new market risks as well as the simple price risks. The traditional investment valuation method using the concept of net present value (NPV) or internal rate of revenue (IRR) might not incorporate the managerial alternatives which enable managers to respond flexibly to the changes in business environment. This study pointed out the problems of the traditional discounted cash flow (DCF) method when evaluating a certain capital investment in energy industry. As an alternative, the real option pricing method (ROPM) was proposed, which is widely adopted in the field of profit projection for the venture business. In addition, when applying to energy sector the feasibility of ROPM was discussed, and the frameworks and major results of previous related studies were described. For those using the ROPM in real business, I explained the detailed procedures and solutions of ROPM, and introduced the log-transformed binomial model which provides a more efficient solution. In order to verify the usefulness of the ROPM, this study performed an empirical analysis for a virtual construction and operation project of power plant. And, the results from the ROPM was compared to those from the traditional DCF method. Based on the empirical results, the values of various investment opportunities were shown to be high. Therefore, the project not justified in terms of traditional DCF would turn into the project with a positive gross project value, properly reflecting managerial flexibilities inherent in the original project. (author). 58 refs., 32 figs., 33 tabs.

  3. An evaluation of nursing care in cancer patients.

    Science.gov (United States)

    Karadeniz, G; Yanikkerem, E; Altiparmak, S; Sevil, U; Ertem, G; Esen, A

    2004-01-01

    The aim of the present study was to identify what hospitalized cancer patients expect from nurses in terms of the care they receive. The specific aims of this study were: (i) to identify those individuals to whom the patients felt closest in the hospital setting and (ii) to evaluate nurses' management of cancer patients during their stay in the hospital. The sample included patients hospitalized at Ege University Hospital and Suat Seren District Hospital, Izmir, Turkey. We found significant differences between the scores of satisfaction and dissatisfaction and gender age, education, occupation, type of cancer and the mode of treatment (p patients reported that nursing management was unsatisfactory. Some demographic factors such as cultural and social status affected patients' expectations.

  4. The Economic Impact of the Child Care Industry in Southeast Wisconsin

    Science.gov (United States)

    Kovach, Melissa; Lam, Eva; Dickman, Anneliese

    2009-01-01

    Discussions of early childhood care and education usually focus on its social and educational value, and how it helps children and families. More recently, the focus in many states, including Wisconsin, has been on potential investments in child care quality improvements as strategies for improving long-term educational outcomes for disadvantaged…

  5. Economic evaluation of pneumococcal conjugate vaccination in The Gambia

    Directory of Open Access Journals (Sweden)

    Kim Sun-Young

    2010-09-01

    pneumococcal diseases caused by S. pneumoniae in The Gambia. Assuming a cost-effectiveness threshold of three times GDP per capita, all PCVs examined would be cost-effective at the tentative Advance Market Commitment (AMC price of $3.5 per dose. Because the cost-effectiveness of a PCV program could be affected by potential serotype replacement or herd immunity effects that may not be known until after a large scale introduction, type-specific surveillance and iterative evaluation will be critical.

  6. Integrated complex care coordination for children with medical complexity: A mixed-methods evaluation of tertiary care-community collaboration

    Directory of Open Access Journals (Sweden)

    Cohen Eyal

    2012-10-01

    Full Text Available Abstract Background Primary care medical homes may improve health outcomes for children with special healthcare needs (CSHCN, by improving care coordination. However, community-based primary care practices may be challenged to deliver comprehensive care coordination to complex subsets of CSHCN such as children with medical complexity (CMC. Linking a tertiary care center with the community may achieve cost effective and high quality care for CMC. The objective of this study was to evaluate the outcomes of community-based complex care clinics integrated with a tertiary care center. Methods A before- and after-intervention study design with mixed (quantitative/qualitative methods was utilized. Clinics at two community hospitals distant from tertiary care were staffed by local community pediatricians with the tertiary care center nurse practitioner and linked with primary care providers. Eighty-one children with underlying chronic conditions, fragility, requirement for high intensity care and/or technology assistance, and involvement of multiple providers participated. Main outcome measures included health care utilization and expenditures, parent reports of parent- and child-quality of life [QOL (SF-36®, CPCHILD©, PedsQL™], and family-centered care (MPOC-20®. Comparisons were made in equal (up to 1 year pre- and post-periods supplemented by qualitative perspectives of families and pediatricians. Results Total health care system costs decreased from median (IQR $244 (981 per patient per month (PPPM pre-enrolment to $131 (355 PPPM post-enrolment (p=.007, driven primarily by fewer inpatient days in the tertiary care center (p=.006. Parents reported decreased out of pocket expenses (p© domains [Health Standardization Section (p=.04; Comfort and Emotions (p=.03], while total CPCHILD© score decreased between baseline and 1 year (p=.003. Parents and providers reported the ability to receive care close to home as a key benefit. Conclusions Complex

  7. Population-based clinical decision support: a clinical and economic evaluation.

    Science.gov (United States)

    Eisenstein, Eric L; Anstrom, Kevin J; Edwards, Rex; Willis, Janese M; Simo, Jessica; Lobach, David F

    2012-01-01

    Governments are investing in health information technologies (HIT) to improve care quality and reduce medical costs. However, evidence of these benefits is limited. We conducted a randomized trial of three clinical decision support (CDS) interventions in 20,180 patients: email to care managers (n=3329), reports to primary care administrators (n=3368), letters to patients (n=3401), and controls (10,082). At 7-month follow-up, the letters to patients group had greater use of outpatient services and higher outpatient and total medical costs; whereas, the other groups had no change in clinical events or medical costs. As our CDS interventions were associated with no change or an increase in medical costs, it appears that investments in HIT without consideration for organizational context may not be sufficient to achieve improvements in clinical and economic outcomes.

  8. Economic evaluation in the context of rare diseases: is it possible?

    Directory of Open Access Journals (Sweden)

    Everton Nunes da Silva

    2015-03-01

    Full Text Available This study analyzes the available evidence on the adequacy of economic evaluation for decision-making on the incorporation or exclusion of technologies for rare diseases. The authors conducted a structured literature review in MEDLINE via PubMed, CRD, LILACS, SciELO, and Google Scholar (gray literature. Economic evaluation studies had their origins in Welfare Economics, in which individuals maximize their utilities based on allocative efficiency. There is no widely accepted criterion in the literature to weigh the expected utilities, in the sense of assigning more weight to individuals with greater health needs. Thus, economic evaluation studies do not usually weigh utilities asymmetrically (that is, everyone is treated equally, which in Brazil is also a Constitutional principle. Healthcare systems have ratified the use of economic evaluation as the main tool to assist decision-making. However, this approach does not rule out the use of other methodologies to complement cost-effectiveness studies, such as Person Trade-Off and Rule of Rescue.

  9. Economics and the evaluation of publicly funded energy R and D

    Energy Technology Data Exchange (ETDEWEB)

    Jones, D.W.; Paik, I.K.

    1998-10-19

    There are three major areas in which economics can contribute to the evaluation of federal R and D: assessment of net benefits, ex ante expected as well as ex post realized; tailoring of R and D portfolios to policy goals; and guiding the contractual organization of R and D production. Additionally, evaluation of R and D and scientific activity tend to be distinctly retrospective, principally because of the long lags between the initial production activity and the observability of consequences. Extending the purview of economic evaluation of R and D, they find ample opportunity for evaluation that can inform current R and D management practice. The conduct of R and D is organized through a series of explicit and implicit contracts designed to elicit long-term commitments by some agents while attempting to limit the commitment by others. It is natural to consider the efficiency with which R and D is conducted as a subject for economic inquiry, although in practice such inquiries generally are restricted to accounting exercises. In evaluating the efficiency with which R and D is done, the current ordinary practice is to look at labor rates and equipment and materials prices while considering quantities of those items as the principal instrument variables in an optimization problem (the authors conceptualization, not that of the typical review of an R and D project). The authors recommend the contractual structure and other elements of the incentive structure (pay and promotion) of R and D production as prime focal points for managerially useful economic evaluation. Non-economic motivations for funding public R and D, including energy R and D, are well known. The US will consider spending several billion dollars on an international space station, partly if not largely, to fund the peaceful employment of scientists from the Former Soviet Union. Nonetheless, it will be useful to understand the economics of the R and D programs even if other considerations play important

  10. A systematic review of economic evaluations of population-based sodium reduction interventions

    Science.gov (United States)

    Hope, Silvia F.; Webster, Jacqui; Trieu, Kathy; Pillay, Arti; Ieremia, Merina; Bell, Colin; Snowdon, Wendy; Neal, Bruce; Moodie, Marj

    2017-01-01

    Objective To summarise evidence describing the cost-effectiveness of population-based interventions targeting sodium reduction. Methods A systematic search of published and grey literature databases and websites was conducted using specified key words. Characteristics of identified economic evaluations were recorded, and included studies were appraised for reporting quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Results Twenty studies met the study inclusion criteria and received a full paper review. Fourteen studies were identified as full economic evaluations in that they included both costs and benefits associated with an intervention measured against a comparator. Most studies were modelling exercises based on scenarios for achieving salt reduction and assumed effects on health outcomes. All 14 studies concluded that their specified intervention(s) targeting reductions in population sodium consumption were cost-effective, and in the majority of cases, were cost saving. Just over half the studies (8/14) were assessed as being of ‘excellent’ reporting quality, five studies fell into the ‘very good’ quality category and one into the ‘good’ category. All of the identified evaluations were based on modelling, whereby inputs for all the key parameters including the effect size were either drawn from published datasets, existing literature or based on expert advice. Conclusion Despite a clear increase in evaluations of salt reduction programs in recent years, this review identified relatively few economic evaluations of population salt reduction interventions. None of the studies were based on actual implementation of intervention(s) and the associated collection of new empirical data. The studies universally showed that population-based salt reduction strategies are likely to be cost effective or cost saving. However, given the reliance on modelling, there is a need for the effectiveness of new

  11. Economic evaluation of SQ-standardized grass allergy immunotherapy tablet (Grazax® in children

    Directory of Open Access Journals (Sweden)

    Ronaldson S

    2014-04-01

    Full Text Available Sarah Ronaldson,1 Matthew Taylor,1 Peter G Bech,2 Ruth Shenton,1 Albrecht Bufe3 1York Health Economics Consortium, York, UK; 2ALK-Abelló A/S, Hørsholm, Denmark; 3Ruhr-Universität Bochum, Bochum, Germany Background: Grass pollen-induced rhinoconjunctivitis is a common allergic respiratory disorder affecting over 20% of the UK population in terms of quality of life and sleep, work, and school patterns. The SQ-standardized grass allergy immunotherapy tablet (AIT has been demonstrated as a disease-modifying treatment which gives a sustained effect even after completion of a treatment course. The objective of this study was to provide an economic assessment of whether treatment with the SQ-standardized grass AIT, Grazax® (Phleum pratense in combination with symptomatic medications is preferable to the standard of care using symptomatic medications only. The analysis was performed for children with grass pollen-induced rhinoconjunctivitis, with or without concomitant asthma, in the UK. Methods: The model evaluated the two treatment regimens in a cohort of 1,000 children from a payer’s perspective. Treatment was modeled in terms of management of symptoms, impact on resource use, and development of allergic asthma. The analysis modeled the use of SQ-standardized grass AIT and the sustained effects of treatment over a 9-year time horizon (ie, 3 years of treatment, with modeled long-term benefits. Data inputs were drawn from a recent clinical trial, published studies, and databases. Results: SQ-standardized grass AIT improves patient outcomes, generating an incremental cost per quality-adjusted life year gained of £12,168. This is below commonly accepted thresholds in the UK. Conclusion: The resulting incremental cost per QALY falls below commonly accepted willingness to pay thresholds. Therefore, the SQ-standardized grass AIT is a cost-effective option for the treatment of grass pollen-induced rhinoconjunctivitis in the UK pediatric population

  12. The public finance of medical and dental care in Newfoundland--some historical and economic considerations.

    Science.gov (United States)

    Brown, M C

    1981-04-01

    The article discusses the evolution of Newfoundland's health care system from the turn of the century to the present. During this time there were considerable changes in social conditions, political arrangements and the availability of public monies, all of which influenced the structure of the health care sector. In general terms, Newfoundland's health care system shifted from one involving low expenditures and many British type institutions to one involving high expenditures and American type institutions. The evidence suggests that the changes have been particularly beneficial for Newfoundland's merchant class, including the doctors and dentists, although some benefits have also accrued to patients and fishermen.

  13. Cost effectiveness of preventing falls and improving mobility in people with Parkinson disease: protocol for an economic evaluation alongside a clinical trial

    Directory of Open Access Journals (Sweden)

    Menz Hylton B

    2008-09-01

    Full Text Available Abstract Background Cost of illness studies show that Parkinson disease (PD is costly for individuals, the healthcare system and society. The costs of PD include both direct and indirect costs associated with falls and related injuries. Methods This protocol describes a prospective economic analysis conducted alongside a randomised controlled trial (RCT. It evaluates whether physical therapy is more cost effective than usual care from the perspective of the health care system. Cost effectiveness will be evaluated using a three-way comparison of the cost per fall averted and the cost per quality adjusted life year saved across two physical therapy interventions and a control group. Conclusion This study has the potential to determine whether targetted physical therapy as an adjunct to standard care can be cost effective in reducing falls in people with PD. Trial Registration No: ACTRN12606000344594

  14. Use of antidepressants in the treatment of major depressive disorder in primary care during a period of economic crisis

    Directory of Open Access Journals (Sweden)

    Sicras-Mainar A

    2015-12-01

    Full Text Available Antoni Sicras-Mainar,1 Ruth Navarro-Artieda2 1Research Unit, Badalona Serveis Assistencials SA, 2Medical Documentation Unit, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain Objective: To describe antidepressant (AD use in the treatment of major depressive disorder during a period of economic crisis.Patients and methods: This was a retrospective, observational study using population-based databases. Two periods were considered: 1 2008–2009, precrisis, and 2 2012–2013, economic crisis. Certain inclusion/exclusion criteria were taken into account for the study (initiation of AD treatment. Patients were followed up for 12 months. The main measures were use (defined daily doses, epidemiologic measures, strategies used and treatment persistence, referrals, and use of resources. Statistical significance was set at P<0.05.Results: In the precrisis period, 3,662 patients were enrolled, and 5,722 were enrolled in the period of economic crisis. Average age was 58.8 years and 65.4% were women. Comparing the two periods, major depressive disorder prevalence was 5.4% vs 8.1%, P<0.001. During the period of economic crisis, AD use rose by 35.2% and drug expenditures decreased by 38.7%. Defined daily dose per patient per day was 10.0 mg vs 13.5 mg, respectively, P<0.001. At 12-month follow-up, the majority of patients (60.8% discontinued the treatment or continued on the same medication as before, and in 23.3% a change of AD was made.Conclusion: Primary health care professionals are highly involved in the management of the illness; in addition, during the period of economic crisis, patients with major depressive disorder showed higher rates of prevalence of the illness, with increased use of AD drugs. Keywords: consumption, antidepressants, economic crisis

  15. Vouchers for Day Care of Children: Evaluating a Program Model.

    Science.gov (United States)

    Parker, Michael D.

    1989-01-01

    Examined effects of a pilot voucher program on the price, supply, and quality of day care. Findings offered no conclusive evidence concerning expected benefits. Discusses vouchers' potential for easing the day care crisis. (RJC)

  16. Evaluation of Health Care System Model Based on Collaborative Algorithms

    OpenAIRE

    2015-01-01

    The rapid development and use of information and communication technologies in the last two decades has influenced a dramatic transformation of public health and health care, changing the roles of the health care support systems and services. Recent trends in health care support systems are focused on developing patient-centric pervasive environments and the use of mobile devices and technologies in medical monitoring and health care systems [1].

  17. Levonorgestrel-releasing intrauterine system vs. usual medical treatment for menorrhagia: an economic evaluation alongside a randomised controlled trial.

    Directory of Open Access Journals (Sweden)

    Sabina Sanghera

    Full Text Available OBJECTIVE: To undertake an economic evaluation alongside the largest randomised controlled trial comparing Levonorgestrel-releasing intrauterine device ('LNG-IUS' and usual medical treatment for women with menorrhagia in primary care; and compare the cost-effectiveness findings using two alternative measures of quality of life. METHODS: 571 women with menorrhagia from 63 UK centres were randomised between February 2005 and July 2009. Women were randomised to having a LNG-IUS fitted, or usual medical treatment, after discussing with their general practitioner their contraceptive needs or desire to avoid hormonal treatment. The treatment was specified prior to randomisation. For the economic evaluation we developed a state transition (Markov model with a 24 month follow-up. The model structure was informed by the trial women's pathway and clinical experts. The economic evaluation adopted a UK National Health Service perspective and was based on an outcome of incremental cost per Quality Adjusted Life Year (QALY estimated using both EQ-5D and SF-6D. RESULTS: Using EQ-5D, LNG-IUS was the most cost-effective treatment for menorrhagia. LNG-IUS costs £100 more than usual medical treatment but generated 0.07 more QALYs. The incremental cost-effectiveness ratio for LNG-IUS compared to usual medical treatment was £1600 per additional QALY. Using SF-6D, usual medical treatment was the most cost-effective treatment. Usual medical treatment was both less costly (£100 and generated 0.002 more QALYs. CONCLUSION: Impact on quality of life is the primary indicator of treatment success in menorrhagia. However, the most cost-effective treatment differs depending on the quality of life measure used to estimate the QALY. Under UK guidelines LNG-IUS would be the recommended treatment for menorrhagia. This study demonstrates that the appropriate valuation of outcomes in menorrhagia is crucial.

