WorldWideScience

Sample records for care economic evaluation

  1. Economic evaluation of integrated care: an introduction

    Directory of Open Access Journals (Sweden)

    Hindrik Vondeling

    2004-03-01

    Full Text Available Background: Integrated care has emerged in a variety of forms in industrialised countries during the past decade. It is generally assumed that these new arrangements result in increased effectiveness and quality of care, while being cost-effective or even cost-saving at the same time. However, systematic evaluation, including an evaluation of the relative costs and benefits of these arrangements, has largely been lacking. Objectives: To stimulate fruitful dialogue and debate about the need for economic evaluation in integrated care, and to outline possibilities for undertaking economic appraisal studies in this relatively new field. Theory: Key concepts, including e.g. scarcity and opportunity costs, are introduced, followed by a brief overview of the most common methods used in economic evaluation of health care programmes. Then a number of issues that seem particularly relevant for economic evaluation of integrated care arrangements are addressed in more detail, illustrated with examples from the literature. Conclusion and discussion: There is a need for well-designed economic evaluation studies of integrated care arrangements, in particular in order to support decision making on the long-term financing of these programmes. Although relatively few studies have been done to date, the field is challenging from a methodological point of view, offering analysts a wealth of opportunities. Guidance to realise these opportunities is provided by the general principles for economic evaluation, which can be tailored to the requirements of this particular field.

  2. Payment and economic evaluation of integrated care

    Directory of Open Access Journals (Sweden)

    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.

  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. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  4. [Measurement and health economic evaluation of informal care].

    Science.gov (United States)

    Zrubka, Zsombor

    2017-09-01

    Informal care is non-financed care outside the realm of formal healthcare, which represents an increasing challenge for aging societies. Informal care has frequently been neglected in health economic analyses, while in recent years its coverage has increased considerably in the international scientific literature. This review summarizes the methodology of the health-economic assessment of informal care, including the objective and subjective metrics of caregiver burden, its financial and non-financial valuation and practical applications, with special emphasis on the introduction of care-related quality of life instruments (e.g. Care Related Quality of Life - CarerQoL instrument). Care-related quality of life is a different entity from health-related quality of life, the two cannot be combined, so their joint evaluation requires multi-criteria decision analysis methods. Therefore, it is important to determine the societal preferences of care-related quality of life versus health-related quality of life, and map the relationship of care-related quality of life with time. The local validation of tools measuring care-related quality of life, its more widespread practical application and the analysis of its effect on decision making are also important part of the future research agenda. Orv Hetil. 2017; 158(35): 1363-1372.

  5. Economic evaluation of emergency obstetric care training: a systematic review.

    Science.gov (United States)

    Banke-Thomas, Aduragbemi; Wilson-Jones, Megan; Madaj, Barbara; van den Broek, Nynke

    2017-12-04

    Training healthcare providers in Emergency Obstetric Care (EmOC) has been shown to be effective in improving their capacity to provide this critical care package for mothers and babies. However, little is known about the costs and cost-effectiveness of such training. Understanding costs and cost-effectiveness is essential in guaranteeing value-for-money in healthcare spending. This study systematically reviewed the available literature on cost and cost-effectiveness of EmOC trainings. Peer-reviewed and grey literature was searched for relevant papers published after 1990. Studies were included if they described an economic evaluation of EmOC training and the training cost data were available. Two reviewers independently searched, screened, and selected studies that met the inclusion criteria, with disagreements resolved by a third reviewer. Quality of studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards statement. For comparability, all costs in local currency were converted to International dollar (I$) equivalents using purchasing power parity conversion factors. The cost per training per participant was calculated. Narrative synthesis was used to summarise the available evidence on cost effectiveness. Fourteen studies (five full and nine partial economic evaluations) met the inclusion criteria. All five and two of the nine partial economic evaluations were of high quality. The majority of studies (13/14) were from low- and middle-income countries. Training equipment, per diems and resource person allowance were the most expensive components. Cost of training per person per day ranged from I$33 to I$90 when accommodation was required and from I$5 to I$21 when training was facility-based. Cost-effectiveness of training was assessed in 5 studies with differing measures of effectiveness (knowledge, skills, procedure cost and lives saved) making comparison difficult. Economic evaluations of EmOC training are limited. There is a

  6. Discounting in the economic evaluation of health care interventions.

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    Krahn, M; Gafni, A

    1993-05-01

    Do economic theories that underlie discounting have specific implications for program evaluation in health? In this study, both the contemporary practice and the theoretical foundations of discounting are reviewed. The social discount rate controversy is considered, and the two major concepts (i.e., opportunity cost and time preference) involved in the formulation of a social discount rate are outlined. Also described are the arguments for discounting proposed by thinkers in non-economic disciplines. Finally, the implications of choosing a discount rate for evaluation of individual health care programs are considered. It is argued that the conventional practice of discounting all health care programs at a rate of 5% may not consistently reflect societal or individual preference. Specific recommendations arising from this paper are: 1) given the considerable disagreement at the theoretical level as to the appropriate social discount rate, analysts should be specific about what theoretical approach underlies their choice of rate, especially when the analytic result is sensitive to the discount rate; 2) the discount rate chosen should be appropriate for the perspective of the analysis (social vs. individual vs. institutional, etc.); 3) when appropriate, measures should be taken to avoid double discounting, because some health related outcome measures already incorporate individuals' time preference; and 4) it is suggested that the political process may serve as the appropriate means of reflecting social values in the choice of a discount rate. In addition, the authors argue that a consensus conference approach, with political participation, offers a flexible, pragmatic, and explicit way of synthesizing the empirical, normative, and ethical considerations that underlie choice of a discount rate.

  7. Performing Economic Evaluation of Integrated Care: Highway to Hell or Stairway to Heaven?

    Science.gov (United States)

    Stein, K. Viktoria; Evers, Silvia; Rutten-van Mölken, Maureen

    2016-01-01

    Health 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 care is still in its early years, facing several difficulties. The aim of this paper is to describe the unique nature of integrated care as a topic for economic evaluation, explore the obstacles to perform economic evaluation, discuss methods and techniques that can be used to address them, and set the basis to develop a research agenda for health economics in integrated care. The paper joins the voices that call health economists to pay more attention to integrated care and argues that there should be no more time wasted for doing it. PMID:28316543

  8. Economic evaluation of occupational health and safety programmes in health care.

    Science.gov (United States)