  18. Revolution then evolution: the advance of health economic evaluation in Australia.

    Science.gov (United States)

    Lopert, Ruth; Viney, Rosalie

    2014-01-01

    All governments face immense challenges in providing affordable healthcare for their citizens, and the diffusion of novel health technologies is a key driver of growth in expenditure for many. Although important methodological and process variations exist around the world, health economic evaluation is increasingly seen as an important tool to support decision-making around the introduction of new health technologies, interventions and programmes in countries of varying stages of economic development. In Australia, the assessment of the comparative cost-effectiveness of new medicines proposed for subsidy under the country's national drug subsidy programme, the Pharmaceutical Benefits Scheme, was introduced in the late 1980s and became mandatory in 1993, making Australia the first country to introduce such a requirement nationally. Since then the use of health economic evaluation has expanded and been applied to support decision-making across a broader range of health technologies, as well as to programmes in public health.

  19. Evaluation of the economic viability of forest management by the Forest Experimental Station in Krynica

    Directory of Open Access Journals (Sweden)

    Kożuch Anna

    2016-09-01

    Full Text Available The Forest Experimental Station (FES in Krynica is a unit specialized in teaching activities. However, it also fulfils other educational, ecological and social functions. Additionally, as the FES in Krynica operates on the free market and needs to be competitive, primarily with respect to the raw timber prizes, it is also a forest management unit that can be subjected to economic evaluation. The aim of this study was to analyze the income, costs and overall financial outcome of the FES in Krynica for the years of 2008–2012. A financial analysis, using indicators of financial liquidity, profitability, economic activity and liabilities, was also carried out to evaluate the economic effectiveness and efficiency of the forest management unit’s operation. The data was obtained from financial documents, particularly balance sheets, as well as profit and loss accounts.

  20. Incorporating Demand and Supply Constraints into Economic Evaluations in Low-Income and Middle-Income Countries.

    Science.gov (United States)

    Vassall, Anna; Mangham-Jefferies, Lindsay; Gomez, Gabriela B; Pitt, Catherine; Foster, Nicola

    2016-02-01

    Global guidelines for new technologies are based on cost and efficacy data from a limited number of trial locations. Country-level decision makers need to consider whether cost-effectiveness analysis used to inform global guidelines are sufficient for their situation or whether to use models that adjust cost-effectiveness results taking into account setting-specific epidemiological and cost heterogeneity. However, demand and supply constraints will also impact cost-effectiveness by influencing the standard of care and the use and implementation of any new technology. These constraints may also vary substantially by setting. We present two case studies of economic evaluations of the introduction of new diagnostics for malaria and tuberculosis control. These case studies are used to analyse how the scope of economic evaluations of each technology expanded to account for and then address demand and supply constraints over time. We use these case studies to inform a conceptual framework that can be used to explore the characteristics of intervention complexity and the influence of demand and supply constraints. Finally, we describe a number of feasible steps that researchers who wish to apply our framework in cost-effectiveness analyses.

  1. A literature review of economic evaluations for a neglected tropical disease: human African trypanosomiasis ("sleeping sickness").

    Science.gov (United States)

    Sutherland, C Simone; Yukich, Joshua; Goeree, Ron; Tediosi, Fabrizio

    2015-02-01

    Human African trypanosomiasis (HAT) is a disease caused by infection with the parasite Trypanosoma brucei gambiense or T. b. rhodesiense. It is transmitted to humans via the tsetse fly. Approximately 70 million people worldwide were at risk of infection in 1995, and approximately 20,000 people across Africa are infected with HAT. The objective of this review was to identify existing economic evaluations in order to summarise cost-effective interventions to reduce, control, or eliminate the burden of HAT. The studies included in the review were compared and critically appraised in order to determine if there were existing standardised methods that could be used for economic evaluation of HAT interventions or if innovative methodological approaches are warranted. A search strategy was developed using keywords and was implemented in January 2014 in several databases. The search returned a total of 2,283 articles. After two levels of screening, a total of seven economic evaluations were included and underwent critical appraisal using the Scottish Intercollegiate Guidelines Network (SIGN) Methodology Checklist 6: Economic Evaluations. Results from the existing studies focused on the cost-effectiveness of interventions for the control and reduction of disease transmission. Modelling was a common method to forecast long-term results, and publications focused on interventions by category, such as case detection, diagnostics, drug treatments, and vector control. Most interventions were considered cost-effective based on the thresholds described; however, the current treatment, nifurtomix-eflornithine combination therapy (NECT), has not been evaluated for cost-effectiveness, and considerations for cost-effective strategies for elimination have yet to be completed. Overall, the current evidence highlights the main components that play a role in control; however, economic evaluations of HAT elimination strategies are needed to assist national decision makers, stakeholders, and

  2. Technical and Economical Evaluation of Power Saving Consumer Electrical Engineering Efficiency Under market Condituions

    Directory of Open Access Journals (Sweden)

    Y. N. Kolesnik

    2008-01-01

    Full Text Available The paper considers an evaluation and justification of power saving efficiency and potential due to installation of power saving electric devices in the housing sector with due account of functioning of market conditions. A number of nomographs have been developed on the basis of modern methods for efficiency evaluation and technical and economical model that make it possible to evaluate efficiency of power-saving equipment. On the one side these nomographs take into account power consumption, service life and mode of electric device operation and on the other side they also take account of equipment and electric power price and bank rate. Evaluation of economically justified potential of power saving has been carried out on the basis of these models.

  3. FUZZY LOGIC APPLICATION FOR ECONOMICAL-FINANCIAL PERFORMANCE EVALUATION OF PRODUCTION COOPERATIVES.

    Directory of Open Access Journals (Sweden)

    Jaciara Treter

    2010-04-01

    Full Text Available In this work a methodology based on Fuzzy Logic was developed for classification and evaluation of Economical-financial Performance of production cooperatives. Continuous scales were introduced and Fuzzy Logic based sub-models, were created to evaluate Own Capital Return, Payment Capacity and Capital Structure of a production cooperative. By applying the developed model, the Performance dynamics of two production cooperatives (Coopermil and Cotricampo was analyzed in a 5 year’s period.. Evaluations carried out through numeric simulation in order to analyse the influence of several indicators on a production cooperative performance and expert evaluations showed good correlation.

  4. Economic Values for Evaluation of Federal Aviation Administration Investment and Regulatory Programs

    Science.gov (United States)

    1989-10-01

    Discounting Personal r.njury Economic Losses," The Journal of Risk and Insurance , 52(1) (March 1985): pp. 144-150. followed by a "Rejoinder," --y Don Schilling...Future Inccme Losses: An Historical Simulation 1900-1982," The Journal of Risk and Insurance 52(1), pp. 100-116. The "Alaskan" method of evaluating

  5. Software Integration of Life Cycle Assessment and Economic Analysis for Process Evaluation

    DEFF Research Database (Denmark)

    Kalakula, Sawitree; Malakula, Pomthong; Siemanonda, Kitipat

    2013-01-01

    This study is focused on the sustainable process design of bioethanol production from cassava rhizome. The study includes: process simulation, sustainability analysis, economic evaluation and life cycle assessment (LCA). A steady state process simulation if performed to generate a base case desig...

  6. Economic evaluation of vaccines : specificities and future challenges illustrated by recent European examples

    NARCIS (Netherlands)

    Postma, M.J.; Westra, T.A.; Quilici, S.; Largeron, N.

    2013-01-01

    This study reviews the current challenges in the economic evaluation of vaccines with a focus on European countries. In particular, the type of clinical evidence generally available, the impact of discounting for time preference and the use of modeling to derive valid cost-effectiveness assessments

  7. Evaluating the Air Quality, Climate Change, and Economic Impacts of Biogas Management Technologies

    Science.gov (United States)

    This is an abstract for a presentation that describes a project to evaluate economic and environmental performance of several biogas management technologies. It will analyze various criteria air pollutants, greenhouse gas emissions, and costs associated with the use of biogas. Th...

  8. Multiple imputation strategies for zero-inflated cost data in economic evaluations : which method works best?

    NARCIS (Netherlands)

    Vroomen, Janet MacNeil; Eekhout, Iris; Dijkgraaf, Marcel G.; van Hout, Hein; de Rooij, Sophia E.; Heymans, Martijn W.; Bosmans, Judith E.

    2016-01-01

    Cost and effect data often have missing data because economic evaluations are frequently added onto clinical studies where cost data are rarely the primary outcome. The objective of this article was to investigate which multiple imputation strategy is most appropriate to use for missing cost-effecti

  9. ENGINEERING AND ECONOMIC EVALUATION OF GAS RECOVERY AND UTILIZATION TECHNOLOGIES AT SELECTED U.S. MINES

    Science.gov (United States)

    Methane liberated in underground coal mines is a severe safety hazard to miners. It is also a major contributor to the build-up of greenhouse gases in the global atmosphere. This report presents an engineering and economic evaluation of several methane recovery and end-use techno...

  10. Multiple imputation strategies for zero-inflated cost data in economic evaluations : which method works best?

    NARCIS (Netherlands)

    MacNeil Vroomen, Janet; Eekhout, Iris; Dijkgraaf, Marcel G; van Hout, Hein; de Rooij, Sophia E; Heymans, Martijn W; Bosmans, Judith E

    2015-01-01

    Cost and effect data often have missing data because economic evaluations are frequently added onto clinical studies where cost data are rarely the primary outcome. The objective of this article was to investigate which multiple imputation strategy is most appropriate to use for missing cost-effecti

  11. The Economic Evaluation of Peer Counselling in Facilitating Computer Use in Higher Education.

    Science.gov (United States)

    Dolton, Peter; And Others

    1994-01-01

    Evaluates a peer counseling program aimed at helping first-year students use computers in the University of Newcastle economics department. The scheme has not harmed students' abilities to use computers and, in some cases, has improved their skill. The scheme is inexpensive and provides significant potential savings in staff and hardware costs.…

  12. Economic evaluation: Concepts, selected studies, system costs, and a proposed program

    Science.gov (United States)

    Osterhoudt, F. H. (Principal Investigator)

    1979-01-01

    The more usual approaches to valuing crop information are reviewed and an integrated approach is recommended. Problems associated with implementation are examined. What has already been accomplished in the economic evaluation of LACIE-type information is reported including various studies of benefits. The costs of the existing and proposed systems are considered. A method and approach is proposed for further studies.

  13. An Evaluation of the Mass Lecture as a Teaching Technique in First-Year Economics

    Science.gov (United States)

    Wiedemann, Paul; Dorward, Neil

    1977-01-01

    Examines a three-tiered class structure: a mass lecture followed by small group instruction followed by student-directed discussion sessions. Course evaluations by staff and students were generally favorable to this approach. Discusses the design of other economically efficient educational processes. For journal availability, see SO 506 073. (JK)

  14. Two Computer Programs for Equipment Cost Estimation and Economic Evaluation of Chemical Processes.

    Science.gov (United States)

    Kuri, Carlos J.; Corripio, Armando B.

    1984-01-01

    Describes two computer programs for use in process design courses: an easy-to-use equipment cost estimation program based on latest cost correlations available and an economic evaluation program which calculates two profitability indices. Comparisons between programed and hand-calculated results are included. (JM)

  15. Cultural, Social, and Economic Capital Constructs in International Assessments: An Evaluation Using Exploratory Structural Equation Modeling

    Science.gov (United States)

    Caro, Daniel H.; Sandoval-Hernández, Andrés; Lüdtke, Oliver

    2014-01-01

    The article employs exploratory structural equation modeling (ESEM) to evaluate constructs of economic, cultural, and social capital in international large-scale assessment (LSA) data from the Progress in International Reading Literacy Study (PIRLS) 2006 and the Programme for International Student Assessment (PISA) 2009. ESEM integrates the…

  16. Tools for Evaluating Research Output: Are Citation-based Rankings of Economics Journals Stable?

    Science.gov (United States)

    Sutter, Matthias; Kocher, Martin G.

    2001-01-01

    Studied the assignment of economics journals to different quartiles of citation-based rankings, a measure of journal quality that has implications for evaluating research output and academic promotions. Found that about 60% of journals remain in the same quartile, and about 95% remain the same or move up within 5- to 10-year intervals, suggesting…

  17. Economic evaluation of the administration of follitropin-beta with a pen device.

    NARCIS (Netherlands)

    Bruynesteyn, K.; Bonsel, G.J.; Braat, D.D.M.; Fauser, B.C.J.M.; Devroey, P.; Genugten, M.L.L van

    2005-01-01

    Previous studies suggest that administration of follitropin-beta with a pen device (Puregon Pen(R)) is more convenient, less painful and 16-18% more efficient. The aim of this study was to perform an economic evaluation of the administration of follitropin-beta by this pen device against follitropin

  18. Educating Medical Laboratory Technologists: Revisiting Our Assumptions in the Current Economic and Health-Care Environment

    Directory of Open Access Journals (Sweden)

    Regina Linder

    2012-08-01

    Full Text Available Health care occupies a distinct niche in an economy struggling to recover from recession. Professions related to the care of patients are thought to be relatively resistant to downturns, and thus become attractive to students typically drawn to more lucrative pursuits. Currently, a higher profile for clinical laboratory technology among college students and those considering career change results in larger and better prepared applicant pools. However, after decades of contraction marked by closing of programs, prospective students encounter an educational system without the capacity or vigor to meet their needs. Here discussed are some principles and proposals to allow universities, partnering with health-care providers, government agencies, and other stakeholders to develop new programs, or reenergize existing ones to serve our students and patients. Principles include academic rigor in biomedical and clinical science, multiple points of entry for students, flexibility in format, cost effectiveness, career ladders and robust partnerships.

  19. [An evaluation of the implementation of the 'Guidelines for oral care for patients dependent on care'].

    Science.gov (United States)

    Hoeksema, A R; Meijer, H J A; Vissink, A; Raghoebar, G M; Visser, A

    2016-05-01

    75% of older people being admitted to a nursing home are found to have oral care problems that have not been treated. Moreover, the Healthcare Inspectorate [in the Netherlands] reports that oral care for patients who depend on care in nursing homes is inadequate. The 'Guidelines for oral care for patients dependent on care in nursing homes', developed in 2007, appears to have been inadequately implemented. The goal of this research was to gain insight into the implementation of these guidelines in healthcare organisations. To that end, a questionnaire was distributed among the staff of 74 nursing homes. An analysis of the data revealed that people are -familiar with the guidelines and that oral care providers are often available. Oral care providers, however, often do not have access to reasonable dental care facilities. Patients are, moreover, generally not screened and/or monitored in accordance with the guidelines. Finally, it seems that the instruction of nurses and care-providers is insufficient. Research supports the conclusion that the nursing home staff is well-acquainted with the 'Guidelines for oral care for patients dependent on care' but that implementation of the guidelines in daily practice leaves much to be desired.

  20. Economic evaluation of seawater desalination by using SMART in the MENA

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyo Sung; Roh, Myung Sub [KEPCO International Nuclear Graduate School, Ulsan (Korea, Republic of)

    2013-10-15

    This paper show the economic evaluation of seawater desalination in the MENA(Middle East and North Africa) by using nuclear source. Especially the evaluation of economics is performed based on comparing the SMART(System integrated Modular Advanced Reactor) developed in Korea with general Combined Cycle Gas Turbine. Taken the economic analysis together, the most important issues for economic feasibility are the management of the construction cost. SMART have a competitive when the construction cost is 3,000$/kWe. Thus plan for the management of the target construction cost will be reflected in the design process like a notion of modularity and mass production methods. Another way is the design optimization of SMART and facility of desalination in a view of the mechanical properties. In other words, it is a way to design improvements for eliminating or sharing of duplicate functions between SMART and desalination facility and maximization the efficiency of energy use. Finally, construction cost can be rationalized by reduce the construction lead time. The potential weakness of SMART is the long construction lead time as compared with alternative. Moreover considering the SMART is suitable for the country which is expected to have the most rapid economic growth in the near future, the construction lead time should be shorten. Managing these concepts to reduce the construction cost is enough to compensate for a disadvantage in power cost and water cost comparing with combined cycle.

  1. Evaluation of clinical pharmacy services offered for palliative care patients in Qatar.

    Science.gov (United States)

    Wilby, Kyle John; Mohamad, Alaa Adil; AlYafei, Sumaya AlSaadi

    2014-09-01

    Palliative care is an emerging concept in the countries of the Gulf Cooperation Council, a political and economic union of Arab states bordering the Persian Gulf, namely Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. Clinical pharmacy services have not yet been evaluated in this region. The objectives of this study were to create a baseline inventory of clinical pharmacy interventions in palliative care and to assess the perceived importance of interventions made. This was a prospective, single-center characterization study. Interventions were documented from September 30 to December 1, 2013. They were characterized into predetermined categories and analyzed using descriptive statistics. Physician acceptance rate and intervention rate per patient were calculated. Classification categories were sent to 10 practicing pharmacists in each of Qatar and Canada, who ranked the categories on the basis of perceived importance. A total of 96 interventions were documented, giving 3 interventions per patient and an acceptance rate of 81%. Discontinuing therapy (29%), initiating therapy (25%), and provision of education/counseling (13.5%) were most common. No differences were found between rankings from pharmacists in Qatar or Canada. Clinical pharmacy interventions are frequent, and those relating to alterations in drug therapy are most common. Interventions align with the perceived importance from pharmacists in both Qatar and Canada.

  2. Evaluation of a Professional Practice Model in the Ambulatory Care Setting

    Science.gov (United States)

    2014-03-10

    patient satisfaction , nurse -sensitive indicators of quality care as measured by...Project Number: N10-C04 Aim one Evaluate levels of nursing and patient satisfaction in ambulatory care clinics following implementation of a...Clarke, S.P., Sloane, D., Lake, E.T., Cheney, T. (2008). Effects of hospital care environment on patient mortality and nurse outcomes. Journal of Nursing

  3. QUALICOPC, a multi-country study evaluating quality, costs and equity in primary care.

    NARCIS (Netherlands)

    Schäfer, W.L.A.; Boerma, W.G.W.; Kringos, D.S.; Maeseneer, J. de; Gress, S.; Heinemann, S.; Rotar-Pavlic, D.; Seghieri, C.; Svab, I.; Berg, M.J. van den; Vainieri, M.; Westert, G.P.; Willems, S.; Groenewegen, P.P.

    2011-01-01

    Background: The QUALICOPC (Quality and Costs of Primary Care in Europe) study aims to evaluate the performance of primary care systems in Europe in terms of quality, equity and costs. The study will provide an answer to the question what strong primary care systems entail and which effects primary c

  4. QUALICOPC, a multi-country study evaluating quality, costs and equity in primary care

    NARCIS (Netherlands)

    Schafer, W.L.; Boerma, W.G.; Kringos, D.S.; Maeseneer, J. De; Gress, S.; Heinemann, S.; Rotar-Pavlic, D.; Seghieri, C.; Svab, I.; Berg, M.J. van den; Vainieri, M.; Westert, G.P.; Willems, S.; Groenewegen, P.P.

    2011-01-01

    ABSTRACT: BACKGROUND: The QUALICOPC (Quality and Costs of Primary Care in Europe) study aims to evaluate the performance of primary care systems in Europe in terms of quality, equity and costs. The study will provide an answer to the question what strong primary care systems entail and which effects

  5. Health and Socio-Economic Status: Factors impacting care and treatment in ovarian cancer patients

    DEFF Research Database (Denmark)

    Seibæk, L.; Petersen, L. K.; Blaakaer, J.

    2011-01-01

    and a tendency to be overweight. Many had a low educational level, were retired, and lived alone with few financial resources. The quality of the surgical treatment had improved in terms of centralisation and staging procedures. Conclusions: As a group the women proved to be in a vulnerable position in terms...... of living conditions and general health. Some of these factors might be compensated via health promotion and supportive preoperative care, others by appropriate organisation of treatment. Substantial advantages might therefore be within reach by introducing nurse-led, supportive preoperative care during...

  6. Act In case of Depression: The evaluation of a care program to improve the detection and treatment of depression in nursing homes. Study Protocol

    Directory of Open Access Journals (Sweden)

    Vernooij-Dassen Myrra JFJ

    2011-05-01

    Full Text Available Abstract Background The aim of this study is evaluating the (cost- effectiveness of a multidisciplinary, evidence based care program to improve the management of depression in nursing home residents of somatic and dementia special care units. The care program is an evidence based standardization of the management of depression, including standardized use of measurement instruments and diagnostical methods, and protocolized psychosocial, psychological and pharmacological treatment. Methods/Design In a 19-month longitudinal controlled study using a stepped wedge design, 14 somatic and 14 dementia special care units will implement the care program. All residents who give informed consent on the participating units will be included. Primary outcomes are the frequency of depression on the units and quality of life of residents on the units. The effect of the care program will be estimated using multilevel regression analysis. Secondary outcomes include accuracy of depression-detection in usual care, prevalence of depression-diagnosis in the intervention group, and response to treatment of depressed residents. An economic evaluation from a health care perspective will also be carried out. Discussion The care program is expected to be effective in reducing the frequency of depression and in increasing the quality of life of residents. The study will further provide insight in the cost-effectiveness of the care program. Trial registration Netherlands Trial Register (NTR: NTR1477

  7. Women's evaluation of abuse and violence care in general practice: a cluster randomised controlled trial (weave

    Directory of Open Access Journals (Sweden)

    Feder Gene

    2010-01-01

    Full Text Available Abstract Background Intimate partner abuse (IPA is a major public health problem with serious implications for the physical and psychosocial wellbeing of women, particularly women of child-bearing age. It is a common, hidden problem in general practice and has been under-researched in this setting. Opportunities for early intervention and support in primary care need to be investigated given the frequency of contact women have with general practice. Despite the high prevalence and health consequences of abuse, there is insufficient evidence for screening in primary care settings. Furthermore, there is little rigorous evidence to guide general practitioners (GPs in responding to women identified as experiencing partner abuse. This paper describes the design of a trial of a general practice-based intervention consisting of screening for fear of partner with feedback to GPs, training for GPs, brief counselling for women and minimal practice organisational change. It examines the effect on women's quality of life, mental health and safety behaviours. Methods/Design weave is a cluster randomised controlled trial involving 40 general practices in Victoria, Australia. Approximately 500 women (16-50 years seen by the GP in the previous year are mailed a short lifestyle survey containing an item to screen for IPA. Women who indicate that they were afraid of a partner/ex-partner in the last year and provide contact details are invited to participate. Once baseline data are collected, GPs are randomly assigned to either a group involving healthy relationship and responding to IPA training plus inviting women for up to 6 sessions of counselling or to a group involving basic education and usual care for women. Outcomes will be evaluated by postal survey at 6 and 12 months following delivery of the intervention. There will be an economic evaluation, and process evaluation involving interviews with women and GPs, to inform understanding about implementation

  8. The Social Ecology of Maternal Infant Care in Socially and Economically Marginalized Community in Southern Israel

    Science.gov (United States)

    Daoud, Nihaya; O'Campo, Patricia; Anderson, Kim; Agbaria, Ayman K.; Shoham-Vardi, Ilana

    2012-01-01

    This study aims to better understand the social ecology of infant care (IC) as experienced and perceived by mothers living in a deprived Arab Bedouin community in Israel, where children's health indicators are poor. We used the integrative model of Garcia Coll et al. (Garcia Coll C, Lamberty G, Jenkins R "et al." An integrative model for the study…

  9. Made in Denmark 2014 - Evaluation of Spectator Experience and Tourism Economic Impacts

    DEFF Research Database (Denmark)

    Toft, Henrik; Zahle Østergaard, Mads

    2015-01-01

    This report is a translation of the impact analysis of the golf tournament, Made in Denmark, which was held in August 2014. The content of the report is divided into two sub-parts. The first part is an analysis of the spectator experience and how well the experience of being at this event...... was asssessed by the spectators. The second part is a tourism economic impact analysis which purpose is to analyse, evaluate and assess the economic impact this event had on the local area where it was held....

  10. Evaluation of the Technical-Economic Potential of Particle- Reinforced Aluminum Matrix Composites and Electrochemical Machining

    Science.gov (United States)

    Schubert, A.; Götze, U.; Hackert-Oschätzchen, M.; Lehnert, N.; Herold, F.; Meichsner, G.; Schmidt, A.

    2016-03-01

    Compared to conventional cutting, the processing of materials by electrochemical machining offers some technical advantages like high surface quality, no thermal or mechanical impact on the work piece and preservation of the microstructure of the work piece material. From the economic point of view, the possibility of process parallelization and the absence of any process-related tool wear are mentionable advantages of electrochemical machining. In this study, based on experimental results, it will be evaluated to what extent the electrochemical machining is technically and economically suitable for the finish-machining of particle- reinforced aluminum matrix composites (AMCs). Initial studies showed that electrochemical machining - in contrast to other machining processes - has the potential to fulfil demanding requirements regarding precision and surface quality of products or components especially when applied to AMCs. In addition, the investigations show that processing of AMCs by electrochemical machining requires less energy than the electrochemical machining of stainless steel. Therefore, an evaluation of electrochemically machined AMCs - compared to stainless steel - from a technical and an economic perspective will be presented in this paper. The results show the potential of electro-chemically machined AMCs and contribute to the enhancement of instruments for technical-economic evaluations as well as a comprehensive innovation control.

  11. Technical and economical evaluation of tape drip and drip line irrigation systems in a strawberry greenhouse

    Directory of Open Access Journals (Sweden)

    Soghra HOSSEINIAN

    2016-04-01

    Full Text Available This study was done in a strawberry greenhouse to examine the technical and the economical evaluation of two drip irrigation systems including the tape and the drip line in the northern part of Iran. The result showed that all of the technical indices with tape were higher than drip line, and due to statistical analysis reveal a significant difference (P < 0.05. Yield and water productivity (WP with tape were higher than drip line (P < 0.05. Benefit per drop (BPD and net benefit per drop (NBPD with tape were higher than drip line. Net present value, internal rate of capital return and benefit to cost ratio in drip line were higher than tape. In general, regarding technical evaluation tape was better than drip line, besides according to the economical evaluation the drip ­lines were better than tape.

  12. Organization and evaluation of generalist palliative care in a Danish hospital

    DEFF Research Database (Denmark)

    Bergenholtz, H; Hølge-Hazelton, B; Jarlbæk, Lene

    2015-01-01

    Background Hospitals have a responsibility to ensure that palliative care is provided to all patients with life-threatening illnesses. Generalist palliative care should therefore be acknowledged and organized as a part of the clinical tasks. However, little is known about the organization...... and evaluation of generalist palliative care in hospitals. Therefore the aim of the study was to investigate the organization and evaluation of generalist palliative care in a large regional hospital by comparing results from existing evaluations. Methods Results from three different data sets, all aiming...... to evaluate generalist palliative care, were compared retrospectively. The data-sets derived from; 1. a national accreditation of the hospital, 2. a national survey and 3. an internal self-evaluation performed in the hospital. The data were triangulated to investigate the organization and evaluation...

  13. Examining the "liberal media" claim: journalists' views on politics, economic and social policy (including health care), and media coverage.

    Science.gov (United States)

    Croteau, D

    1999-01-01

    The conservative critique of the news media rests on two general propositions: journalists hold views that are to the left of the public, and journalists frame news content in a way that accentuates these left perspectives. Previous research has revealed persuasive evidence against the latter claim, but the validity of the former claim has often been taken for granted. This research project examined the supposed left orientation of media personnel by surveying Washington-based journalists who cover national politics and/or economic policy at U.S. outlets. The findings include: (1) On select issues from corporate power and trade to Social Security and Medicare to health care and taxes, journalists are actually more conservative than the general public. (2) Journalists are mostly centrist in their political orientation. (3) The minority of journalists who do not identify with the "center" are more likely to identify with the "right" when it comes to economic issues and to identify with the "left" when it comes to social issues. (4) Journalists report that "business-oriented news outlets" and "major daily newspapers" provide the highest quality coverage of economic policy issues, while "broadcast network TV news" and "cable news services" provide the worst.

  14. Protocol and baseline data from The Inala Chronic Disease Management Service evaluation study: a health services intervention study for diabetes care

    Science.gov (United States)

    2010-01-01

    Background Type 2 Diabetes Mellitus is one of the most disabling chronic conditions worldwide, resulting in significant human, social and economic costs and placing huge demands on health care systems. The Inala Chronic Disease Management Service aims to improve the efficiency and effectiveness of care for patients with type 2 diabetes who have been referred by their general practitioner to a specialist diabetes outpatient clinic. Care is provided by a multidisciplinary, integrated team consisting of an endocrinologist, diabetes nurse educators, General Practitioner Clinical Fellows (general practitioners who have undertaken focussed post-graduate training in complex diabetes care), and allied health personnel (a dietitian, podiatrist and psychologist). Methods/Design Using a geographical control, this evaluation study tests the impact of this model of diabetes care provided by the service on patient outcomes compared to usual care provided at the specialist diabetes outpatient clinic. Data collection at baseline, 6 and 12-months will compare the primary outcome (glycaemic control) and secondary outcomes (serum lipid profile, blood pressure, physical activity, smoking status, quality of life, diabetes self-efficacy and cost-effectiveness). Discussion This model of diabetes care combines the patient focus and holistic care valued by the primary care sector with the specialised knowledge and skills of hospital diabetes care. Our study will provide empirical evidence about the clinical effectiveness of this model of care. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12608000010392. PMID:20492731

  15. Economic evaluation for first-line anti-hypertensive medicines: applications for the Philippines

    Directory of Open Access Journals (Sweden)

    Geroy Lester Sam Araneta

    2012-12-01

    Full Text Available Abstract Background Medicines to control hypertension, a leading cause of morbidity and mortality, are a major component of health expenditures in the Philippines. This study aims to review economic studies for first line anti-hypertensive medical treatment without co-morbidities; and discuss practical, informational and policy implications on the use of economic evaluation in the Philippines. Methods A systematic literature review was performed using the following databases: MEDLINE, EMBASE, BIOSIS, PubMed, The Cochrane Library, Health Economics Evaluations Database (HEED and the Centre for Reviews and Dissemination – NHS NICE. Six existing economic analytical frameworks were reviewed and one framework for critical appraisal was developed. Results Out of 1336 searched articles, 12 fulfilled the inclusion criteria. The studies were summarized according to their background characteristics (year, journal, intervention and comparators, objective/study question, target audience, economic study type, study population, setting and country and source of funding/conflict of interest and technical characteristics (perspective, time horizon, methodology/modeling, search strategy for parameters, costs, effectiveness measures, discounting, assumptions and biases, results, cost-effectiveness ratio, endpoints, sensitivity analysis, generalizability, strengths and limitations, conclusions, implications and feasibility and recommendations. The studies represented different countries, perspectives and stakeholders. Conclusions Diuretics were the most cost-effective drug class for first-line treatment of hypertension without co-morbidities. Although the Philippine Health Insurance Corporation may apply the recommendations given in previous studies (i.e. to subsidize diuretics, ACE inhibitors and calcium channel blockers, it is uncertain how much public funding is justified. There is an information gap on clinical data (transition probabilities, relative risks

  16. Primary Medical Care Provider Accreditation (PMCPA): pilot evaluation.

    NARCIS (Netherlands)

    Campbell, S.M.; Chauhan, U.; Lester, H.

    2010-01-01

    BACKGROUND: While practice-level or team accreditation is not new to primary care in the UK and there are organisational indicators in the Quality and Outcomes Framework (QOF) organisational domain, there is no universal system of accreditation of the quality of organisational aspects of care in the

  17. Home care in childhood diabetes : a controlled evaluation study

    NARCIS (Netherlands)

    M.W. Zoeteweij (Moniek)

    1992-01-01

    textabstractThis thesis considers children with insulin-dependent diabetes mellitus and their psychological and medical functioning during 31 months of participation in a home-care program compared to traditional hospital-based care. In general, diabetes mellitus -derived from the greek diabainein (

  18. Economic and environmental evaluation of nitrogen removal and recovery methods from wastewater.

    Science.gov (United States)

    Lin, Yanzi; Guo, Miao; Shah, Nilay; Stuckey, David C

    2016-09-01

    The driver for waste-based economic growth is long-term strategic design, and a paradigm-shift from waste treatment to resource recovery. This study aims to use an integrated modelling approach to evaluate the holistic economic and environmental profiles of three alternative nitrogen removal and recovery methods integrated into wastewater treatment systems, including conventional nitrification-denitrification, Anammox, and the anaerobic ion exchange route, to provide insights into N recovery system designs which are key elements in building a sustainable circular economy. Our results suggest that ion exchange is a promising technology showing high N removal-recovery efficiency from municipal wastewater and delivering competitive sustainability scores. In comparison with the well-developed conventional route, ion exchange and Anammox are undergoing significant research and development; as highlighted in sensitivity analyses, there is considerable room for process design and optimisation of ion exchange systems to achieve economically and environmentally optimal performance.

  19. The economical contracting management in Agricultural Cooperatives: tools for evaluating their performance.

    Directory of Open Access Journals (Sweden)

    Rafael Enrique Viña Echevarría

    2014-06-01

    Full Text Available The economic and management contracts involve strategic actions, legal and operational purposes that make possible to convert the goal of an organization on results that express the fulfillment of the mandates and satisfies customers on the basis of the duties and obligations set out in the negotiating document. This article aims to get inside into the performance evaluation of the management of the recruitment of Agricultural Cooperatives and to reflex about the insufficiencies evidenced in this process. To which we developed a theoretical valuation and economic procurement praxiological showing a group of deficiencies that have impacted in the contracts management The study was able to obtain, process, analyze, interpret and argue the problems associated with economic contracting and justify the need to propose a system of indicators to assess recruitment management Agricultural Cooperatives in the province of Sancti Spiritus, the results revealed the ineffectiveness of the process and the negative impact on the productive base.

  20. Designing economic evaluations to facilitate optimal decisions: the need to avoid bias

    Directory of Open Access Journals (Sweden)

    Lee KM

    2016-04-01

    Full Text Available Karen M Lee,1,3 Kathryn Coyle,2 Doug Coyle2,31Canadian Agency for Drugs and Technologies in Health (CADTH, Ottawa, ON, Canada; 2Health Economics Research Group, Brunel University, Uxbridge, UK; 3School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, CanadaGuertin et al1 argue in their article “Bias within economic evaluations” that if researchersfail to incorporate the future availability of generics entrants for new patented drugs, the incremental cost-effectiveness ratio (ICER will be overestimated.1 Before addressing the validity of this argument, it is first worthwhile to consider the nature of both bias and economic evaluation.Read the original paper by Guertin et al 

  1. Health care consumer reports: an evaluation of consumer perspectives.

    Science.gov (United States)

    Longo, Daniel R; Everet, Kevin D

    2003-01-01

    There has been a proliferation of health care consumer reports, also known as "consumer guides," "report cards," and "performance reports," which are designed to assist consumers in making more informed health care decisions. While there is evidence that providers use such reports to identify and make changes in practice, thus improving the quality of care, there is little empirical evidence on how consumer guides/report cards are used by consumers. This study fills that gap by surveying 925 patients as they wait for ambulatory care in several clinics in a midwestern city. Findings indicate that consumers are selective in their use of these reports and quickly identify those sections of the report of most interest to them. Report developers should take precautions to ensure such reports are viewed as credible sources of health care information.

  2. Workshop Report: concepts and methods in the economics of nutrition--gateways to better economic evaluation of nutrition interventions.