    Guzman, J; Tompa, E; Koehoorn, M; de Boer, H; Macdonald, S; Alamgir, H

    2015-10-01

    Evidence-based resource allocation in the public health care sector requires reliable economic evaluations that are different from those needed in the commercial sector. To describe a framework for conducting economic evaluations of occupational health and safety (OHS) programmes in health care developed with sector stakeholders. To define key resources and outcomes to be considered in economic evaluations of OHS programmes and to integrate these into a comprehensive framework. Participatory action research supported by mixed qualitative and quantitative methods, including a multi-stakeholder working group, 25 key informant interviews, a 41-member Delphi panel and structured nominal group discussions. We found three resources had top priority: OHS staff time, training the workers and programme planning, promotion and evaluation. Similarly, five outcomes had top priority: number of injuries, safety climate, job satisfaction, quality of care and work days lost. The resulting framework was built around seven principles of good practice that stakeholders can use to assist them in conducting economic evaluations of OHS programmes. Use of a framework resulting from this participatory action research approach may increase the quality of economic evaluations of OHS programmes and facilitate programme comparisons for evidence-based resource allocation decisions. The principles may be applicable to other service sectors funded from general taxes and more broadly to economic evaluations of OHS programmes in general. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  9. 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. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  10. Economic evaluation of nurse staffing and nurse substitution in health care: a scoping review.

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    Goryakin, Yevgeniy; Griffiths, Peter; Maben, Jill

    2011-04-01

    Several systematic reviews have suggested that greater nurse staffing as well as a greater proportion of registered nurses in the health workforce is associated with better patient outcomes. Others have found that nurses can substitute for doctors safely and effectively in a variety of settings. However, these reviews do not generally consider the effect of nurse staff on both patient outcomes and costs of care, and therefore say little about the cost-effectiveness of nurse-provided care. Therefore, we conducted a scoping literature review of economic evaluation studies which consider the link between nurse staffing, skill mix within the nursing team and between nurses and other medical staff to determine the nature of the available economic evidence. Scoping literature review. English-language manuscripts, published between 1989 and 2009, focussing on the relationship between costs and effects of care and the level of registered nurse staffing or nurse-physician substitution/nursing skill mix in the clinical team, using cost-effectiveness, cost-utility, or cost-benefit analysis. Articles selected for the review were identified through Medline, CINAHL, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Google Scholar database searches. After selecting 17 articles representing 16 unique studies for review, we summarized their main findings, and assessed their methodological quality using criteria derived from recommendations from the guidelines proposed by the Panel on Cost-Effectiveness in Health Care. In general, it was found that nurses can provide cost effective care, compared to other health professionals. On the other hand, more intensive nurse staffing was associated with both better outcomes and more expensive care, and therefore cost effectiveness was not easy to assess. Although considerable progress in economic evaluation studies has been reached in recent years, a number of methodological issues remain. In the future

  11. Evaluating the Economic Impact of Smart Care Platforms: Qualitative and Quantitative Results of a Case Study.

    Science.gov (United States)

    Vannieuwenborg, Frederic; Van der Auwermeulen, Thomas; Van Ooteghem, Jan; Jacobs, An; Verbrugge, Sofie; Colle, Didier

    2016-10-31

    In response to the increasing pressure of the societal challenge because of a graying society, a gulf of new Information and Communication Technology (ICT) supported care services (eCare) can now be noticed. Their common goal is to increase the quality of care while decreasing its costs. Smart Care Platforms (SCPs), installed in the homes of care-dependent people, foster the interoperability of these services and offer a set of eCare services that are complementary on one platform. These eCare services could not only result in more quality care for care receivers, but they also offer opportunities to care providers to optimize their processes. The objective of the study was to identify and describe the expected added values and impacts of integrating SCPs in current home care delivery processes for all actors. In addition, the potential economic impact of SCP deployment is quantified from the perspective of home care organizations. Semistructured and informal interviews and focus groups and cocreation workshops with service providers, managers of home care organizations, and formal and informal care providers led to the identification of added values of SCP integration. In a second step, process breakdown analyses of home care provisioning allowed defining the operational impact for home care organization. Impacts on 2 different process steps of providing home care were quantified. After modeling the investment, an economic evaluation compared the business as usual (BAU) scenario versus the integrated SCP scenario. The added value of SCP integration for all actors involved in home care was identified. Most impacts were qualitative such as increase in peace of mind, better quality of care, strengthened involvement in care provisioning, and more transparent care communication. For home care organizations, integrating SCPs could lead to a decrease of 38% of the current annual expenses for two administrative process steps namely, care rescheduling and the billing for

  12. A Systematic Review of the State of Economic Evaluation for Health Care in India.

    Science.gov (United States)

    Prinja, Shankar; Chauhan, Akashdeep Singh; Angell, Blake; Gupta, Indrani; Jan, Stephen

    2015-12-01

    Economic evaluations are one of the important tools in policy making for rational allocation of resources. Given the very low public investment in the health sector in India, it is critical that resources are used wisely on interventions proven to yield best results. Hence, we undertook this study to assess the extent and quality of evidence for economic evaluation of health-care interventions and programmes in India. A comprehensive search was conducted to search for published full economic evaluations pertaining to India and addressing a health-related intervention or programme. PubMed, Scopus, Embase, ScienceDirect, and York CRD database and websites of important research agencies were identified to search for economic evaluations published from January 1980 to the middle of November 2014. Two researchers independently assessed the quality of the studies based on Drummond and modelling checklist. Out of a total of 5013 articles enlisted after literature search, a total of 104 met the inclusion criteria for this systematic review. The majority of these papers were cost-effectiveness studies (64%), led by a clinician or public-health professional (77%), using decision analysis-based methods (59%), published in an international journal (80%) and addressing communicable diseases (58%). In addition, 42% were funded by an international funding agency or UN/bilateral aid agency, and 30% focussed on pharmaceuticals. The average quality score of these full economic evaluations was 65.1%. The major limitation was the inability to address uncertainties involved in modelling as only about one-third of the studies assessed modelling structural uncertainties (33%), or ran sub-group analyses to account for heterogeneity (36.5%) or analysed methodological uncertainty (32%). The existing literature on economic evaluations in India is inadequate to feed into sound policy making. There is an urgent need to generate awareness within the government of how economic evaluation can

  13. Cost-Effectiveness of a Chronic Care Model for Frail Older Adults in Primary Care: Economic Evaluation Alongside a Stepped-Wedge Cluster-Randomized Trial

    NARCIS (Netherlands)

    van Leeuwen, K.M.; Bosmans, J.E.; Jansen, A.P.D.; Hoogendijk, E.O.; Muntinga, M.E.; van Hout, H.P.J.; Nijpels, G.; van der Horst, H.E.; van Tulder, M.W.

    2015-01-01

    Objectives To evaluate the cost-effectiveness of the Geriatric Care Model (GCM), an integrated care model for frail older adults based on the Chronic Care Model, with that of usual care. Design Economic evaluation alongside a 24-month stepped-wedge cluster-randomized controlled trial. Setting

  14. Cost-Effectiveness of a Chronic Care Model for Frail Older Adults in Primary Care : Economic Evaluation Alongside a Stepped-Wedge Cluster-Randomized Trial

    NARCIS (Netherlands)

    van Leeuwen, Karen M; Bosmans, Judith E; Jansen, Aaltje P D; Hoogendijk, Emiel O; Muntinga, Maaike E; van Hout, Hein P J; Nijpels, Giel; van der Horst, Henriette E; van Tulder, Maurits W

    2015-01-01

    OBJECTIVES: To evaluate the cost-effectiveness of the Geriatric Care Model (GCM), an integrated care model for frail older adults based on the Chronic Care Model, with that of usual care. DESIGN: Economic evaluation alongside a 24-month stepped-wedge cluster-randomized controlled trial. SETTING:

  15. 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.

  16. Economic evaluation of neonatal care packages in a cluster-randomized controlled trial in Sylhet, Bangladesh.

    Science.gov (United States)

    LeFevre, Amnesty E; Shillcutt, Samuel D; Waters, Hugh R; Haider, Sabbir; El Arifeen, Shams; Mannan, Ishtiaq; Seraji, Habibur R; Shah, Rasheduzzaman; Darmstadt, Gary L; Wall, Steve N; Williams, Emma K; Black, Robert E; Santosham, Mathuram; Baqui, Abdullah H

    2013-10-01

    To evaluate and compare the cost-effectiveness of two strategies for neonatal care in Sylhet division, Bangladesh. In a cluster-randomized controlled trial, two strategies for neonatal care--known as home care and community care--were compared with existing services. For each study arm, economic costs were estimated from a societal perspective, inclusive of programme costs, provider costs and household out-of-pocket payments on care-seeking. Neonatal mortality in each study arm was determined through household surveys. The incremental cost-effectiveness of each strategy--compared with that of the pre-existing levels of maternal and neonatal care--was then estimated. The levels of uncertainty in our estimates were quantified through probabilistic sensitivity analysis. The incremental programme costs of implementing the home-care package were 2939 (95% confidence interval, CI: 1833-7616) United States dollars (US$) per neonatal death averted and US$ 103.49 (95% CI: 64.72-265.93) per disability-adjusted life year (DALY) averted. The corresponding total societal costs were US$ 2971 (95% CI: 1844-7628) and US$ 104.62 (95% CI: 65.15-266.60), respectively. The home-care package was cost-effective--with 95% certainty--if healthy life years were valued above US$ 214 per DALY averted. In contrast, implementation of the community-care strategy led to no reduction in neonatal mortality and did not appear to be cost-effective. The home-care package represents a highly cost-effective intervention strategy that should be considered for replication and scale-up in Bangladesh and similar settings elsewhere.

  17. Effect of integrated care for sick listed patients with chronic low back pain: economic evaluation alongside a randomised controlled trial

    OpenAIRE

    Lambeek, Ludeke C; Bosmans, Judith E; Van Royen, Barend J; Van Tulder, Maurits W; Van Mechelen, Willem; Anema, Johannes R

    2010-01-01

    Objective To evaluate the cost effectiveness, cost utility, and cost-benefit of an integrated care programme compared with usual care for sick listed patients with chronic low back pain. Design Economic evaluation alongside a randomised controlled trial with 12 months? follow-up. Setting Primary care (10 physiotherapy practices, one occupational health service, one occupational therapy practice) and secondary care (five hospitals) in the Netherlands, 2005-9. Participants 134 adults aged 18-65...

  18. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial

    NARCIS (Netherlands)

    Korthals-de Bos, Ingeborg B. C.; Hoving, Jan L.; van Tulder, Maurits W.; Rutten-van Mölken, Maureen P. M. H.; Adèr, Herman J.; de Vet, Henrica C. W.; Koes, Bart W.; Vondeling, Hindrik; Bouter, Lex M.

    2003-01-01

    OBJECTIVE: To evaluate the cost effectiveness of physiotherapy, manual therapy, and care by a general practitioner for patients with neck pain. DESIGN: Economic evaluation alongside a randomised controlled trial. SETTING: Primary care. PARTICIPANTS: 183 patients with neck pain for at least two weeks

  19. Economic evaluation of pharmacist-led medication reviews in residential aged care facilities.

    Science.gov (United States)

    Hasan, Syed Shahzad; Thiruchelvam, Kaeshaelya; Kow, Chia Siang; Ghori, Muhammad Usman; Babar, Zaheer-Ud-Din

    2017-10-01

    Medication reviews is a widely accepted approach known to have a substantial impact on patients' pharmacotherapy and safety. Numerous options to optimise pharmacotherapy in older people have been reported in literature and they include medication reviews, computerised decision support systems, management teams, and educational approaches. Pharmacist-led medication reviews are increasingly being conducted, aimed at attaining patient safety and medication optimisation. Cost effectiveness is an essential aspect of a medication review evaluation. Areas covered: A systematic searching of articles that examined the cost-effectiveness of medication reviews conducted in aged care facilities was performed using the relevant databases. Pharmacist-led medication reviews confer many benefits such as attainment of biomarker targets for improved clinical outcomes, and other clinical parameters, as well as depict concrete financial advantages in terms of decrement in total medication costs and associated cost savings. Expert commentary: The cost-effectiveness of medication reviews are more consequential than ever before. A critical evaluation of pharmacist-led medication reviews in residential aged care facilities from an economical aspect is crucial in determining if the time, effort, and direct and indirect costs involved in the review rationalise the significance of conducting medication reviews for older people in aged care facilities.

  20. Economic evaluation of an intensive group training protocol compared with usual care physiotherapy in patients with chronic low back pain

    NARCIS (Netherlands)

    van der Roer, N.; van Tulder, M.; van Mechelen, W.; de Vet, H.C.W.

    2008-01-01

    STUDY DESIGN. Economic evaluation from a societal perspective conducted alongside a randomized controlled trial with a follow-up of 52 weeks. OBJECTIVE. To evaluate the cost effectiveness and cost utility of an intensive group training protocol compared with usual care physiotherapy in patients with

  1. Effect of integrated care for sick listed patients with chronic low back pain: economic evaluation alongside a randomised controlled trial.