    Science.gov (United States)

    Lenoir-Wijnkoop, I; Nuijten, M J C; Gutiérrez-Ibarluzea, I; Hutton, J; Poley, M J; Segal, L; Bresson, J L; van Ganse, E; Jones, P; Moreno, L; Salminen, S; Dubois, D

    2012-11-14

    Improving health through better nutrition of the population may contribute to enhanced efficiency and sustainability of healthcare systems. A recent expert meeting investigated in detail a number of methodological aspects related to the discipline of nutrition economics. The role of nutrition in health maintenance and in the prevention of non-communicable diseases is now generally recognised. However, the main scope of those seeking to contain healthcare expenditures tends to focus on the management of existing chronic diseases. Identifying additional relevant dimensions to measure and the context of use will become increasingly important in selecting and developing outcome measurements for nutrition interventions. The translation of nutrition-related research data into public health guidance raises the challenging issue of carrying out more pragmatic trials in many areas where these would generate the most useful evidence for health policy decision-making. Nutrition exemplifies all the types of interventions and policy which need evaluating across the health field. There is a need to start actively engaging key stakeholders in order to collect data and to widen health technology assessment approaches for achieving a policy shift from evidence-based medicine to evidence-based decision-making in the field of nutrition.

  3. The quality and economic impact of disruptive behaviors on clinical outcomes of patient care.

    Science.gov (United States)

    Rosenstein, Alan H

    2011-01-01

    Disruptive behaviors have been shown to have a negative impact on work relationships, team collaboration, communication efficiency, and process flow, all of which can adversely affect patient safety and quality of care. Despite the growing recognition of the damage that can be done, there are still pockets of resistance to taking action to address the issue head-on. Given the new call to action from the Joint Commission accreditation standard and the growing public accountability for patient safety, organizations need to recognize the full impact of disruptive behaviors and implement appropriate policies, procedures, and educational programs to raise levels of awareness regarding the seriousness of the issue, hold individuals accountable for their behavior, and provide training and support not only to reduce the incidence and consequences of disruptive events but also to improve efficiency of communication and team collaboration in an effort to improve outcomes of care.

  4. Socio-economic inequalities in health, habits and self-care during pregnancy in Spain.

    Science.gov (United States)

    Larrañaga, Isabel; Santa-Marina, Loreto; Begiristain, Haizea; Machón, Mónica; Vrijheid, Martine; Casas, Maribel; Tardón, Adonina; Fernández-Somoano, Ana; Llop, Sabrina; Rodriguez-Bernal, Clara L; Fernandez, Mariana F

    2013-09-01

    Socioeconomic disadvantage can be harmful for mother's health and can influence child's health long term. The aim of this study is to analyse social inequalities between pregnant women from four INMA (INfancia y Medio Ambiente) cohorts. The analysis included 2,607 pregnant women recruited between 2004 and 2008 from four INMA cohorts. Data on maternal characteristics were collected through two questionnaires completed in the first and third trimester of pregnancy. The relationship between socioeconomic status (SES) and maternal health, dietary intake, lifestyle habits and self-care related variables was modelled using logistic regression analysis. 33.5 % of women had a university level of education and 47 % had high occupational class. Women with higher SES reported healthier habits, fewer complications during pregnancy, better weight gain control and attended more prenatal appointments than women with lower SES. The risk of sedentary behaviour and passive smoking was higher among women with a lower level of education (OR = 1.7, 95 % CI 1.3-2.2 and OR = 1.6, 95 % CI 1.2-2.3, respectively) and with less skilled occupations (OR = 1.7, 95 % CI 1.4-2.0 and OR = 1.2, 95 % CI 1.0-1.5, respectively). Although both SES indicators-occupation and education-act as social determinants of diet, occupation was a more powerful determinant than education. For other lifestyle and self-caring variables, education was a more powerful predictor than occupation. Social inequalities were observed in health, habits and self-care during pregnancy. Proper care during pregnancy requires the control of common clinical variables and the knowledge of socioeconomic conditions of the pregnant women.

  5. Association of socio-economic status with diabetes prevalence and utilization of diabetes care services

    Directory of Open Access Journals (Sweden)

    Svenson Lawrence W

    2006-10-01

    Full Text Available Abstract Background Low income appears to be associated with a higher prevalence of diabetes and diabetes related complications, however, little is known about how income influences access to diabetes care. The objective of the present study was to determine whether income is associated with referral to a diabetes centre within a universal health care system. Methods Data on referral for diabetes care, diabetes prevalence and median household income were obtained from a regional Diabetes Education Centre (DEC database, the Canadian National Diabetes Surveillance System (NDSS and the 2001 Canadian Census respectively. Diabetes rate per capita, referral rate per capita and proportion with diabetes referred was determined for census dissemination areas. We used Chi square analyses to determine if diabetes prevalence or population rates of referral differed across income quintiles, and Poisson regression to model diabetes rate and referral rate in relation to income while controlling for education and age. Results There was a significant gradient in both diabetes prevalence (χ2 = 743.72, p 2 = 168.435, p Conclusion Low income is associated with a higher prevalence of diabetes and a higher population rate of referral to this regional DEC. After accounting for diabetes prevalence, however, the equal proportions referred to the DEC across income groups suggest that there is no access bias based on income.

  6. Manipulative therapy in addition to usual medical care accelerates recovery of shoulder complaints at higher costs: economic outcomes of a randomized trial

    Directory of Open Access Journals (Sweden)

    Bergman Gert JD

    2010-09-01

    Full Text Available Abstract Background Shoulder complaints are common in primary care and have unfavourable long term prognosis. Our objective was to evaluate the clinical effectiveness of manipulative therapy of the cervicothoracic spine and the adjacent ribs in addition to usual medical care (UMC by the general practitioner in the treatment of shoulder complaints. Methods This economic evaluation was conducted alongside a randomized trial in primary care. Included were 150 patients with shoulder complaints and a dysfunction of the cervicothoracic spine and adjacent ribs. Patients were treated with UMC (NSAID's, corticosteroid injection or referral to physical therapy and were allocated at random (yes/no to manipulative therapy (manipulation and mobilization. Patient perceived recovery, severity of main complaint, shoulder pain, disability and general health were outcome measures. Data about direct and indirect costs were collected by means of a cost diary. Results Manipulative therapy as add-on to UMC accelerated recovery on all outcome measures included. At 26 weeks after randomization, both groups reported similar recovery rates (41% vs. 38%, but the difference between groups in improvement of severity of the main complaint, shoulder pain and disability sustained. Compared to the UMC group the total costs were higher in the manipulative group (€1167 vs. €555. This is explained mainly by the costs of the manipulative therapy itself and the higher costs due sick leave from work. The cost effectiveness ratio showed that additional manipulative treatment is more costly but also more effective than UMC alone. The cost-effectiveness acceptability curve shows that a 50%-probability of recovery with AMT within 6 months after initiation of treatment is achieved at €2876. Conclusion Manipulative therapy in addition to UMC accelerates recovery and is more effective than UMC alone on the long term, but is associated with higher costs. International Standard

  7. The seagrass Posidonia oceanica: Ecosystem services identification and economic evaluation of goods and benefits.

    Science.gov (United States)

    Campagne, Carole Sylvie; Salles, Jean-Michel; Boissery, Pierre; Deter, Julie

    2015-08-15

    Posidonia oceanica is a marine angiosperm endemic from the Mediterranean. Despite their protection, its meadows are regressing. The economic valuation of ecosystem services (ES) assesses the contribution of ecosystems to human well-being and may provide local policy makers help in territorial development. To estimate the economic value of P. oceanica seagrass and the meadows that it forms to better account its presence in coastal development, identification and assessment of ES provided are first performed. Then goods and benefits (GB) and their economical values are estimated. In total, 25ES are identified and 7GB are economically evaluated. The economic value of GB provided by P. oceanica ranges between 25.3 million and 45.9 million€/year which means 283-513€/ha/year. Because of the lack of existing available data, only 7GB linked to 11/25ES have been estimated. Despite this overall undervaluation, this study offers a value for coastal development policies to take into account.

  8. Methods Used in Economic Evaluations of Chronic Kidney Disease Testing — A Systematic Review

    Science.gov (United States)

    Sutton, Andrew J.; Breheny, Katie; Deeks, Jon; Khunti, Kamlesh; Sharpe, Claire; Ottridge, Ryan S.; Stevens, Paul E.; Cockwell, Paul; Kalra, Philp A.; Lamb, Edmund J.

    2015-01-01

    Background The prevalence of chronic kidney disease (CKD) is high in general populations around the world. Targeted testing and screening for CKD are often conducted to help identify individuals that may benefit from treatment to ameliorate or prevent their disease progression. Aims This systematic review examines the methods used in economic evaluations of testing and screening in CKD, with a particular focus on whether test accuracy has been considered, and how analysis has incorporated issues that may be important to the patient, such as the impact of testing on quality of life and the costs they incur. Methods Articles that described model-based economic evaluations of patient testing interventions focused on CKD were identified through the searching of electronic databases and the hand searching of the bibliographies of the included studies. Results The initial electronic searches identified 2,671 papers of which 21 were included in the final review. Eighteen studies focused on proteinuria, three evaluated glomerular filtration rate testing and one included both tests. The full impact of inaccurate test results was frequently not considered in economic evaluations in this setting as a societal perspective was rarely adopted. The impact of false positive tests on patients in terms of the costs incurred in re-attending for repeat testing, and the anxiety associated with a positive test was almost always overlooked. In one study where the impact of a false positive test on patient quality of life was examined in sensitivity analysis, it had a significant impact on the conclusions drawn from the model. Conclusion Future economic evaluations of kidney function testing should examine testing and monitoring pathways from the perspective of patients, to ensure that issues that are important to patients, such as the possibility of inaccurate test results, are properly considered in the analysis. PMID:26465773

  9. Methods Used in Economic Evaluations of Chronic Kidney Disease Testing - A Systematic Review.

    Directory of Open Access Journals (Sweden)

    Andrew J Sutton

    Full Text Available The prevalence of chronic kidney disease (CKD is high in general populations around the world. Targeted testing and screening for CKD are often conducted to help identify individuals that may benefit from treatment to ameliorate or prevent their disease progression.This systematic review examines the methods used in economic evaluations of testing and screening in CKD, with a particular focus on whether test accuracy has been considered, and how analysis has incorporated issues that may be important to the patient, such as the impact of testing on quality of life and the costs they incur.Articles that described model-based economic evaluations of patient testing interventions focused on CKD were identified through the searching of electronic databases and the hand searching of the bibliographies of the included studies.The initial electronic searches identified 2,671 papers of which 21 were included in the final review. Eighteen studies focused on proteinuria, three evaluated glomerular filtration rate testing and one included both tests. The full impact of inaccurate test results was frequently not considered in economic evaluations in this setting as a societal perspective was rarely adopted. The impact of false positive tests on patients in terms of the costs incurred in re-attending for repeat testing, and the anxiety associated with a positive test was almost always overlooked. In one study where the impact of a false positive test on patient quality of life was examined in sensitivity analysis, it had a significant impact on the conclusions drawn from the model.Future economic evaluations of kidney function testing should examine testing and monitoring pathways from the perspective of patients, to ensure that issues that are important to patients, such as the possibility of inaccurate test results, are properly considered in the analysis.

  10. Formative evaluation of practice changes for managing depression within a Shared Care model in primary care.

    Science.gov (United States)

    Beaulac, Julie; Edwards, Jeanette; Steele, Angus

    2017-01-01

    Aim To investigate the implementation and initial impact of the Physician Integrated Network (PIN) mental health indicators, which are specific to screening and managing follow-up for depression, in three primary care practices with Shared Mental Health Care in Manitoba.

  11. Economic Evaluation of SMART Deployment in the MENA Region using DEEP 5..0

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Han-Ok; Lee, Man-Ki; Zee, Sung-Kyun; Kim, Young-In; Kim, Keung Koo [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2014-10-15

    Some countries have officially announced that the development of atomic energy is essential to meet the growing nation's requirements for energy to generate electricity, produce desalination water, and reduce reliance on depleting hydrocarbon resources. SMART (system-integrated modular advanced reactor) is a small-sized advanced integral reactor with a rated thermal power of 330 MW. It can produce 100 MW of electricity, or 90 MW of electricity and 40,000 tons of desalinated water concurrently, which is sufficient for 100,000 residents. It is an integral type reactor with a sensible mixture of proven technologies and advanced design features. SMART aims at achieving enhanced safety and improved economics; the enhancement of safety and reliability is realized by incorporating inherent safety-improving features and reliable passive safety systems. The improvement in the economics is achieved through a system simplification, component modularization, reduction of construction time, and high plant availability. The standard design approval assures the safety of the SMART system. The economics of SMART are evaluated for the deployment in MENA region in this study. DEEP 5.0 software was selected for the economic evaluation of SMART plant. By using the collected technical and economic data as the input data into DEEP program, the power and water costs are calculated. Electric power and fresh water production costs for the case of SMART deployment at the MENA region is evaluated using the DEEP 5.0 software in this study. Technical input data are prepared on the basis of the local environmental conditions of the MENA region. The results show that the SMART plant can supply 94 MWe to an external grid system with 40,000 m{sup 3}/d of fresh water. The power and water costs are calculated for the various specific construction costs.

  12. Unrelated medical costs in life-years gained : should they be included in economic evaluations of healthcare interventions?

    NARCIS (Netherlands)

    Rappange, David R; van Baal, Pieter H M; van Exel, N Job A; Feenstra, Talitha L; Rutten, Frans F H; Brouwer, Werner B F

    2008-01-01

    Which costs and benefits to consider in economic evaluations of healthcare interventions remains an area of much controversy. Unrelated medical costs in life-years gained is an important cost category that is normally ignored in economic evaluations, irrespective of the perspective chosen for the an

  13. Aspergillosis in Intensive Care Unit (ICU patients: epidemiology and economic outcomes

    Directory of Open Access Journals (Sweden)

    Baddley John W

    2013-01-01

    Full Text Available Abstract Background Few data are available regarding the epidemiology of invasive aspergillosis (IA in ICU patients. The aim of this study was to examine epidemiology and economic outcomes (length of stay, hospital costs among ICU patients with IA who lack traditional risk factors for IA, such as cancer, transplants, neutropenia or HIV infection. Methods Retrospective cohort study using Premier Inc. Perspective™ US administrative hospital database (2005–2008. Adults with ICU stays and aspergillosis (ICD-9 117.3 plus 484.6 who received initial antifungal therapy (AF in the ICU were included. Patients with traditional risk factors (cancer, transplant, neutropenia, HIV/AIDS were excluded. The relationship of antifungal therapy and co-morbidities to economic outcomes were examined using Generalized linear models. Results From 6,424 aspergillosis patients in the database, 412 (6.4% ICU patients with IA were identified. Mean age was 63.9 years and 53% were male. Frequent co-morbidities included steroid use (77%, acute respiratory failure (76% and acute renal failure (41%. In-hospital mortality was 46%. The most frequently used AF was voriconazole (71% received at least once. Mean length of stay (LOS was 26.9 days and mean total hospital cost was $76,235. Each 1 day lag before initiating AF therapy was associated with 1.28 days longer hospital stay and 3.5% increase in costs (p  Conclusions Invasive aspergillosis in ICU patients is associated with high mortality and hospital costs. Antifungal timing impacts economic outcomes. These findings underscore the importance of timely diagnosis, appropriate treatment, and consideration of Aspergillus as a potential etiology in ICU patients.

  14. Structured pro-active care for chronic depression by practice nurses in primary care: a qualitative evaluation.

    Directory of Open Access Journals (Sweden)

    Madeleine Bennett

    Full Text Available PURPOSE: This qualitative study explored the impact and appropriateness of structured pro-active care reviews by practice nurses for patients with chronic or recurrent depression and dysthymia within the ProCEED trial. ProCEED (Pro-active Care and its Evaluation for Enduring Depression was a United Kingdom wide randomised controlled trial, comparing usual general practitioner care with structured 'pro-active care' which involved 3 monthly review appointments with practice nurses over 2 years for patients with chronic or recurrent depression. METHOD: In-depth interviews were completed with 41 participants: 26 patients receiving pro-active care and 15 practice nurses providing this care. Interview transcripts were analysed thematically using a 'framework' approach. RESULTS: Patients perceived the practice nurses to be appropriate professionals to engage with regarding their depression and most nurses felt confident in a case management role. The development of a therapeutic alliance between the patient and nurse was central to this model and, where it appeared lacking, dissatisfaction was felt by both patients and nurses with a likely negative impact on outcomes. Patient and nurse factors impacting on the therapeutic alliance were identified and nurse typologies explored. DISCUSSION: Pro-active care reviews utilising practice nurses as case managers were found acceptable by the majority of patients and practice nurses and may be a suitable way to provide care for patients with long-term depression in primary care. Motivated and interested practice nurses could be an appropriate and valuable resource for this patient group. This has implications for resource decisions by clinicians and commissioners within primary care.