    Science.gov (United States)

    Lambeek, Ludeke C; Bosmans, Judith E; Van Royen, Barend J; Van Tulder, Maurits W; Van Mechelen, Willem; Anema, Johannes R

    2010-11-30

    To evaluate the cost effectiveness, cost utility, and cost-benefit of an integrated care programme compared with usual care for sick listed patients with chronic low back pain. Economic evaluation alongside a randomised controlled trial with 12 months' follow-up. Primary care (10 physiotherapy practices, one occupational health service, one occupational therapy practice) and secondary care (five hospitals) in the Netherlands, 2005-9. 134 adults aged 18-65 sick listed because of chronic low back pain: 66 were randomised to integrated care and 68 to usual care. Integrated care consisted of a workplace intervention based on participatory ergonomics, with involvement of a supervisor, and a graded activity programme based on cognitive behavioural principles. Usual care was provided by general practitioners and occupational physicians according to Dutch guidelines. The primary outcome was duration until sustainable return to work. The secondary outcome was quality adjusted life years (QALYs), measured using EuroQol. Total costs in the integrated care group (£13 165, SD £13 600) were significantly lower than in the usual care group (£18 475, SD £13 616). Cost effectiveness planes and acceptability curves showed that integrated care was cost effective compared with usual care for return to work and QALYs gained. The cost-benefit analyses showed that every £1 invested in integrated care would return an estimated £26. The net societal benefit of integrated care compared with usual care was £5744. Implementation of an integrated care programme for patients sick listed with chronic low back pain has a large potential to significantly reduce societal costs, increase effectiveness of care, improve quality of life, and improve function on a broad scale. Integrated care therefore has large gains for patients and society as well as for employers.

  2. A systematic review and economic evaluation of exercise referral schemes in primary care: a short report.

    Science.gov (United States)

    Campbell, Fiona; Holmes, Mike; Everson-Hock, Emma; Davis, Sarah; Buckley Woods, Helen; Anokye, Nana; Tappenden, Paul; Kaltenthaler, Eva

    2015-07-01

    , Moxham T, Fox KR, et al. The clinical effectiveness and cost-effectiveness of exercise referral schemes: a systematic review and economic evaluation. Health Technol Assess 2011;15(44)] to give a total of eight studies with 5190 participants. The proportion of individuals achieving 90-150 minutes of at least moderate-intensity activity per week at 6-12 months' follow-up was greater for ERSs than usual care (relative risk 1.12; 95% confidence interval 1.04 to 1.20). Older patients and those referred for CHD risk factors appeared to be more likely than others to increase their levels of physical activity. Qualitative evidence suggests that interventions enabling the development of social support networks are beneficial in promoting uptake and adherence. Exercise referral gained 0.003 quality-adjusted life-years (QALYs) at an additional cost of £225 per person. The estimated mean incremental cost-effectiveness ratio (ICER) in the probabilistic sensitivity analysis was £76,276. In the univariate sensitivity analysis the results were very sensitive (ICERs ranged from  £100,000) to changes in the effect of ERSs on physical activity uptake and the duration of the protective effects and the direct health-related quality-of-life gains attributable to physical activity. Exercise referral schemes result in a small improvement in the number of people who increase their levels of physical activity. The cost-effectiveness analysis indicates that the ICER for ERSs compared with usual care is around £76,000 per QALY, although the cost-effectiveness of ERSs is subject to considerable uncertainty. This study is registered as PROSPERO CRD42013005200. National Institute for Health Research Health Technology Assessment programme.

  3. Is home-based palliative care cost-effective? An economic evaluation of the Palliative Care Extended Packages at Home (PEACH) pilot.

    Science.gov (United States)

    McCaffrey, Nikki; Agar, Meera; Harlum, Janeane; Karnon, Jonathon; Currow, David; Eckermann, Simon

    2013-12-01

    The aim of this study was to evaluate the cost-effectiveness of a home-based palliative care model relative to usual care in expediting discharge or enabling patients to remain at home. Economic evaluation of a pilot randomised controlled trial with 28 days follow-up. Mean costs and effectiveness were calculated for the Palliative Care Extended Packages at Home (PEACH) and usual care arms including: days at home; place of death; PEACH intervention costs; specialist palliative care service use; acute hospital and palliative care unit inpatient stays; and outpatient visits. PEACH mean intervention costs per patient ($3489) were largely offset by lower mean inpatient care costs ($2450) and in this arm, participants were at home for one additional day on average. Consequently, PEACH is cost-effective relative to usual care when the threshold value for one extra day at home exceeds $1068, or $2547 if only within-study days of hospital admission are costed. All estimates are high uncertainty. The results of this small pilot study point to the potential of PEACH as a cost-effective end-of-life care model relative to usual care. Findings support the feasibility of conducting a definitive, fully powered study with longer follow-up and comprehensive economic evaluation.

  4. Health Economic Evaluation of Telehealthcare

    DEFF Research Database (Denmark)

    Udsen, Flemming Witt

    for decision making meant to inform adaptation of the health economic evaluation approach. Based on developments in realist evaluation and experiences with conducting the evaluation of TeleCare North, four principles for health economic evaluation of complex telehealthcare interventions is outlined in order....... The results from the TeleCare North trial were used directly in a national decision to implement the telehealthcare solution to patients with severe COPD in Denmark and lead to considerable debate nationally. This debate could be viewed as an actual account of the usefulness of health economic evaluation...

  5. A health economic model for the development and evaluation of innovations in aged care: an application to consumer-directed care-study protocol.

    Science.gov (United States)

    Ratcliffe, Julie; Lancsar, Emily; Luszcz, Mary; Crotty, Maria; Gray, Len; Paterson, Jan; Cameron, Ian D

    2014-06-25

    Consumer-directed care is currently being embraced within Australia and internationally as a means of promoting autonomy and choice in the delivery of health and aged care services. Despite its wide proliferation little research has been conducted to date to assess the views and preferences of older people for consumer-directed care or to assess the costs and benefits of such an approach relative to existing models of service delivery. A comprehensive health economic model will be developed and applied to the evolution, implementation and evaluation of consumer-directed care in an Australian community aged care setting. A mixed methods approach comprising qualitative interviews and a discrete choice experiment will determine the attitudes and preferences of older people and their informal carers for consumer-directed care. The results of the qualitative interviews and the discrete choice experiment will inform the introduction of a new consumer-directed care innovation in service delivery. The cost-effectiveness of consumer-directed care will be evaluated by comparing incremental changes in resource use, costs and health and quality of life outcomes relative to traditional services. The discrete choice experiment will be repeated at the end of the implementation period to determine the extent to which attitudes and preferences change as a consequence of experience of consumer-directed care. The proposed framework will have wide applicability in the future development and economic evaluation of new innovations across the health and aged care sectors. The study is approved by Flinders University Social and Behavioural Research Ethics Committee (Project No. 6114/SBREC). Findings from the qualitative interviews, discrete choice experiments and the economic evaluation will be reported at a workshop of stakeholders to be held in 2015 and will be documented in reports and in peer reviewed journal articles. Published by the BMJ Publishing Group Limited. For permission to

  6. Economic evaluation of home-based telebehavioural health care compared to in-person treatment delivery for depression.