  15. Development of a System Dynamics Model for Evaluating the Economics of an Advanced CANDU Fuel

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Jong Yeob; Park, Joo Hwan [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2009-10-15

    Since the early 1990's, the Korea Atomic Energy Research Institute (KAERI) and the Atomic Energy of Canada Limited (AECL) have cooperated to develop, verify, and demonstrate the advanced CANDU fuel, so called CANFLEX-NU (Natural Uranium). The CANFLEX-NU fuel bundle consists of 43 fuel elements and has the buttons on the outer surface of the fuel elements for improving the CHF (Critical-Heat-Flux) characteristics. Because of this features of CANFLEXNU fuel, it offers higher operating and safety margins than current 37-element fuel. Recently, the interest for a CANFLEX-NU has been increased because of the power de-rating due to aging of CANDU reactors. Wolsong Unit 1 CANDU reactor has been operated over 25 years and the operating power at the present time is less than 90% of a full power because of a reduction of the margin of ROP trip set point. The most appropriate way to overcome such a power de-rating due to a crept pressure tube is the introduction of a CANFLEX-NU fuel into a CANDU reactor. Now, a CANFLEX-NU fuel is ready to be commercialized in a CANDU-6 reactor because the design and demonstration irradiation have been completed in both Korea and Canada. Economic evaluation for commercializing a CANFLEX-NU fuel in Wolsong Units was carried out by calculating the unit prime cost of electricity production. Throughout the economic evaluation, it was found that the introduction of CANFLEX-NU fuel into Wolsong Units would have much economic benefits due to a better operating performance. However, the amount of economic profit due to introducing CANFLEX-NU fuel depends on several parameters such as the required time to get license from regulatory institute before commercializing, licensing cost, failure probability of commercializing etc. Therefore, it is necessary to determine the optimum condition to get the highest economic profit. In this paper, an economic evaluation was carried out based on the starting year of the licensing study with considering the

  16. A literature review to evaluate the economic value of ranolazine for the symptomatic treatment of chronic angina pectoris.

    Science.gov (United States)

    Vellopoulou, Katerina; Kourlaba, Georgia; Maniadakis, Nikos; Vardas, Panagiotis

    2016-05-15

    To conduct a systematic review of the evidence regarding the economic value of ranolazine relative to standard-of-care (SOC) for the treatment of symptomatic chronic stable angina (CSA). Electronic databases were searched using relevant keywords. The identified studies were independently reviewed by two investigators against pre-determined inclusion and exclusion criteria. Their data were extracted using a relevant form and consequently were synthesized. Studies were also evaluated using the Quality of Health Economic Studies scale. The main outcomes considered were the cost and effectiveness for each comparator and the incremental cost per quality-adjusted-life year (QALY) gained. Six studies were included in the review. Five of these assessed the cost-utility of ranolazine added to SOC, compared to SOC alone, using decision trees or Markov models whereas one was a retrospective cost evaluation study. The analysis was conducted from a payer perspective in five studies and from a societal perspective in one study with the time horizon varying between six months and a year. The incremental cost-effectiveness ratio (ICER), ranged from €4000 to €15,000 per QALY gained. Ranolazine appears to be dominant or cost-effective, mainly due to its ability to decrease angina-related hospitalizations and also due to a marginal improvement in quality of life. The acquisition cost of ranolazine was the variable with the greatest impact upon the ICER. The existing evidence, although limited, indicates that ranolazine may be a dominant or cost-effective therapy option, for the treatment of patients with symptomatic CSA. Further research is required to evaluate the cost-effectiveness of ranolazine.

  17. Medical store management: an integrated economic analysis of a tertiary care hospital in central India.

    Science.gov (United States)

    Mahatme, Ms; Dakhale, Gn; Hiware, Sk; Shinde, At; Salve, Am

    2012-04-01

    Economic analysis plays a pivotal role in the management of medical store. The main objectives of this study were to consider always better control-vital, essential and desirable (ABC-VED) analysis with economic order quantity (EOQ), comparison of indexed cost and the actual cost, and to assess the expenditure for the forthcoming years. Based on cost and criticality, a matrix of nine groups by combining ABC and VED analysis was formulated. Drug categories were narrowed down for prioritization to direct supervisory monitoring. The subgroups AE and AV of the categories category I and II should be ordered based on EOQ. The difference between the actual annual drug expenditure (ADE) and the derived indexed cost using the cost inflation index (CII) was calculated. Linear regression was used to assess the expenditure for the forth coming years. The total ADE for the financial year of 2010-2011 was Rs. 1,91,44,253 which was only 7.68% of annual hospital expenditure. Using the inflation index, the indexed cost of acquisition of ADE for year 2010-2011 was Rs. 1,95,10,387. The difference between the two was estimated to be 2.11%. Thus, the CII justifies the demand of increased budget for next year and prompts us for cautious use of drugs. By taking into consideration the ADE of last 10 years, we have forecasted the budget for forthcoming years which will help significantly for making policies according to the available budget.

  18. Development of a conceptual model evaluating the humanistic and economic burden of Crohn's disease: implications for patient-reported outcomes measurement and economic evaluation.

    Science.gov (United States)

    Gater, Adam; Kitchen, Helen; Heron, Louise; Pollard, Catherine; Håkan-Bloch, Jonas; Højbjerre, Lise; Hansen, Brian Bekker; Strandberg-Larsen, Martin

    2015-01-01

    The primary objective of this review is to develop a conceptual model for Crohn's disease (CD) outlining the disease burden for patients, healthcare systems and wider society, as reported in the scientific literature. A search was conducted using MEDLINE, PsycINFO, EconLit, Health Economic Evaluation Database and Centre for Reviews and Dissemination databases. Patient-reported outcome (PRO) measures widely used in CD were reviewed according to the US FDA PRO Guidance for Industry. The resulting conceptual model highlights the characterization of CD by gastrointestinal disturbances, extra-intestinal and systemic symptoms. These symptoms impact physical functioning, ability to complete daily activities, emotional wellbeing, social functioning, sexual functioning and ability to work. Gaps in conceptual coverage and evidence of reliability and validity for some PRO measures were noted. Review findings also highlight the substantial direct and indirect costs associated with CD. Evidence from the literature confirms the substantial burden of CD to patients and wider society; however, future research is still needed to further understand burden from the perspective of patients and to accurately understand the economic burden of disease. Challenges with existing PRO measures also suggest the need for future research to refine or develop new measures.

  19. Coal gasification systems engineering and analysis. Appendix E: Cost estimation and economic evaluation methodology

    Science.gov (United States)

    1980-01-01

    The cost estimation and economic evaluation methodologies presented are consistent with industry practice for assessing capital investment requirements and operating costs of coal conversion systems. All values stated are based on January, 1980 dollars with appropriate recognition of the time value of money. Evaluation of project economic feasibility can be considered a two step process (subject to considerable refinement). First, the costs of the project must be quantified and second, the price at which the product can be manufacturd must be determined. These two major categories are discussed. The summary of methodology is divided into five parts: (1) systems costs, (2)instant plant costs, (3) annual operating costs, (4) escalation and discounting process, and (5) product pricing.

  20. The valuation of prenatal life in economic evaluations of perinatal interventions.

    Science.gov (United States)

    Simon, Judit; Petrou, Stavros; Gray, Alastair

    2009-04-01

    Perinatal interventions delivered during the prenatal period have the potential to directly impact prenatal life. The decision on when to begin 'counting' the life of an infant in the calculus has received little attention in previous economic evaluations of perinatal interventions. We illustrate, using data from a recent trial-based economic evaluation of magnesium sulphate given to women with pre-eclampsia to prevent eclampsia, how different definitions of when human life commences can have a significant impact upon cost-effectiveness estimates based on composite outcome measures such as life years or quality-adjusted life years gained or disability-adjusted life years averted. Further, we suggest ways in which methods in this area can be improved.

  1. How has the economic downturn affected communities and implementation of science-based prevention in the randomized trial of communities that care?

    Science.gov (United States)

    Kuklinski, Margaret R; Hawkins, J David; Plotnick, Robert D; Abbott, Robert D; Reid, Carolina K

    2013-06-01

    This study examined implications of the economic downturn that began in December 2007 for the Community Youth Development Study (CYDS), a longitudinal randomized controlled trial of the Communities That Care (CTC) prevention system. The downturn had the potential to affect the internal validity of the CYDS research design and implementation of science-based prevention in study communities. We used archival economic indicators and community key leader reports of economic conditions to assess the extent of the economic downturn in CYDS communities and potential internal validity threats. We also examined whether stronger economic downturn effects were associated with a decline in science-based prevention implementation. Economic indicators suggested the downturn affected CYDS communities to different degrees. We found no evidence of systematic differences in downturn effects in CTC compared to control communities that would threaten internal validity of the randomized trial. The Community Economic Problems scale was a reliable measure of community economic conditions, and it showed criterion validity in relation to several objective economic indicators. CTC coalitions continued to implement science-based prevention to a significantly greater degree than control coalitions 2 years after the downturn began. However, CTC implementation levels declined to some extent as unemployment, the percentage of students qualifying for free lunch, and community economic problems worsened. Control coalition implementation levels were not related to economic conditions before or after the downturn, but mean implementation levels of science-based prevention were also relatively low in both periods.

  2. ECONOMIC MODEL FOR EVALUATION OF INTEGRAL COMPETITIVENESS OF AUTOMOTIVE ENTERPRISES (AE

    Directory of Open Access Journals (Sweden)

    A. F. Zubritsky

    2010-01-01

    Full Text Available The paper considers problems pertaining to evaluation of competitiveness of automotive enterprises in the field of international consignments. An economic model for determination of the integral AE competitiveness is proposed in the paper and the model permits to substitute an expert estimation in respect of some factors by their qualitative calculation on the basis of data on enterprise activity in the international consignment market.

  3. Cost-effectiveness of screening for hepatitis C virus: a systematic review of economic evaluations

    Science.gov (United States)

    Coward, Stephanie; Leggett, Laura; Kaplan, Gilaad G; Clement, Fiona

    2016-01-01

    Objectives With the developments of near-cures for hepatitis C virus (HCV), who to screen has become a high-priority policy issue in many western countries. Cost-effectiveness of screening programmes should be one consideration when developing policy. The objective of this work is to synthesise the cost-effectiveness of HCV screening programmes. Setting A systematic review was completed. 5 databases were searched until May 2016 (NHSEED, MEDLINE, the HTA Health Technology Assessment Database, EMBASE, EconLit). Participants Any study reporting an economic evaluation (any type) of screening compared with opportunistic or no screening for HCV was included. Exclusion criteria were: (1) abstracts or commentaries, (2) economic evaluations of other interventions for HCV, including blood donors screening, diagnosis tests for HCV, screening for concurrent disease or medications for treatment. Primary and secondary outcome measures Data extraction included type of model, target population, perspective, comparators, time horizon, discount rate, clinical inputs, cost inputs and outcome. Quality was evaluated using the Consolidated Health Economic Evaluation Reporting Standards checklist. Data are summarised using narrative synthesis by population. Results 2305 abstracts were identified with 52 undergoing full-text review. 30 papers met inclusion criteria addressing 7 populations: drug users (n=6), high risk (n=5), pregnant (n=4), prison (n=3), birth cohort (n=8), general population (n=5) and other (n=6). The majority (77%) of the studies were high quality. Drug users, birth cohort and high-risk populations were associated with cost-effectiveness ratios of under £30 000 per quality-adjusted-life-year (QALY). The remaining populations were associated with cost-effectiveness ratios that exceeded £30 000 per QALY. Conclusions Economic evidence for screening populations is robust. If a cost per QALY of £30 000 is considered reasonable value for money, then screening birth

  4. Cooperating with a palliative home-care team: expectations and evaluations of GPs and district nurses

    DEFF Research Database (Denmark)

    Goldschmidt, Dorthe; Groenvold, Mogens; Johnsen, Anna Thit

    2005-01-01

    BACKGROUND: Palliative home-care teams often cooperate with general practitioners (GPs) and district nurses. Our aim was to evaluate a palliative home-care team from the viewpoint of GPs and district nurses. METHODS: GPs and district nurses received questionnaires at the start of home-care and one...... month later. Questions focussed on benefits to patients, training issues for professionals and cooperation between the home-care team and the GP/ district nurse. A combination of closed- and open-ended questions was used. RESULTS: Response rate was 84% (467/553). Benefits to patients were experienced....... Dissatisfaction was caused mainly by lack of information from the home-care team to primary-care professionals. CONCLUSION: GPs and district nurses welcomed the palliative home-care team and most experienced benefits to patients. Strengthened communication, initiated by the home-care team would enhance...

  5. A Systematic Review of the Level of Evidence in Economic Evaluations of Medical Devices: The Example of Vertebroplasty and Kyphoplasty.

    Directory of Open Access Journals (Sweden)

    Nicolas Martelli

    Full Text Available Economic evaluations are far less frequently reported for medical devices than for drugs. In addition, little is known about the quality of existing economic evaluations, particularly for innovative devices, such as those used in vertebroplasty and kyphoplasty.To assess the level of evidence provided by the available economic evaluations for vertebroplasty and kyphoplasty.A systematic review of articles in English or French listed in the MEDLINE, PASCAL, COCHRANE and National Health Service Economic Evaluation databases, with limits on publication date (up to the date of the review, March 2014.We included only economic evaluations of vertebroplasty or kyphoplasty. Editorial and methodological articles were excluded.Data were extracted from articles by two authors working independently and using two analysis grids to measure the quality of economic evaluations.Twenty-one studies met our inclusion criteria. All were published between 2008 and 2014. Eighteen (86% were full economic evaluations. Cost-effectiveness analysis (CEA was the most frequent type of economic evaluation, and was present in 11 (52% studies. Only three CEAs complied fully with the British Medical Journal checklist. The quality of the data sources used in the 21 studies was high, but the CEAs conforming to methodological guidelines did not use high-quality data sources for all components of the analysis.This systematic review shows that the level of evidence in economic evaluations of vertebroplasty and kyphoplasty is low, despite the recent publication of a large number of studies. This finding highlights the challenges to be faced to improve the quality of economic evaluations of medical devices.

  6. Economic Evaluations for the Carbon Dioxide-involved Production of High-value Chemicals

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ji Hyun; Lee, Dong Woog; Jang, Se Gyu; Kwak, No-Sang; Lee, In Young; Jang, Kyung Ryoung; Shim, Jae-Goo [KEPCO Research Institute, Daejon (Korea, Republic of); Choi, Jong Shin [Korea East-West Power Co. LTD, Seoul (Korea, Republic of)

    2014-06-15

    Economic evaluation of the manufacturing technology of high-value chemicals through the carbonation reaction of carbon dioxide contained in the flue gas was performed, and analysis of the IRR (Internal Rate of Return) and whole profit along the production plan of the final product was conducted. Through a carbonation reaction with sodium hydroxide that is generated from electrolysis and by using carbon dioxide in the combustion gas that is generated in the power plant, it is possible to get a high value products such as sodium bicarbonate compound and also to reduce the carbon dioxide emission simultaneously. The IRR (Internal Rate of Return) and NPV (Net Present Value) methods were used for the economic evaluation of the process which could handle carbon dioxide of 100 tons per day in the period of the 20 years of plant operation. The results of economic evaluation showed that the IRR of baseline case of technology was 67.2% and the profit that obtained during the whole operation period (20 years) was 346,922 million won based on NPV value. When considering ETS due to the emissions trading enforcement that will be activated in 2015, the NPV was improved to a 6,000 million won. Based on this results, it could be concluded that this CO2 carbonation technology is an cost-effective technology option for the reduction of greenhouse gas.

  7. Economic evaluation of bone stimulation modalities: A systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Button Melissa

    2009-01-01

    Full Text Available Various bone stimulation modalities are commonly used in treatment of fresh fractures and nonunions; however, the effectiveness and efficiency of these modalities remain uncertain. A systematic review of trials evaluating the clinical and economical outcomes of ultrasounds, electrical stimulation, and extracorporeal sound waves on fracture healing was conducted. We searched four electronic databases for economic evaluations that assessed bone stimulation modalities using ultrasound therapy, electrical stimulation, or extracorporeal shock waves. In addition, we searched the references and related articles of eligible studies, and a content expert was contacted. Information on the clinical and economical outcomes of patients was independently extracted by reviewers. Fourteen studies met the inclusion criteria; therefore, very limited research was found on the cost associated with treatments and the corresponding outcomes. The data available focus primarily on the efficacy of newly introduced treatment methods for bone growth, but failed to incorporate the costs of implementing such treatments. One economic analysis was identified that assessed different treatment paths using ultrasound. A total cost savings of 24-40% per patient occurred when ultrasound was used for fresh fractures and nonunions (grade C recommendation. The results suggest that the ultrasound is a viable alternative for bone stimulation; however, the impacts of the other modalities are left unknown due to the lack of research available. Methodological limitations leave the overall economic and clinical impact of these modalities uncertain. Large, prospective, randomized controlled trials that include cost-effectiveness analyses are needed to further define the clinical effectiveness and financial burden associated with bone stimulation modalities.

  8. Psychometric evaluation of the Swedish version of the Person-Centered Care Assessment Tool (P-CAT)

    OpenAIRE

    Sjögren, Karin; Lindkvist, Marie; Sandman, Per-Olof; Zingmark, Karin; Edvardsson, David

    2012-01-01

    Background: Person-centered care is a multidimensional concept describing good care, especially within aged care and care for people with dementia. Research studies evaluating person-centered care interventions seldom use direct measurement of levels of person-centeredness. Existing scales that measure person-centeredness need further testing. This study evaluated the psychometric properties of the Swedish version of the Person-Centered Care Assessment Tool (P-CAT). Methods: A cross-sectional...

  9. Conversion of transuranic waste to low level waste by decontamination: a technical and economic evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Allen, R.P.; Hazelton, R.F.

    1984-12-01

    A study was conducted to evaluate the technical and economic feasibility of using in-situ decontamination techniques to convert glove boxes and other large TRU-contaminated components directly into LLW. The results of the technical evaluation indicate that in-situ decontamination of these types of components to non-TRU levels is technically feasible. Applicable decontamination techniques include electropolishing, hand scrubbing, chemical washes/sprays, strippable coatings and Freon spray-cleaning. The removal of contamination from crevices and other holdup areas remains a problem, but may be solved through further advances in decontamination technology. Also, the increase in the allowable maximum TRU level from 10 nCi/g to 100 nCi/g as defined in DOE Order 5820.2 reduces the removal requirement and facilitates measurement of the remaining quantities. The major emphasis of the study was on a cost/benefit evaluation that included a review and update of previous analyses and evaluations of TRU-waste volume reduction and conversion options. The results of the economic evaluation show, for the assumptions used, that there is a definite cost incentive to size reduce large components, and that decontamination of sectioned material has become cost competitive with the size reduction options. In-situ decontamination appears to be the lowest cost option when based on routine-type operations conducted by well-trained and properly equipped personnel. 16 references, 1 figure, 7 tables.