    Science.gov (United States)

    Bounthavong, Mark; Pruitt, Larry D; Smolenski, Derek J; Gahm, Gregory A; Bansal, Aasthaa; Hansen, Ryan N

    2018-02-01

    Introduction Home-based telebehavioural healthcare improves access to mental health care for patients restricted by travel burden. However, there is limited evidence assessing the economic value of home-based telebehavioural health care compared to in-person care. We sought to compare the economic impact of home-based telebehavioural health care and in-person care for depression among current and former US service members. Methods We performed trial-based cost-minimisation and cost-utility analyses to assess the economic impact of home-based telebehavioural health care versus in-person behavioural care for depression. Our analyses focused on the payer perspective (Department of Defense and Department of Veterans Affairs) at three months. We also performed a scenario analysis where all patients possessed video-conferencing technology that was approved by these agencies. The cost-utility analysis evaluated the impact of different depression categories on the incremental cost-effectiveness ratio. One-way and probabilistic sensitivity analyses were performed to test the robustness of the model assumptions. Results In the base case analysis the total direct cost of home-based telebehavioural health care was higher than in-person care (US$71,974 versus US$20,322). Assuming that patients possessed government-approved video-conferencing technology, home-based telebehavioural health care was less costly compared to in-person care (US$19,177 versus US$20,322). In one-way sensitivity analyses, the proportion of patients possessing personal computers was a major driver of direct costs. In the cost-utility analysis, home-based telebehavioural health care was dominant when patients possessed video-conferencing technology. Results from probabilistic sensitivity analyses did not differ substantially from base case results. Discussion Home-based telebehavioural health care is dependent on the cost of supplying video-conferencing technology to patients but offers the opportunity to

  7. [Economic evaluation of the demand of medical care for mental health in Mexico: schizophrenia and depression, 1996-2000].

    Science.gov (United States)

    Arredondo, Armando; Ramos, René; Zúñiga, Alexis

    2003-01-01

    Financing protection for both, users and providers of health care services is one of the main objectives of National Program of Health in Mexico, 2001-2006. In fact one of the elements of the present health care reform initiatives is need for the efficient allocation of financial resources, using resource allocation schemes by specific health care demands that combine both the economic, clinical and the epidemiological perspectives. The evaluation of such schemes has been approached in several ways; however, in the case of mental health services, there is dearth of studies that use economic assessment methods. Moreover, such studies are of limited scope, often a response to unmated health needs, disregarding the economic implication for health services production and financing and ensuing medical care market imbalances. This paper presents the results of an evaluative research work aimed to assess the average cost of depression and schizophrenia case management, the financial resources required to meet the health care demands by type of institution, period 1996-2000, in Mexico by type of health care provider. The case management average cost for schizophrenia was $211.00 US, and that for depression was $221.00 US. The demand of services for both conditions in each type of institution showed that the greatest relative demands (96% of the national total for depression and 94% of the national total for schizophrenia) occur in three institutions: IMSS, SSA and ISSSTE. The greatest demand of the health services for the two study condition corresponded to those insured by the IMSS, followed by those uninsured who use the SSA services, and those insured by the ISSSTE. The case management costs for mental conditions are in the middle range between hypertension and diabetes in the upper end, pneumonia and diarrhea in the lower end. The case managment costs of health care demands for the selected tracer conditions differ considerably among institutions for insure populations

  8. Economic evaluation of angiographic interventions including a whole-radiology in- and outpatient care

    International Nuclear Information System (INIS)

    Nolte-Ernsting, C.; Abel, K.; Krupski, G.; Lorenzen, J.; Adam, G.

    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.)

  9. The efficiency frontier approach to economic evaluation of health-care interventions.

    Science.gov (United States)

    Caro, J Jaime; Nord, Erik; Siebert, Uwe; McGuire, Alistair; McGregor, Maurice; Henry, David; de Pouvourville, Gérard; Atella, Vincenzo; Kolominsky-Rabas, Peter

    2010-10-01

    IQWiG commissioned an international panel of experts to develop methods for the assessment of the relation of benefits to costs in the German statutory health-care system. The panel recommended that IQWiG inform German decision makers of the net costs and value of additional benefits of an intervention in the context of relevant other interventions in that indication. To facilitate guidance regarding maximum reimbursement, this information is presented in an efficiency plot with costs on the horizontal axis and value of benefits on the vertical. The efficiency frontier links the interventions that are not dominated and provides guidance. A technology that places on the frontier or to the left is reasonably efficient, while one falling to the right requires further justification for reimbursement at that price. This information does not automatically give the maximum reimbursement, as other considerations may be relevant. Given that the estimates are for a specific indication, they do not address priority setting across the health-care system. This approach informs decision makers about efficiency of interventions, conforms to the mandate and is consistent with basic economic principles. Empirical testing of its feasibility and usefulness is required.

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

    Science.gov (United States)

    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

  11. Economic evaluation of an intensive group training protocol compared with usual care physiotherapy in patients with chronic low back pain.

    Science.gov (United States)

    van der Roer, Nicole; van Tulder, Maurits; van Mechelen, Willem; de Vet, Henrica

    2008-02-15

    Economic evaluation from a societal perspective conducted alongside a randomized controlled trial with a follow-up of 52 weeks. To evaluate the cost effectiveness and cost utility of an intensive group training protocol compared with usual care physiotherapy in patients with nonspecific chronic low back pain. The intensive group training protocol combines exercise therapy, back school, and behavioral principles. Two studies found a significant reduction in absenteeism for a graded activity program in occupational health care. This program has not yet been evaluated in a primary care physiotherapy setting. Participating physical therapists in primary care recruited 114 patients with chronic nonspecific low back pain. Eligible patients were randomized to either the protocol group or the guideline group. Outcome measures included functional status (Roland Morris Disability Questionnaire), pain intensity (11-point numerical rating scale), general perceived effect and quality of life (EuroQol-5D). Cost data were measured with cost diaries and included direct and indirect costs related to low back pain. After 52 weeks, the direct health care costs were significantly higher for patients in the protocol group, largely due to the costs of the intervention. The mean difference in total costs amounted to [Euro sign] 233 (95% confidence interval: [Euro sign] -2.185; [Euro sign] 2.764). The cost-effectiveness planes indicated no significant differences in cost effectiveness between the 2 groups. The results of this economic evaluation showed no difference in total costs between the protocol group and the guideline group. The differences in effects were small and not statistically significant. At present, national implementation of the protocol is not recommended.

  12. Biases in cost measurement for economic evaluation studies in health care.

    Science.gov (United States)

    Jacobs, P; Baladi, J F

    1996-01-01

    This paper addresses the issue of biases in cost measures which used in economic evaluation studies. The basic measure of hospital costs which is used by most investigators is unit cost. Focusing on this measure, a set of criteria which the basic measures must fulfil in order to approximate the marginal cost (MC) of a service for the relevant product, in the representative site, was identified. Then four distinct biases--a scale bias, a case mix bias, a methods bias and a site selection bias--each of which reflects the divergence of the unit cost measure from the desired MC measure, were identified. Measures are proposed for several of these biases and it is suggested how they can be corrected.

  13. Health-care decision-making processes in Latin America: problems and prospects for the use of economic evaluation.

    Science.gov (United States)

    Iglesias, Cynthia P; Drummond, Michael F; Rovira, Joan

    2005-01-01

    The use of economic evaluation studies (EE) in the decision-making process within the health-care system of nine Latin American (LA) and three European countries was investigated. The aim was to identify the opportunities, obstacles, and changes needed to facilitate the introduction of EE as a formal tool in health-care decision-making processes in LA. A comparative study was conducted based on existing literature and information provided through a questionnaire applied to decision makers in Argentina, Brazil, Colombia, Cuba, Mexico, Nicaragua, Peru, Portugal Spain, United Kingdom, Uruguay, and Venezuela. Systematic electronic searches of HEED, NHS EED, and LILACS were conducted to identify published economic evaluation studies in LA from 1982 onward. There is relatively little evidence of the conduct and use of EE within the health care systems in LA. Electronic searches retrieved 554 records; however, only 93 were EE. In the nine LA participating countries, broad allocation of health-care resources is primarily based on political criteria, historical records, geographical areas, and specific groups of patients and diseases. Public-health provision and inclusion of services in health-insurance package are responsibilities of the Ministry of Health. Decisions regarding the purchase of medicines are primarily made through public tenders, and mainly based on differences in clinical efficacy and the price of health technologies of interest. To expedite the process of incorporating EE as a formal tool to inform decision-making processes within the health-care systems in LA countries, two main conditions need to be fulfilled. First, adequate resources and skills need to be available to conduct EE of good quality. Second, decision-making procedures need to be modified to accommodate "evidence-based" approaches such as EE.

  14. An economic evaluation of colorectal cancer screening in primary care practice.

    Science.gov (United States)

    Meenan, Richard T; Anderson, Melissa L; Chubak, Jessica; Vernon, Sally W; Fuller, Sharon; Wang, Ching-Yun; Green, Beverly B

    2015-06-01

    Recent colorectal cancer screening studies focus on optimizing adherence. This study evaluated the cost effectiveness of interventions using electronic health records (EHRs); automated mailings; and stepped support increases to improve 2-year colorectal cancer screening adherence. Analyses were based on a parallel-design, randomized trial in which three stepped interventions (EHR-linked mailings ["automated"]; automated plus telephone assistance ["assisted"]; or automated and assisted plus nurse navigation to testing completion or refusal [navigated"]) were compared to usual care. Data were from August 2008 to November 2011, with analyses performed during 2012-2013. Implementation resources were micro-costed; research and registry development costs were excluded. Incremental cost-effectiveness ratios (ICERs) were based on number of participants current for screening per guidelines over 2 years. Bootstrapping examined robustness of results. Intervention delivery cost per participant current for screening ranged from $21 (automated) to $27 (navigated). Inclusion of induced testing costs (e.g., screening colonoscopy) lowered expenditures for automated (ICER=-$159) and assisted (ICER=-$36) relative to usual care over 2 years. Savings arose from increased fecal occult blood testing, substituting for more expensive colonoscopies in usual care. Results were broadly consistent across demographic subgroups. More intensive interventions were consistently likely to be cost effective relative to less intensive interventions, with willingness to pay values of $600-$1,200 for an additional person current for screening yielding ≥80% probability of cost effectiveness. Two-year cost effectiveness of a stepped approach to colorectal cancer screening promotion based on EHR data is indicated, but longer-term cost effectiveness requires further study. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  15. Health economic evaluation of home and hospital-based care in ...

    African Journals Online (AJOL)

    ... diabetes treatment satisfaction, diabetes knowledge and costs during three months ... Results: The cost of home-based care in insulin therapy diabetes was 61% ... Conclusions: The care at home approach for type 2 diabetic patients can be ...

  16. Economic evaluation of a pharmaceutical care program for elderly diabetic and hypertensive patients in primary health care: a 36-month randomized controlled clinical trial.

    Science.gov (United States)

    Obreli-Neto, Paulo Roque; Marusic, Srecko; Guidoni, Camilo Molino; Baldoni, André de Oliveira; Renovato, Rogério Dias; Pilger, Diogo; Cuman, Roberto Kenji Nakamura; Pereira, Leonardo Régis Leira

    2015-01-01

    Most diabetic and hypertensive patients, principally the elderly, do not achieve adequate disease control and consume 5%-15% of annual health care budgets. Previous studies verified that pharmaceutical care is useful for achieving adequate disease control in diabetes and hypertension. To evaluate the economic cost and the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) of pharmaceutical care in the management of diabetes and hypertension in elderly patients in a primary public health care system in a developing country. A 36-month randomized controlled clinical trial was performed with 200 patients who were divided into a control group (n = 100) and an intervention group (n = 100). The control group received the usual care offered by the Primary Health Care Unit (medical and nurse consultations). The intervention group received the usual care plus a pharmaceutical care intervention. The intervention and control groups were compared with regard to the direct costs of health services (i.e., general practitioner, specialist, nurse, and pharmacist appointments; emergency room visits; and drug therapy costs) and the ICER per QALY. These evaluations used the health system perspective. No statistically significant difference was found between the intervention and control groups in total direct health care costs ($281.97 ± $49.73 per patient vs. $212.28 ± $43.49 per patient, respectively; P = 0.089); pharmaceutical care added incremental costs of $69.60 (± $7.90) per patient. The ICER per QALY was $53.50 (95% CI = $51.60-$54.00; monetary amounts are given in U.S. dollars). Every clinical parameter evaluated improved for the pharmaceutical care group, whereas these clinical parameters remained unchanged in the usual care group. The difference in differences (DID) tests indicated that for each clinical parameter, the patients in the intervention group improved more from pre to post than the control group (P < 0.001). While pharmaceutical

  17. Measuring care-related quality of life of caregivers for use in economic evaluations: CarerQol tariffs for Australia, Germany, Sweden, the UK and the US.

    NARCIS (Netherlands)

    Hoefman, R.J.; Exel, N.J.A. van; Brouwer, W.B.F.