  10. The entrance of "the economic man" in Health Care Quality - a Danish case study

    DEFF Research Database (Denmark)

    Peyton, Margit Malmmose

    Inspired by New Public Management and global meta discourse, such as democratisation and commodity (Fairclough, 1992), Performance Measurements has made its entry into the Danish health sector. As a result considerable changes have been made within the health structure with a new health reform...... qualitative to quantitative outputs. The output measures form the foundation for a number of decisions such as allocation of human resources and funding. The purpose of this paper is to show how performance measurements have had a dominant impact on different stakeholders and their influences, which...... sector, which was to offer patients treatment and care on a high professional level. However, the aim and focus has become on giving the patient the most efficient treatment as in the quickest and cheapest....

  11. A noticeable difference? Productivity costs related to paid and unpaid work in economic evaluations on expensive drugs.

    Science.gov (United States)

    Krol, Marieke; Papenburg, Jocé; Tan, Siok Swan; Brouwer, Werner; Hakkaart, Leona

    2016-05-01

    Productivity costs can strongly impact cost-effectiveness outcomes. This study investigated the impact in the context of expensive hospital drugs. This study aimed to: (1) investigate the effect of productivity costs on cost-effectiveness outcomes, (2) determine whether economic evaluations of expensive drugs commonly include productivity costs related to paid and unpaid work, and (3) explore potential reasons for excluding productivity costs from the economic evaluation. We conducted a systematic literature review to identify economic evaluations of 33 expensive drugs. We analysed whether evaluations included productivity costs and whether inclusion or exclusion was related to the study population's age, health and national health economic guidelines. The impact on cost-effectiveness outcomes was assessed in studies that included productivity costs. Of 249 identified economic evaluations of expensive drugs, 22 (9 %) included productivity costs related to paid work. One study included unpaid productivity. Mostly, productivity cost exclusion could not be explained by the study population's age and health status, but national guidelines appeared influential. Productivity costs proved often highly influential. This study indicates that productivity costs in economic evaluations of expensive hospital drugs are commonly and inconsistently ignored in economic evaluations. This warrants caution in interpreting and comparing the results of these evaluations.

  12. Economic valuation of environmental benefits of removing pharmaceutical and personal care products from WWTP effluents by ozonation.

    Science.gov (United States)

    Molinos-Senante, M; Reif, R; Garrido-Baserba, M; Hernández-Sancho, F; Omil, F; Poch, M; Sala-Garrido, R

    2013-09-01

    Continuous release of pharmaceutical and personal care products (PPCPs) present in effluents from wastewater treatment plants (WWTPs) is nowadays leading to the adoption of specific measures within the framework of the Directive 2000/60/EC (Water Framework Directive). The ozonation process, normally employed for drinking water production, has also proven its potential to eliminate PPCPs from secondary effluents in spite of their low concentrations. However, there is a significant drawback related with the costs associated with its implementation. This lack of studies is especially pronounced regarding the economic valuation of the environmental benefits associated to avoid the discharge of these pollutants into water bodies. For the first time the shadow prices of 5 PPCPs which are ethynilestradiol, sulfamethoxazole, diclofenac, tonalide and galaxolide from treated effluent using a pilot-scale ozonation reactor have been estimated. From non-sensitive areas their values are -73.73; -34.95; -42.20; -10.98; and -8.67 respectively and expressed in €/kg. They represent a proxy to the economic value of the environmental benefits arisen from undischarged pollutants. This paper contributes to value the environmental benefits of implementing post-treatment processes aimed to achieve the quality standards required by the Priority Substances Directive.

  13. Economic evaluation of the Diamer-Basha dam: Analysis with an integrated economic/water simulation model of Pakistan:

    OpenAIRE

    Robinson, Sherman; Gueneau, Arthur

    2014-01-01

    This paper describes the potential impact on the economy of Pakistan of building the Diamer-Basha dam. An integrated system of economic and water simulation models is applied to Pakistan to analyze the economywide impacts of changes in water resources in the Indus river basin, focusing on agricultural and hydropower benefits provided by the Diamer-Basha dam under different climate scenarios. The model framework links separate economic and water models, drawing on the strengths of both approac...

  14. Development of the Methodology for the Economic Evaluation of Managerial Decisions as a Factor of Economic Security Increase

    OpenAIRE

    Olga Aleksandrovna Romanova; Vladimir Yevgenyevich Strovskiy

    2016-01-01

    In the article, it is noted that the emergence of the phenomenon of interdependence between security and development — so-called security-development nexus, becomes determining during the development of strategic documents at all hierarchical levels. It gives relevance to the search of the methodological decisions allowing to consider the possible threats to economic security at the strategic level, and the pragmatical actions which are not contradicting a strategic vector of economic entitie...

  15. Systematic review of economic evaluations of preparedness strategies and interventions against influenza pandemics.

    Directory of Open Access Journals (Sweden)

    Román Pérez Velasco

    Full Text Available BACKGROUND: Although public health guidelines have implications for resource allocation, these issues were not explicitly considered in previous WHO pandemic preparedness and response guidance. In order to ensure a thorough and informed revision of this guidance following the H1N1 2009 pandemic, a systematic review of published and unpublished economic evaluations of preparedness strategies and interventions against influenza pandemics was conducted. METHODS: The search was performed in September 2011 using 10 electronic databases, 2 internet search engines, reference list screening, cited reference searching, and direct communication with relevant authors. Full and partial economic evaluations considering both costs and outcomes were included. Conversely, reviews, editorials, and studies on economic impact or complications were excluded. Studies were selected by 2 independent reviewers. RESULTS: 44 studies were included. Although most complied with the cost effectiveness guidelines, the quality of evidence was limited. However, the data sources used were of higher quality in economic evaluations conducted after the 2009 H1N1 pandemic. Vaccination and drug regimens were varied. Pharmaceutical plus non-pharmaceutical interventions are relatively cost effective in comparison to vaccines and/or antivirals alone. Pharmaceutical interventions vary from cost saving to high cost effectiveness ratios. According to ceiling thresholds (Gross National Income per capita, the reduction of non-essential contacts and the use of pharmaceutical prophylaxis plus the closure of schools are amongst the cost effective strategies for all countries. However, quarantine for household contacts is not cost effective even for low and middle income countries. CONCLUSION: The available evidence is generally inconclusive regarding the cost effectiveness of preparedness strategies and interventions against influenza pandemics. Studies on their effectiveness and cost

  16. Thermal paint production: the techno-economic evaluation of muscovite as insulating additive.

    Directory of Open Access Journals (Sweden)

    Gabriela Fernandes Ribas

    2016-09-01

    Full Text Available Muscovite is known by its thermal and electrical insulating properties. Based on this, it was hypothesized that its addition on paints should increase the thermal resistance. The use of muscovite as mineral insulating is pointed out as advantageous due to its low cost compared to other materials used for this purpose, such as the ceramic microsphere. The use of a low cost material could open the access to the medium and low income families, implying two aspects: the life quality increase by thermal comfort and the increase of energy saving. Thus, this part of the population could open a new market to thermal paints. Aiming to contribute to this issue, this work evaluated the thermal insulation performance of commercial paints containing muscovite additions and determined the economic evaluation for its industrial production. The thermal paint was formulated by adding 10%, 20% and 40% of muscovite to the commercial paint. This was applied on steel reinforced mortar boards. Thermal insulation tests were carried out in bench scale using an adapted box. The economic evaluation of the industrial production of muscovite-based thermal paint was conducted, considering the Brazilian economic market in this activity. The results showed its ability as an insulating agent due to a reduction of 0.667 °C/mm board by the addition of 40% muscovite. The economic analysis also demonstrated the feasibility of the thermal paint industrial production. The payback is favorable to 5 years when compared to the Selic short-term lending rate, with 21.53% of internal rate return and a net present value of US$ 15,085.76.

  17. Evaluating β-convergence of the Socio-Economic Development of Ukraine’s Regions

    Directory of Open Access Journals (Sweden)

    Kyzym Mykola O.

    2016-08-01

    Full Text Available The article is devoted to evaluating β-convergence of the socio-economic development of Ukraine’s regions. The essence and theoretical basis of evaluation of σ- and β-convergence is studied. The neoclassical theory of growth of R. Solow that serves as a basis for models of β-convergence is considered. The essence and features of evaluation of the absolute (unconditional and conditional β-convergence is examined. The existing empirical researches of the economic development of countries and their regions with the use of convergence models are analyzed and it is found that: the theory of convergent-divergent development of countries and their regions is sufficiently developed; there are certain studies aimed at evaluation and analysis of the convergence of regional development in Ukraine, but there is no comprehensive study that comprises the building of all the above types of β-convergence models for the period covering the years before and after the crisis of 2008–2009. A scheme of the investigation of the convergence process in regions of Ukraine is proposed, and on this basis the evaluation of β-convergence for Ukraine’s regions is conducted with the use of four types of models: the Barro and Sala-i-Martin model, the Baumol model, the Solow-Swan model, the Cuadrado-Roura model. On the basis of the study it has been found that for the peripheral regions the presence of convergence of their social and economic development is determined by the share of services in the gross regional product to a greater extent and availability of mineral resources to a less extent, but the given result is obtained only with the use of the Barro Sala-i-Martin model, for the other models the condition of β-convergence is not met.

  18. An organizing framework for informal caregiver interventions: detailing caregiving activities and caregiver and care recipient outcomes to optimize evaluation efforts

    Directory of Open Access Journals (Sweden)

    Van Houtven Courtney

    2011-11-01

    outcomes, including considering whether expanding to economic status and health care use of the caregiver can be accommodated, to ease subsequent economic evaluations of caregiving. Third, intervention studies should measure a common set of outcomes to facilitate cross-time and cross-study comparisons of effectiveness.

  19. Pharmaco-economics analysis, as a strategy on facilitating choices between health and non-health programs in the establishment of the national health care system

    OpenAIRE

    Adanela Musaraj; Arta Musaraj; Aida Dervishi

    2014-01-01

    Due to the significant boost in community expenditure with health topics, mainly regarding drugs, numerous countries, have already put into operation, or are in the process of arguing the adoption of actions to guarantee the excellence of health care provided to the population. One of the less risky strategies-is the adoption of economic procedures applied to health, more specifically, pharmaco-economics analysis. This paper aims to contribute to the dissemination of notions and techniques...

  20. A Trial-Based Economic Evaluation Comparing Spinal Cord Stimulation With Best Medical Treatment in Painful Diabetic Peripheral Neuropathy.

    Science.gov (United States)

    Slangen, Rachel; Faber, Catharina G; Schaper, Nicolaas C; Joosten, Elbert A; van Dongen, Robert T; Kessels, Alfons G; van Kleef, Maarten; Dirksen, Carmen D

    2017-04-01

    The objective was to perform an economic evaluation comparing spinal cord stimulation (SCS) in combination with best medical treatment (BMT) with BMT in painful diabetic peripheral neuropathy patients. Alongside a prospective 2-center randomized controlled trial, involving 36 painful diabetic peripheral neuropathy patients with severe lower limb pain not responding to conventional therapy, an economic evaluation was performed. Incremental cost-effectiveness ratios were based on: 1) societal costs and quality-adjusted life years (QALYs), and 2) direct health care costs and the number of successfully treated patients, respectively, both with a time horizon of 12 months. Bootstrap and secondary analyses were performed to address uncertainty. Total societal cost amounted to €26,539.18 versus €5,313.45 per patient in the SCS and BMT group, respectively. QALYs were .58 versus .36 and the number of successfully treated patients was 55% versus 7% for the SCS and BMT group, respectively. This resulted in incremental cost-effectiveness ratios of €94,159.56 per QALY and €34,518.85 per successfully treated patient, respectively. Bootstrap analyses showed that the probability of SCS being cost-effective ranges from 0 to 46% with willingness to pay threshold values ranging between €20,000 and €80,000 for a QALY. Secondary analyses showed that cost-effectiveness of SCS became more favorable after correcting for baseline cost imbalance between the 2 groups, extending the depreciation period of SCS material to 4 years, and extrapolation of the data up to 4 years. Although SCS was considerably more effective compared with BMT, the substantial initial investment that is required resulted in SCS not being cost-effective in the short term. Cost-effectiveness results were sensitive to baseline cost imbalances between the groups and the depreciation period of the SCS material.

  1. Preventive Care Use among the Belgian Elderly Population: Does Socio-Economic Status Matter?

    Directory of Open Access Journals (Sweden)

    Sarah Hoeck

    2013-12-01

    Full Text Available Objective: To analyze the association between influenza and pneumococcus vaccination and blood cholesterol and blood sugar measurement by Belgian elderly respondents (≥65 years and socio-demographic characteristics, risk factors, health status and socio-economic status (SES. Methods: A cross-sectional study based on 4,544 non-institutionalized elderly participants of the Belgian Health Interview Surveys 2004 and 2008. Multivariate logistic regression models were constructed to examine the independent effect of socio-demographic characteristics, risk factors, health status and SES on the four preventive services. Results: After adjustment for age, sex, region, survey year, living situation, risk factors (body mass index, smoking status, physical activity and health status (self-assessed health and longstanding illness lower educated elderly were significantly less likely to report a blood cholesterol and blood sugar measurement. For instance, elderly participants with no degree or only primary education were less likely to have had a cholesterol and blood sugar measurement compared with those with higher education. Pneumococcus vaccination was not related to educational level, but lower income groups were more likely to have had a pneumococcus immunization. Influenza vaccination was not significantly related to SES. Conclusion: The results highlight the need to promote cholesterol and blood sugar measurement for lower SE groups, and pneumococcus immunization for the entire elderly population. Influenza immunization seems to be equally spread among different SE groups.

  2. The Integration of Environmental Issues in The Agricultural Policy: The Role of Economic Evaluation

    Directory of Open Access Journals (Sweden)

    the Editors

    2011-01-01

    Full Text Available The integration of environmental issues into agricultural policies has attracted significant attention in recent years. The objective of this paper is to discuss the (past and future research questions in this area and the role of economic analysis in supporting decisions regarding the integration of environmental issues into agricultural policies, with a special focus on the Common Agricultural Policy (CAP of the European Union (EU. The paper first examines the evolution of the process integrating environmental concerns into the CAP. Then, the role of economic analysis is discussed with reference to selected major issues, including: the evaluation of the relationship between agriculture and environmental impacts, and the economic value of such effects; the evaluation of policy effectiveness and efficiency; optimal policy design; the effects on markets and farm structures; and the coordination and governance of policy measures. The contents of these study areas are discussed and the research priorities required to meet future needs are identified. The work concludes by highlighting the need to develop more detailed policy analysis studies while, at the same time, developing a wider and more innovative vision of the role of agricultural policy in the global context.

  3. Economic evaluation of proposed pure and mixed stands in Central Vietnam highlands

    Directory of Open Access Journals (Sweden)

    Lubomir Salek

    2012-04-01

    Full Text Available In comparison with mixed forest stands, the cultivation of pure plantations in Vietnam entails serious ecological consequences such as loss of biodiversity and higher rate of soil erosion. The economic evaluation is elaborated between pure plantations and mixed forests where the fast-growing tree species are mixed with slow growing tree species which are planted in stripes separating the segments with fast-growing tree species (Acacia sp.. For the evaluation, the input values were used from local costs of goods, services and labour. The results show that the internal rate of return is the highest in the case of pure plantation in comparison with mixed forests – 86% to 77%(first planting pattern: Acacia sp. + noble hardwood species and 54% (second planting pattern: Acacia + Dipterocarpus sp. + Sindora sp.. The average profit per hectare and year is almost five times higher in the case of mixed stands. The first planting pattern reaches 2,650 $, the second planting pattern 2,280 $ and the pure acacia plantation only 460 $. From an economic point of view, the cultivation of mixed forests that corresponds to the principles of sustainable forestry generates a good economical profit while maintaining habitat complexity and biodiversity.