    2017-01-01

    Background: Informal care is often not included in economic evaluations in healthcare, while the impact of caregiving can be relevant for cost-effectiveness recommendations from a societal perspective. The impact of informal care can be measured and valued with the CarerQol instrument, which

  18. Applications of utility theory in the economic evaluation of health care

    NARCIS (Netherlands)

    H. Bleichrodt (Han)

    1996-01-01

    textabstractThis thesis studies the applicability of quality-adjusted life years (QALYs) and other utility based outcome measures in medical decision making and health economics. The main conclusion will be that utility based measures are more useful to model health related behaviour than has

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

    Directory of Open Access Journals (Sweden)

    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

  20. Cost-Effectiveness of a Chronic Care Model for Frail Older Adults in Primary Care: Economic Evaluation Alongside a Stepped-Wedge Cluster-Randomized Trial.

    Science.gov (United States)

    van Leeuwen, Karen M; Bosmans, Judith E; Jansen, Aaltje P D; Hoogendijk, Emiel O; Muntinga, Maaike E; van Hout, Hein P J; Nijpels, Giel; van der Horst, Henriette E; van Tulder, Maurits W

    2015-12-01

    To evaluate the cost-effectiveness of the Geriatric Care Model (GCM), an integrated care model for frail older adults based on the Chronic Care Model, with that of usual care. Economic evaluation alongside a 24-month stepped-wedge cluster-randomized controlled trial. Primary care (35 practices) in two regions in the Netherlands. Community-dwelling older adults who were frail according to their primary care physicians and the Program on Research for Integrating Services for the Maintenance of Autonomy case-finding tool questionnaire (N = 1,147). The GCM consisted of the following components: a regularly scheduled in-home comprehensive geriatric assessment by a practice nurse followed by a customized care plan, management and training of practice nurses by a geriatric expert team, and coordination of care through community network meetings and multidisciplinary team consultations of individuals with complex care needs. Outcomes were measured every 6 months and included costs from a societal perspective, health-related quality of life (Medical Outcomes Study 12-item Short-Form Survey (SF-12) physical (PCS) and mental component summary (MCS) scales), functional limitations (Katz activities of daily living and instrumental activities of daily living), and quality-adjusted life years based on the EQ-5D. Multilevel regression models adjusted for time and baseline confounders showed no significant differences in costs ($356, 95% confidence interval = -$488-1,134) and outcomes between intervention and usual care phases. Cost-effectiveness acceptability curves showed that, for the SF-12 PCS and MCS, the probability of the intervention being cost-effective was 0.76 if decision-makers are willing to pay $30,000 per point improvement on the SF-12 scales (range 0-100). For all other outcomes the probability of the intervention being cost-effective was low. Because the GCM was not cost-effective compared to usual care after 24 months of follow-up, widespread implementation

  1. Labor and health status in economic evaluation of health care. The Health and Labor Questionnaire

    NARCIS (Netherlands)

    van Roijen, L.; Essink-Bot, M. L.; Koopmanschap, M. A.; Bonsel, G.; Rutten, F. F.

    1996-01-01

    A health care program may influence both costs and health effects. We developed the Health and Labor Questionnaire (HLQ), which consists of four modules, to collect data on absence from work, reduced productivity, unpaid labor production, and labor-related problems. We applied the HLQ in several

  2. Economic bid evaluation

    International Nuclear Information System (INIS)

    Bode, T.

    1975-01-01

    When it is intended to install a new nuclear power station, the usual procedure is to invite for tenders. In due course, bids will be received from various manufacturers, out of which the most favourable one is then to be selected. Appraisal is concluded in the Economic Bid Evaluation, the purpose of which is to define the economically most favourable bid by comparing overall costs and benefits of the various alternatives. Thus, Economic Bid Evaluation is a most important instrument for deciding on award of contract. (orig.) [de

  3. Public health interventions: evaluating the economic evaluations

    Directory of Open Access Journals (Sweden)

    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...

  4. Economic evaluation of nurse staffing and nurse substitution in health care: a scoping review

    OpenAIRE

    Griffiths, P; Goryakin, Y.; Maben, J.

    2010-01-01

    OBJECTIVE: Several systematic reviews have suggested that greater nurse staffing as well as a greater proportion of registered nurses in the health workforce is associated with better patient outcomes. Others have found that nurses can substitute for doctors safely and effectively in a variety of settings. However, these reviews do not generally consider the effect of nurse staff on both patient outcomes and costs of care, and therefore say little about the cost-effectiveness of nurse-provide...

  5. Values for the ICECAP-Supportive Care Measure (ICECAP-SCM) for use in economic evaluation at end of life.

    Science.gov (United States)

    Huynh, Elisabeth; Coast, Joanna; Rose, John; Kinghorn, Philip; Flynn, Terry

    2017-09-01

    End of life care may have elements of value that go beyond health. A generic measure of the benefits of end of life care could be helpful to decision makers. Such a measure, based on the capability approach, has recently been developed: the ICECAP Supportive Care Measure. This paper reports the first valuation exercise for that measure, with data from 6020 individuals collected from an on-line general population panel during June 2013. Individuals were asked to complete a stated choice experiment that combined best-worst scaling and a standard discrete choice experiment. Analysis of the best-worst data used limited dependent variable models within the random utility framework including the multinomial logit models and latent class choice model analysis. Exploratory steps were taken to determine the similarity of the best-worst and DCE data before formal testing and pooling of the two data sources. Combined data were analysed in a heteroscedastic conditional logit model adjusting for continuous scale. Two sets of tariffs were generated, one from the best-worst data capturing only main effects, and a second from the pooled data allowing for two-way interactions. Either tariff could be used in economic evaluation of interventions at the end of life, although there are advantages and disadvantages with each. This extensive valuation exercise for the ICECAP Supportive Care Measure, with a large number of members of the general public, could be complemented in the future with best-worst scaling studies amongst those experiencing the end of life. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Discounting and decision making in the economic evaluation of health-care technologies.

    Science.gov (United States)

    Claxton, Karl; Paulden, Mike; Gravelle, Hugh; Brouwer, Werner; Culyer, Anthony J

    2011-01-01

    Discounting costs and health benefits in cost-effectiveness analysis has been the subject of recent debate - some authors suggesting a common rate for both and others suggesting a lower rate for health. We show how these views turn on key judgments of fact and value: on whether the social objective is to maximise discounted health outcomes or the present consumption value of health; on whether the budget for health care is fixed; on the expected growth in the cost-effectiveness threshold; and on the expected growth in the consumption value of health. We demonstrate that if the budget for health care is fixed and decisions are based on incremental cost effectiveness ratios (ICERs), discounting costs and health gains at the same rate is correct only if the threshold remains constant. Expecting growth in the consumption value of health does not itself justify differential rates but implies a lower rate for both. However, whether one believes that the objective should be the maximisation of the present value of health or the present consumption value of health, adopting the social time preference rate for consumption as the discount rate for costs and health gains is valid only under strong and implausible assumptions about values and facts. 2010 John Wiley & Sons, Ltd.