  4. Economic evaluation of temsirolimus on the basis of the results of the ARCC (Advanced Renal-Cell Carcinoma study

    Directory of Open Access Journals (Sweden)

    Simona de Portu

    2009-06-01

    Full Text Available Introduction: metastatic renal cell carcinoma (mRCC is highly resistant to chemotherapeutics, rendering limited antitumor effect. Temsirolimus, a specific inhibitor of the mammalian target of rapamycin kinase, may benefit patients with this disease. The Global ARCC Trial (Temsirolimus, Interferon Alfa, or Both for Advanced Renal-Cell Carcinoma compared temsirolimus alone or temsirolimus plus interferon alfa with interferon alfa alone in mRCC. It has demonstrated that, as compared with interferon alfa, temsirolimus improved overall survival among patients with metastatic renal-cell carcinoma and a poor prognosis while the addition of temsirolimus to interferon did not improve survival. Aim: the objective of our study was to investigate the pharmacoeconomic impact in the Italian context of temsirolimus vs interferon alfa in patients with metastatic renal-cell carcinoma and a poor prognosis. Methods: economic evaluation is based on clinical outcome data from the ARCC trial and was carried out conducting a cost/effectiveness analysis, comparing economic and clinical consequences of temsirolimus (25 mg weekly vs interferon alfa (18 MU 3 times weekly in the perspective of the Italian National Health Service. Direct medical costs included in the analysis were drug costs, costs associated with the management of treatment-related serious adverse events (grade 3 and 4, cost related to progression and best supportive care. Effects were measured in terms of overall survival. A sensitivity analysis was performed. Results: the cost of temsirolimus or interferon alfa therapy amounted to approximately € 14,000 and € 2,000 patient respectively. The cost of hospitalization related to drug toxicity was about € 1,500 for temsirolimus and € 2,100 for interferon alfa. Temsirolimus shows an incremental cost per patient per month saved of € 3,767. Sensitivity analysis demonstrates that cost consequences parameters are sensitive to fluctuation. Discussion

  5. An economic evaluation comparison of solar water pumping system with engine pumping system for rice cultivation

    Science.gov (United States)

    Treephak, Kasem; Thongpron, Jutturit; Somsak, Dhirasak; Saelao, Jeerawan; Patcharaprakiti, Nopporn

    2015-08-01

    In this paper we propose the design and economic evaluation of the water pumping systems for rice cultivation using solar energy, gasoline fuel and compare both systems. The design of the water and gasoline engine pumping system were evaluated. The gasoline fuel cost used in rice cultivation in an area of 1.6 acres. Under same conditions of water pumping system is replaced by the photovoltaic system which is composed of a solar panel, a converter and an electric motor pump which is compose of a direct current (DC) motor or an alternating current (AC) motor with an inverter. In addition, the battery is installed to increase the efficiency and productivity of rice cultivation. In order to verify, the simulation and economic evaluation of the storage energy battery system with batteries and without batteries are carried out. Finally the cost of four solar pumping systems was evaluated and compared with that of the gasoline pump. The results showed that the solar pumping system can be used to replace the gasoline water pumping system and DC solar pump has a payback less than 10 years. The systems that can payback the fastest is the DC solar pumping system without batteries storage system. The system the can payback the slowest is AC solar pumping system with batteries storage system. However, VAC motor pump of 220 V can be more easily maintained than the motor pump of 24 VDC and batteries back up system can supply a more stable power to the pump system.

  6. Qustionnaire to evaluate the capacity of self-care in patients with high blood pressure

    OpenAIRE

    Achury Saldaña, Diana Marcela; Pontificia Universidad Javeriana; Sepúlveda, Gloria Judith; Pontificia Universidad Javeriana; Rodríguez Colmenares, Sandra Mónica; Pontificia Universidad Javeriana

    2011-01-01

    Introduction: this paper describes the initial construction and validation of an instument used to evaluate the capacity of self-care in patients with hypertension. The instrument is based on Dorothea Orem's Theory of Self-Care and is comprised of 17 items grouped into three dimensions: fundamental capacities; power components; and capacity of self-care management. Methods: the instument was administered to 159 people with hypertension. Construct validity was established using factorial analy...

  7. Qualifying instrument for evaluation of food and nutritional care in hospital

    OpenAIRE

    R. W. Díez García; A. A.; de Souza; R. P. C. Proença

    2012-01-01

    Establishing criteria for hospital nutrition care ensures that quality care is delivered to patients. The responsibility of the Hospital Food and Nutrition Service (HFNS) is not always well defined, despite efforts to establish guidelines for patient clinical nutrition practice. This study describes the elaboration of an Instrument for Evaluation of Food and Nutritional Care (IEFNC) aimed at directing the actions of the Hospital Food and Nutrition Service. This instrument was qualified by mea...

  8. Solar energy system economic evaluation: final report for SEMCO-Loxahatchee, Loxahatchee National Wildlife Refuge, Palm Beach County, Florida

    Energy Technology Data Exchange (ETDEWEB)

    None

    1980-07-01

    The economic analysis of the solar energy system that was installed at Loxahatchee, Florida Operational Test Site (OTS) is developed for Loxahatchee and four other sites typical of a wide range of environmental and economic conditions in the continental United States. This analysis is accomplished based on the technical and economic models in the f-Chart design procedure with inputs based on the characteristics of the installed system and local conditions. The results are expressed in terms of the economic parameters of present worth of system costs over a projected twenty year life, life cycle savings, year of positive savings and year of payback for the optimized solar energy system at each of the analysis sites. The sensitivity of the economic evaluation to uncertainties in constituent system and economic variables is also investigated. The results demonstrate that the solar energy system is economically viable at all of the five sites for which the analysis was conducted.

  9. Psycho-social and Economic Evaluation of Onchocerciasis: A Literature Review

    Directory of Open Access Journals (Sweden)

    Laura Moya Alonso

    2009-02-01

    Full Text Available Background: Onchocerciasis or river blindness is a chronic parasitic disease caused by the filarial nematode Onchocerca Volvulus. It occurs in 38 countries in the world, including Africa, Latin America and the Arabian Peninsula. The infection predominantly causes visual impairment and blindness and skin disease. Objectives: The aim of this project is to review the literature on the psycho-social and economic consequences of onchocerciasis in endemic areas. Economic evaluation studies on onchocerciasis and its control programmes were also reviewed. Methods: Electronic searches of PUBMED and Google were made. In addition, the Cochrane Library and WHO website were searched. Different types of economic analysis were reviewed to quantify the relationship between the programme costs and impacts. Results: Eighty papers were identified from different sources, most of which are quantitative studies or literature reviews, and only two were clinical trials. Onchocerciasis has severe socio-economic and psychological consequences. The stigma associated with the disease may reduce marital prospects among affected individuals, disrupt social relationships and cause loss of self-confidence. Also among agricultural workers onchocerciasis has been associated with increased time away from work and reduced productivity, leading to lower income. Discussion: Most of the papers analysed were cross-sectional studies based on data collection through questionnaires. Although there is an increasing number of published papers about the importance of the psycho-social and economic perspective of onchocerciasis, further research is still necessary to quantify and control its consequences. Conclusion: Onchocerciasis is still a serious problem in poor countries. Infected people face physical disability and social stigma that can dramatically reduce the quality of life and land productivity. Control programmes, though costly, have been very successful and cost

  10. Emergy evaluation and economic analysis of three wetland fish farming systems in Nansi Lake area, China.

    Science.gov (United States)

    Zhang, L X; Ulgiati, S; Yang, Z F; Chen, B

    2011-03-01

    Emergy and economic methods were used to evaluate and compare three fish production models, i.e., cage fish farming system, pond intensive fish rearing system and semi-natural extensive pond fish rearing system, in Nansi Lake area in China in the year 2007. The goal of this study was to understand the benefits and driving forces of selected fish production models from ecological and economic points of view. The study considered input structure, production efficiency, environmental impacts, economic viability and sustainability. Results show that the main difference among the three production systems was the emergy cost for fish feed associated with their feeding system, i.e., feeding on natural biomass such as plankton and grass or on commercial feedstock. As indicated by EYR, ELR and ESI, it can be clearly shown that the intensive production model with commercial feed is not a sustainable pattern. However, the point is that more environmentally sound patterns do not seem able to provide a competitive net profit in the short run. The intensive pond fish farming system had a net profit of 2.57E+03 $/ha, much higher than 1.27E+03 $/ha for cage fish farming system and slightly higher than 2.37E+03 $/ha for semi-natural fish farming system. With regard to the drivers of local farmer's decisions, the accessibility of land for the required use and investment ability determine the farmer's choice of the production model and the scale of operation, while other factors seem to have little effect. Theoretically, the development of environmentally sustainable production patterns, namely water and land conservation measures, greener feed as well as low waste systems is urgently needed, to keep production activities within the carrying capacity of ecosystems. Coupled emergy and economic analyses can provide better insight into the environmental and economic benefits of fish production systems and help solve the problems encountered during policy making.

  11. Economic evaluation of investment project in the area of sheet metal processing

    Directory of Open Access Journals (Sweden)

    P. Trebuňa

    2017-01-01

    Full Text Available The article is oriented on the process modelling in selected company. The aim of the process modelling is a possibility to prevent the formation of future risks as a consequence of a wrong decision concerning a capital project. The analysis of actual state in society with the focus on the means of processing the lamination using computer numeric control technology is also a part of article. Based on the analysis mentioned above, the selection and the definition of the capital project have already been carried out. Final section evaluates the capital project using methodology of economic indicators by means of economic indicators of effectiveness and brings a decision whether to accept or refuse given investment.

  12. Innovation by discourse - a new approach in the evaluation of sustainable economics success

    Energy Technology Data Exchange (ETDEWEB)

    O`Hara, S. [Rensselaer Polytechnic Institute, Troy, NY (United States)

    1997-12-31

    Standard economic valuation relies on input prices (costs) and product prices (revenues) to communicate the value of economic activity to the firm as well as society at large. This reliance of prices to communicate value discriminates against services, products and activities that are not easily priced or evaluated according to their exchange value. Even when methods are applied which seek to assign monetary value artificially, that is outside the common market mechanism of production and consumption activities, price based valuation remains seriously flawed. It assumes the commensurability of wants, the preference of present value and the ability to express uncertainty in risk assessment categories. This paper outlines the expanded rationality of discourse based valuation and argues the advantages discursive valuation offers in addressing large scale complex systems changes like global climate change.

  13. A stochastic approach for integrating market and technical uncertainties in economic evaluations of petroleum development

    Institute of Scientific and Technical Information of China (English)

    Changhyup Park; Joe M.Kang; Taewoong Ahn

    2009-01-01

    The paper presents a stochastic and economic analysis for petroleum development under uncertain market and technical environments. Mean-reversion with jumps for price forecasting is used to consider market uncertainty, while various scenarios for the reservoir properties and cost are employed to consider technical uncertainty. Monte Carlo simulation is carried out to obtain the feasible range of net present values and internal rates of return. The influence of stochastic parameters is examined through correlation coefficients. The stochastic approach yields more reliable evaluation and effectively investigates the characteristics of development. The integration of uncertainties and contractual terms results in an irregular tendency in the future cash flow and reveals that a larger reserve does not guarantee a greater profit. The reserve and the well rate affect the economic values whereas the parameters for price prediction don't. The research confirms the necessity of qualifying uncertainties for realistic decision-making at the initial stage of development.

  14. A model of techno-economic evaluation for eco-industrial park project

    Institute of Scientific and Technical Information of China (English)

    Cai Xiaojun; Wang Yan; Liu Qihao

    2006-01-01

    An eco-industrial park or estate is a community of manufacturing and service businesses located together on a common property. The goal of EIP is to create a win-win harmonious development aspect of economic development and environmental protection. This paper emphasizes that the external effect of an EIP is its main characteristic of technoeconomic evaluation for eco-industrial park project. From the view of the property rights, the EIP's product is typically public-private. The government should take some measures for the quantitative analysis on ecological positive externalities of the enterprises in EIP, and also should adopt Coase 's Theorem, which supports that the market transaction is the best way to deal with positive externalities (external economics or diseconomics), or Pigou 's Theorem, which holds that the government anti-positive externalities programs are the best way to cope with positive externalities, to internalize the EIP's external effects, which is also a fundamental tool to encourage investors to actively invest in EIP projects.Furthermore, this paper thinks that the EIP' s income should be equal to the income of staple products of the private property and that of its by-products of the public property. According to this principle, this paper has put forward three major indicators, net present value (NPV), internal rate of return (IRR), and investment repayment period (IRP), which are also extensively used indicators in ordinary project techno-economic evaluation model to evaluate EIP technoeconomic effects. Theoretically, the indicators not only can be used in EIP project evaluation, but also can provide a quantitative measure tool for the government to support EIP's construction to the maximum. In the end, a case is analyzed.

  15. Economic evaluation of cystic fibrosis screening: A Review of the literature, CHERE Working Paper 2006/6

    OpenAIRE

    Muralikrishnan Radhakrishnan; Kees van Gool; Jane Hall; Martin Delatycki; John Massie

    2006-01-01

    Objectives: To critically examine the economic evidence on Cystic Fibrosis (CF) screening and to understand issues relating to the transferability of findings to the Australian context for policy decisions. Methods: A systematic literature search identified 25 economic studies with empirical results on CF published between 1990 and 2005. These articles were then assessed against international benchmarks on conducting and reporting of economic evaluations, focusing on the transferability of th...

  16. Economic and Environmental Evaluation of Farm Bill Policy Options Using the CEEPES-FAPRI Modeling System, An

    OpenAIRE

    P. G. Lakshminarayan; Bruce A. Babcock

    1995-01-01

    This report estimates the economic and environmental trade-offs of the 1995 Farm Bill policy options evaluated by FAPRI. Assessments are provided for the 1995 FAPRI baseline, 25 percent Normal Flex, and the Revenue Assurance program. The authors describe the modeling systems and the CEEPES-FAPRI linkage, delineate the policy options and their likely economic and environmental impacts, and discuss predicted economic and environmental impacts of these policy options.

  17. Community-acquired pneumonia: economics of inpatient medical care vis-à-vis clinical severity,

    Directory of Open Access Journals (Sweden)

    Vojislav Cupurdija

    2015-02-01

    Full Text Available Objective: To assess the direct and indirect costs of diagnosing and treating community-acquired pneumonia (CAP, correlating those costs with CAP severity at diagnosis and identifying the major cost drivers. Methods: This was a prospective cost analysis study using bottom-up costing. Clinical severity and mortality risk were assessed with the pneumonia severity index (PSI and the mental Confusion-Urea-Respiratory rate-Blood pressure-age ≥ 65 years (CURB-65 scale, respectively. The sample comprised 95 inpatients hospitalized for newly diagnosed CAP. The analysis was run from a societal perspective with a time horizon of one year. Results: Expressed as mean ± standard deviation, in Euros, the direct and indirect medical costs per CAP patient were 696 ± 531 and 410 ± 283, respectively, the total per-patient cost therefore being 1,106 ± 657. The combined budget impact of our patient cohort, in Euros, was 105,087 (66,109 and 38,979 in direct and indirect costs, respectively. The major cost drivers, in descending order, were the opportunity cost (lost productivity; diagnosis and treatment of comorbidities; and administration of medications, oxygen, and blood derivatives. The CURB-65 and PSI scores both correlated with the indirect costs of CAP treatment. The PSI score correlated positively with the overall frequency of use of health care services. Neither score showed any clear relationship with the direct costs of CAP treatment. Conclusions: Clinical severity at admission appears to be unrelated to the costs of CAP treatment. This is mostly attributable to unwarranted hospital admission (or unnecessarily long hospital stays in cases of mild pneumonia, as well as to over-prescription of antibiotics. Authorities should strive to improve adherence to guidelines and promote cost-effective prescribing practices among physicians in southeastern Europe.

  18. Evaluation of Quality in Social Care: Aplus Program

    Science.gov (United States)

    Dutrenit, Jean-Marc

    2005-01-01

    France is not advanced regarding evaluation in social work, despite a law established in January 2002 making evaluation a legal obligation every 5 years. This article presents a software program to help social services evaluate on both individual and group levels. Automatic dashboard results of the program with special emphasis on the main…

  19. Supportive nursing care around breast cancer surgery : An evaluation of the 1997 status in The Netherlands

    NARCIS (Netherlands)

    Thijs-Boer, FM; de Kruif, ATC; van de Wiel, HBM

    1999-01-01

    This study aimed to assess nurses' involvement in the supportive care of patients with recently diagnosed breast cancer in Dutch hospitals. A questionnaire used to evaluate various aspects of nursing care for breast cancer patients was sent to the surgical nursing teams in all 120 Dutch hospitals th

  20. Development and Evaluation of an Integrated Pest Management Toolkit for Child Care Providers

    Science.gov (United States)

    Alkon, Abbey; Kalmar, Evie; Leonard, Victoria; Flint, Mary Louise; Kuo, Devina; Davidson, Nita; Bradman, Asa

    2012-01-01

    Young children and early care and education (ECE) staff are exposed to pesticides used to manage pests in ECE facilities in the United States and elsewhere. The objective of this pilot study was to encourage child care programs to reduce pesticide use and child exposures by developing and evaluating an Integrated Pest Management (IPM) Toolkit for…

  1. Evaluation of the european heart failure self-care behaviour scale in a united kingdom population

    NARCIS (Netherlands)

    Shuldham, Caroline; Theaker, Chris; Jaarsma, Tiny; Cowie, Martin R.

    2007-01-01

    Title. Evaluation of the European Heart Failure Self-care Behaviour Scale in a United Kingdom population Aim. This paper is a report of a study to test the internal consistency, reliability and validity of the 12-item European Heart Failure Self-care Behaviour Scale in an English-speaking sample in

  2. Evaluating the Quality of the Learning Outcome in Healthcare Sector: The Expero4care Model

    Science.gov (United States)

    Cervai, Sara; Polo, Federica

    2015-01-01

    Purpose: This paper aims to present the Expero4care model. Considering the growing need for a training evaluation model that does not simply fix processes, the Expero4care model represents the first attempt of a "quality model" dedicated to the learning outcomes of healthcare trainings. Design/Methodology/Approach: Created as development…

  3. Process Evaluation of a Workplace Integrated Care Intervention for Workers with Rheumatoid Arthritis

    NARCIS (Netherlands)

    Vlisteren, M. van; Boot, C.R.; Voskuyl, A.E.; Steenbeek, R.; Schaardenburg, D. van; Anema, J.R.

    2016-01-01

    Purpose To perform a process evaluation of the implementation of a workplace integrated care intervention for workers with rheumatoid arthritis to maintain and improve work productivity. The intervention consisted of integrated care and a participatory workplace intervention with the aim to make ada

  4. The economic role of the Emergency Department in the health care continuum: applying Michael Porter's five forces model to Emergency Medicine.

    Science.gov (United States)

    Pines, Jesse M

    2006-05-01

    Emergency Medicine plays a vital role in the health care continuum in the United States. Michael Porters' five forces model of industry analysis provides an insight into the economics of emergency care by showing how the forces of supplier power, buyer power, threat of substitution, barriers to entry, and internal rivalry affect Emergency Medicine. Illustrating these relationships provides a view into the complexities of the emergency care industry and offers opportunities for Emergency Departments, groups of physicians, and the individual emergency physician to maximize the relationship with other market players.

  5. Evaluation of the impact of interdisciplinarity in cancer care

    Directory of Open Access Journals (Sweden)

    Touati Nassera

    2011-06-01

    Full Text Available Abstract Background Teamwork is a key component of the health care renewal strategy emphasized in Quebec, elsewhere in Canada and in other countries to enhance the quality of oncology services. While this innovation would appear beneficial in theory, empirical evidences of its impact are limited. Current efforts in Quebec to encourage the development of local interdisciplinary teams in all hospitals offer a unique opportunity to assess the anticipated benefits. These teams working in hospital outpatient clinics are responsible for treatment, follow-up and patient support. The study objective is to assess the impact of interdisciplinarity on cancer patients and health professionals. Methods/Design This is a quasi-experimental study with three comparison groups distinguished by intensity of interdisciplinarity: strong, moderate and weak. The study will use a random sample of 12 local teams in Quebec, stratified by intensity of interdisciplinarity. The instrument to measure the intensity of the interdisciplinarity, developed in collaboration with experts, encompasses five dimensions referring to aspects of team structure and process. Self-administered questionnaires will be used to measure the impact of interdisciplinarity on patients (health care utilization, continuity of care and cancer services responsiveness and on professionals (professional well-being, assessment of teamwork and perception of teamwork climate. Approximately 100 health professionals working on the selected teams and 2000 patients will be recruited. Statistical analyses will include descriptive statistics and comparative analysis of the impact observed according to the strata of interdisciplinarity. Fixed and random multivariate statistical models (multilevel analyses will also be used. Discussion This study will pinpoint to what extent interdisciplinarity is linked to quality of care and meets the complex and varied needs of cancer patients. It will ascertain to what extent

  6. Alternative decision modelling techniques for the evaluation of health care technologies: Markov processes versus discrete event simulation.

    Science.gov (United States)

    Karnon, Jonathan

    2003-10-01

    Markov models have traditionally been used to evaluate the cost-effectiveness of competing health care technologies that require the description of patient pathways over extended time horizons. Discrete event simulation (DES) is a more flexible, but more complicated decision modelling technique, that can also be used to model extended time horizons. Through the application of a Markov process and a DES model to an economic evaluation comparing alternative adjuvant therapies for early breast cancer, this paper compares the respective processes and outputs of these alternative modelling techniques. DES displays increased flexibility in two broad areas, though the outputs from the two modelling techniques were similar. These results indicate that the use of DES may be beneficial only when the available data demonstrates particular characteristics.

  7. ECONOMIC EVALUATION OF CO2 SEQUESTRATION TECHNOLOGIES TASK 4, BIOMASS GASIFICATION-BASED PROCESSING

    Energy Technology Data Exchange (ETDEWEB)

    Martha L. Rollins; Les Reardon; David Nichols; Patrick Lee; Millicent Moore; Mike Crim; Robert Luttrell; Evan Hughes

    2002-06-01

    Biomass derived energy currently accounts for about 3 quads of total primary energy use in the United States. Of this amount, about 0.8 quads are used for power generation. Several biomass energy production technologies exist today which contribute to this energy mix. Biomass combustion technologies have been the dominant source of biomass energy production, both historically and during the past two decades of expansion of modern biomass energy in the U. S. and Europe. As a research and development activity, biomass gasification has usually been the major emphasis as a method of more efficiently utilizing the energy potential of biomass, particularly wood. Numerous biomass gasification technologies exist today in various stages of development. Some are simple systems, while others employ a high degree of integration for maximum energy utilization. The purpose of this study is to conduct a technical and economic comparison of up to three biomass gasification technologies, including the carbon dioxide emissions reduction potential of each. To accomplish this, a literature search was first conducted to determine which technologies were most promising based on a specific set of criteria. The technical and economic performances of the selected processes were evaluated using computer models and available literature. Using these results, the carbon sequestration potential of the three technologies was then evaluated. The results of these evaluations are given in this final report.

  8. Construction of the Government Support and Evaluation Index System of Farmers’ Cooperative Economic Organizations

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    On the basis of expounding the necessity of evaluation index system of farmers’ cooperative economic organization,the three first level indexes including organization development index,member development index and social development index and 13 second level indexes including aggregate capital of cooperative organization,annual profit share of cooperative organization,annual total income of cooperative organization,etc.,are established according to the principles of Systematics and the methods of Statistics and Quantitative economics.By using the analytical hierarchy process,the weight of each index is tested and the operation result and evaluation mode is established,as well as the index standard value and comprehensive value.As for the result of the evaluation,it is suggested that the government should support the farmers’ cooperative organizations in hierarchy and targeted way according to local conditions.Though the construction of index system and comprehensive score,the government should establish the entry and exit mechanism of farmers’ cooperative organizations to reasonably guild the rapid development of cooperators.

  9. The Evaluation Indicator System for the Audit of Township Leading Cadres’ Economic Responsibility: Based on the Survey of One County in Chongqing

    Institute of Scientific and Technical Information of China (English)

    Yanfen; LUO; Chaozhou; LU

    2014-01-01

    Economic responsibility audit evaluation of township cadres is important and difficult. According to the evaluation content and principles,the paper constructs the evaluation indicator of five subsystems: " economic management", " economic decision-making", " implementation of economic policy", " economic development",and " honest and upright administration". Through the field survey of some county in Chongqing,evaluation indicator is screened. According to the expert questionnaire,it uses the Hierarchy Analysis Process method to construct the judgment matrix and calculate the indicator weight and thereby build evaluation indicator system. It focuses on traditional indicators and evaluation indicator of sustainable development to construct a new,more complete evaluation indicator system.

  10. Workshop Report: Concepts and methods in the economics of nutrition - Gateways to better economic evaluation of nutrition interventions

    NARCIS (Netherlands)

    I. Lenoir-Wijnkoop (Irene); M.J.C. Nuijten (Mark); I. Gutiérrez-Ibarluzea (Iñaki); J. Hutton; M.J. Poley (Marten); L. Segal; J.L. Bresson; E. Ganse (Éric); P. Jones; L. Moreno (Luis); S. Salminen (Seppo); D. Dubois

    2012-01-01

    textabstractImproving health through better nutrition of the population may contribute to enhanced efficiency and sustainability of healthcare systems. A recent expert meeting investigated in detail a number of methodological aspects related to the discipline of nutrition economics. The role of nutr

  11. [Economic evaluation of prevention programmes for occupational health and safety: the pertinence of cost-benefit analysis].

    Science.gov (United States)

    Antonopoulou, Lila; Targoutzidis, Antonis

    2010-01-01

    This article provides a critical examination of economic evaluation methods for health programmes and of techniques in the specific area of occupational health and safety. The study focuses on the evaluation methods that can be applied at two levels - the business level and the societal level. With respect to evaluation at the level of society, the importance of the social conception of risk as an influential factor that affects economic evaluation is emphasized. This study points to the need to formulate measures that will incorporate such social parameters in the evaluation of prevention programmes for health and safety in the workplace.

  12. An evaluation of an interprofessional master's level programme in children's palliative care. Part 1 the students' evaluation of the programme.

    LENUS (Irish Health Repository)

    Nicholl, Honor

    2014-04-01

    In 2010\\/12 an innovative children\\'s palliative care interprofessional educational project funded by the Irish Hospice Foundation was undertaken in a University faculty (Trinity College Dublin). This initiative responded to international educational recommendations to meet the palliative care needs of children. The project involved the development and delivery of 3 standalone modules at Master\\'s level and a substantive research evaluation of the project to examine stakeholders and students perspectives to provide an insight into their experiences and to gather data for future developments. The research evaluation was conducted in two parts, part one sought students\\' evaluation and part two sought stakeholders\\

  13. National Policy on Health Care Hearing: an evaluative study from covering services and diagnostic procedures

    OpenAIRE

    2014-01-01

    PURPOSE: To evaluate the National Policy on Hearing Health Care (PNASA) based on the coverage of specialized services and diagnostic procedures in hearing health care in Brazil. METHODS: This is an evaluation study focused on the coverage of specialized services that offer moderate- and high-complexity diagnostic procedures by region and in Brazil as a whole. We analyzed the data for the period of 2004-2011 collected from the Unified Health System's Informatics Department database (DATASUS), ...

  14. Evaluation of Arizona Health Care Cost Containment System, 1984-85

    OpenAIRE

    1987-01-01

    In this article, we describe the evaluation of the Arizona Health Care Cost Containment System (AHCCCS), Arizona's alternative to the acute care portion of Medicaid. We provide an assessment of implementation of the program's innovative features during its second 18 months of operation, from April 1984 through September 1985. Included in the evaluation are assessments of the administration of the program, provider relations, eligibility, enrollment and marketing, information systems, quality ...

  15. The clinical and economic impact of point-of-care CD4 testing in mozambique and other resource-limited settings: a cost-effectiveness analysis.

    Directory of Open Access Journals (Sweden)

    Emily P Hyle

    2014-09-01

    Full Text Available BACKGROUND: Point-of-care CD4 tests at HIV diagnosis could improve linkage to care in resource-limited settings. Our objective is to evaluate the clinical and economic impact of point-of-care CD4 tests compared to laboratory-based tests in Mozambique. METHODS AND FINDINGS: We use a validated model of HIV testing, linkage, and treatment (CEPAC-International to examine two strategies of immunological staging in Mozambique: (1 laboratory-based CD4 testing (LAB-CD4 and (2 point-of-care CD4 testing (POC-CD4. Model outcomes include 5-y survival, life expectancy, lifetime costs, and incremental cost-effectiveness ratios (ICERs. Input parameters include linkage to care (LAB-CD4, 34%; POC-CD4, 61%, probability of correctly detecting antiretroviral therapy (ART eligibility (sensitivity: LAB-CD4, 100%; POC-CD4, 90% or ART ineligibility (specificity: LAB-CD4, 100%; POC-CD4, 85%, and test cost (LAB-CD4, US$10; POC-CD4, US$24. In sensitivity analyses, we vary POC-CD4-specific parameters, as well as cohort and setting parameters to reflect a range of scenarios in sub-Saharan Africa. We consider ICERs less than three times the per capita gross domestic product in Mozambique (US$570 to be cost-effective, and ICERs less than one times the per capita gross domestic product in Mozambique to be very cost-effective. Projected 5-y survival in HIV-infected persons with LAB-CD4 is 60.9% (95% CI, 60.9%-61.0%, increasing to 65.0% (95% CI, 64.9%-65.1% with POC-CD4. Discounted life expectancy and per person lifetime costs with LAB-CD4 are 9.6 y (95% CI, 9.6-9.6 y and US$2,440 (95% CI, US$2,440-US$2,450 and increase with POC-CD4 to 10.3 y (95% CI, 10.3-10.3 y and US$2,800 (95% CI, US$2,790-US$2,800; the ICER of POC-CD4 compared to LAB-CD4 is US$500/year of life saved (YLS (95% CI, US$480-US$520/YLS. POC-CD4 improves clinical outcomes and remains near the very cost-effective threshold in sensitivity analyses, even if point-of-care CD4 tests have lower sensitivity

  16. Economic evaluation of the technological development of coal extraction. Ekonomicheskaya otsenka tekhnologicheskogo razvitiya ugledobychu

    Energy Technology Data Exchange (ETDEWEB)

    Golland, E.B.; Rybakova, T.A.

    1985-01-01

    The monograph investigates the trends and prospects in the development of major technological directions in coal extraction. The characteristics of the development of the coal industry at the modern stage are analyzed and the basic trends of technical progress in coal extraction are characterized. Attention is devoted to the problems of evaluating the effectiveness and of determining the rational scales for using different technologies for coal extraction in the long range using economic and mathematical modeling. A model for optimizing the technological development of a coal basin is proposed. The results of calculation variants in terms of a model for the Kuzbass are presented.

  17. Training systems in Rocha pear. Evaluation of production, qualitative and economic aspects

    OpenAIRE

    Comporta, Ana Sofia Ferreira

    2010-01-01

    Mestrado em Engenharia Agronómica - Hortofruticultura e Viticultura - Instituto Superior de Agronomia With the aim of evaluating production, qualitative and economic aspects of four training systems during 2010, at Peral, Cadaval, 4-yr-old ‗Rocha‘ pear trees (Pyrus communis L.) grafted on Sydo and trained as vertical axis (1.0 x 4.0 m), open tatura trellis (0.8 x 4 m), palmette (1.2 x 4.0 m) and solaxe (1.0 x 4.0 m) were monitored. The highest canopy volume and the lower pruning weight wer...

  18. Burden of disease and economic evaluation of healthcare interventions: are we investigating what really matters?

    Directory of Open Access Journals (Sweden)

    Gènova-Maleras Ricard

    2011-04-01

    Full Text Available Abstract Background The allocation of limited available healthcare resources demands an agreed rational allocation principle and the consequent priority setting. We assessed the association between economic evaluations of healthcare interventions published in Spain (1983-2008 and the disease burden in the population. Methods Electronic databases (e.g., PubMed/MEDLINE, SCOPUS, ISI Web of Knowledge, CRD, IME, IBECS and reports from health technology assessment agencies were systematically reviewed. For each article, multiple variables were recorded such as: year and journal of publication, type of study, health intervention targetted, perspective of analysis, type of costs and sources of information, first author's affiliation, explicit recommendations aimed at decision-making, and the main disease cause to which the intervention was addressed. The following disease burden measures were calculated: years of life lost (YLLs, years lived with disability (YLDs, disability-adjusted life years (DALYs, and mortality by cause. Correlation and linear regression models were fitted. Results Four hundred and seventy-seven economic evaluations were identified. Cardiovascular diseases (15.7%, infectious diseases (15.3%, malignant neoplasms (13.2%, and neuropsychiatric diseases (9.6% were the conditions most commonly addressed. Accidents and injuries, congenital anomalies, oral conditions, nutritional deficiencies and other neoplasms were the categories with a lowest number of studies (0.6% for each of them. For the main disease categories (n = 20, a correlation was seen with: mortality 0.67 (p = 0.001, DALYs 0.63 (p = 0.003, YLLs 0.54 (p = 0.014, and YLDs 0.51 (p = 0.018. By disease sub-categories (n = 51, the correlations were generally low and non statistically significant. Conclusions Examining discrepancies between economic evaluations in particular diseases and the overall burden of disease helps shed light on whether there are potentially over- and under

  19. Economic burden related to chemotherapy-related adverse events in patients with metastatic breast cancer in an integrated health care system

    Directory of Open Access Journals (Sweden)

    Rashid N

    2016-10-01

    Full Text Available Nazia Rashid,1 Han A Koh,2 Hilda C Baca,3 Kathy J Lin,1 Susan E Malecha,4 Anthony Masaquel5 1Drug Information Services, Kaiser Permanente, Downey, 2Southern California Permanente Medical Group, Kaiser Permanente, Bellflower, 3Pharmacy Analytical Services, Kaiser Permanente, Downey, 4US Medical Affairs, Genetech Inc., San Francisco, 5Health Economics and Outcomes, Genentech Inc., San Francisco, CA, USA Background: Breast cancer is treated with many different modalities, including chemotherapy that can be given as a single agent or in combination. Patients often experience adverse events from chemotherapy during the cycles of treatment which can lead to economic burden.Objective: The objective of this study was to evaluate costs related to chemotherapy-related adverse events in patients with metastatic breast cancer (mBC in an integrated health care delivery system.Methods: Patients with mBC newly initiated on chemotherapy were identified and the first infusion was defined as the index date. Patients were ≥18 years old at time of index date, had at least 6 months of health plan membership and drug eligibility prior to their index date. The chemotherapy adverse events were identified after the index date and during first line of chemotherapy. Episodes of care (EOC were created using healthcare visits. Chart review was conducted to establish whether the adverse events were related to chemotherapy. Costs were calculated for each visit, including medications related to the adverse events, and aggregated to calculate the total EOC cost.Results: A total of 1,682 patients with mBC were identified after applying study criteria; 54% of these patients had one or more adverse events related to chemotherapy. After applying the EOC method, there were a total of 5,475 episodes (4,185 single episodes [76.4%] and 1,290 multiple episodes [23.6%] related to chemotherapy-related adverse events. Within single episodes, hematological (1,387 EOC, 33

  20. Implementing intimate partner violence care in a rural sub-district of South Africa: a qualitative evaluation

    Directory of Open Access Journals (Sweden)

    Kate Rees

    2014-09-01

    Full Text Available Background: Despite a high burden of disease, in South Africa, intimate partner violence (IPV is known to be poorly recognised and managed. To address this gap, an innovative intersectoral model for the delivery of comprehensive IPV care was piloted in a rural sub-district. Objective: To evaluate the initiative from the perspectives of women using the service, service providers, and managers. Design: A qualitative evaluation was conducted. Service users were interviewed, focus groups were conducted amongst health care workers (HCW, and a focus group and interviews were conducted with the intersectoral implementation team to explore their experiences of the intervention. A thematic analysis approach was used, triangulating the various sources of data. Results: During the pilot, 75 women received the intervention. Study participants described their experience as overwhelmingly positive, with some experiencing improvements in their home lives. Significant access barriers included unaffordable indirect costs, fear of loss of confidentiality, and fear of children being removed from the home. For HCW, barriers to inquiry about IPV included its normalisation in this community, poor understanding of the complexities of living with violence and frustration in managing a difficult emotional problem. Health system constraints affected continuity of care, privacy, and integration of the intervention into routine functioning, and the process of intersectoral action was hindered by the formation of alliances. Contextual factors, for example, high levels of alcohol misuse and socio-economic disempowerment, highlighted the need for a multifaceted approach to addressing IPV. Conclusions: This evaluation draws attention to the need to take a systems approach and focus on contextual factors when implementing complex interventions. The results will be used to inform decisions about instituting appropriate IPV care in the rest of the province. In addition, there is