  7. How health economic evaluation (HEE) contributes to decision-making in public health care: the case of Brazil.

    Science.gov (United States)

    Elias, Flávia Tavares Silva; Araújo, Denizar Vianna

    2014-01-01

    The universal access to a health care system for the Brazilian population was established in 1990. Brazil is a country with no tradition in the production and use of health economic evaluation (HEE) to guide decision making in the public health system. It is only within the last two decades that HEEs using a microeconomic approach have appeared in the academic field. On a national level, HEE and Health Technology Assessment (HTA), in a wider sense, were first taken into account in 2003. Two policies deserve to be mentioned - (i) the regulation of medicines in the Brazilian market, and (ii) science, technology and innovation policy. The latter required the fostering of applied research to encourage the application of methods which employ systematic reviews and economic analyses of cost-effectiveness to guide the incorporation of technologies in the Brazilian health care system. The Ministry of Health has initiated the process of incorporating these new technologies on a federal level during the last ten years. In spite of the improvement of HEE methods at Brazilian universities and research institutes, these technologies have not yet reached the governmental bodies. In Brazil, the main challenge lies in the production, interpretation and application of HEE to all technologies within the access scheme(s), and there is limited capacity building. Setting priorities can be the solution for Brazil to be able to perform HEE for relevant technologies within the access scheme(s) while the universal coverage system struggles with a triple burden of disease. Copyright © 2014. Published by Elsevier GmbH.

  8. Quality Assessment of Published Articles in Iranian Journals Related to Economic Evaluation in Health Care Programs Based on Drummond’s Checklist: A Narrative Review

    Directory of Open Access Journals (Sweden)

    Aziz Rezapour

    2017-09-01

    Full Text Available Health economic evaluation research plays an important role in selecting cost-effective interventions. The purpose of this study was to assess the quality of published articles in Iranian journals related to economic evaluation in health care programs based on Drummond’s checklist in terms of numbers, features, and quality. In the present review study, published articles (Persian and English in Iranian journals related to economic evaluation in health care programs were searched using electronic databases. In addition, the methodological quality of articles’ structure was analyzed by Drummond’s standard checklist. Based on the inclusion criteria, the search of databases resulted in 27 articles that fully covered economic evaluation in health care programs. A review of articles in accordance with Drummond’s criteria showed that the majority of studies had flaws. The most common methodological weakness in the articles was in terms of cost calculation and valuation. Considering such methodological faults in these studies, it is anticipated that these studies would not provide an appropriate feedback to policy makers to allocate health care resources correctly and select suitable cost-effective interventions. Therefore, researchers are required to comply with the standard guidelines in order to better execute and report on economic evaluation studies.

  9. Quality Assessment of Published Articles in Iranian Journals Related to Economic Evaluation in Health Care Programs Based on Drummond's Checklist: A Narrative Review.

    Science.gov (United States)

    Rezapour, Aziz; Jafari, Abdosaleh; Mirmasoudi, Kosha; Talebianpour, Hamid

    2017-09-01

    Health economic evaluation research plays an important role in selecting cost-effective interventions. The purpose of this study was to assess the quality of published articles in Iranian journals related to economic evaluation in health care programs based on Drummond's checklist in terms of numbers, features, and quality. In the present review study, published articles (Persian and English) in Iranian journals related to economic evaluation in health care programs were searched using electronic databases. In addition, the methodological quality of articles' structure was analyzed by Drummond's standard checklist. Based on the inclusion criteria, the search of databases resulted in 27 articles that fully covered economic evaluation in health care programs. A review of articles in accordance with Drummond's criteria showed that the majority of studies had flaws. The most common methodological weakness in the articles was in terms of cost calculation and valuation. Considering such methodological faults in these studies, it is anticipated that these studies would not provide an appropriate feedback to policy makers to allocate health care resources correctly and select suitable cost-effective interventions. Therefore, researchers are required to comply with the standard guidelines in order to better execute and report on economic evaluation studies.

  10. Discounting in Economic Evaluations.

    Science.gov (United States)

    Attema, Arthur E; Brouwer, Werner B F; Claxton, Karl

    2018-05-19

    Appropriate discounting rules in economic evaluations have received considerable attention in the literature and in national guidelines for economic evaluations. Rightfully so, as discounting can be quite influential on the outcomes of economic evaluations. The most prominent controversies regarding discounting involve the basis for and height of the discount rate, whether costs and effects should be discounted at the same rate, and whether discount rates should decline or stay constant over time. Moreover, the choice for discount rules depends on the decision context one adopts as the most relevant. In this article, we review these issues and debates, and describe and discuss the current discounting recommendations of the countries publishing their national guidelines. We finish the article by proposing a research agenda.

  11. Do Economic Evaluations in Primary Care Prevention and the Management of Hypertension Conform to Good Practice Guidelines? A Systematic Review

    Directory of Open Access Journals (Sweden)

    Maria Cristina Peñaloza Ramos MA

    2016-09-01

    Full Text Available Background: Results of previous research have identified the need for further investigation into the compliance with good practice guidelines for current decision-analytic modeling (DAM. Objective: To identify the extent to which recent model-based economic evaluations of interventions focused on lowering the blood pressure (BP of patients with hypertension conform to published guidelines for DAM in health care using a five-dimension framework developed to assess compliance to DAM guidelines. Methods: A systematic review of English language articles was undertaken to identify published model-based economic evaluations that examined interventions aimed at lowering BP. The review covered the period January 2000 to March 2015 and included the following electronic bibliographic databases: EMBASE and Medline via Ovid interface and the Centre for Reviews and Dissemination’s (CRD NHS-EED. Data were extracted based on different components of good practice across five dimensions utilizing a framework to assess compliance to DAM guidelines. Results: Thirteen articles were included in this review. The review found limited compliance to good practice DAM guidelines, which was most frequently justified by the lack of data. Conclusions: The assessment of structural uncertainty cannot yet be considered common practice in primary prevention and management of hypertension, and researchers seem to face difficulties with identifying sources of structural uncertainty and then handling them correctly. Additional guidelines are needed to aid researchers in identifying and managing sources of potential structural uncertainty. Adherence to guidelines is not always possible and it does pose challenges, in particular when there are limitations due to data availability that restrict, for example, a validation process.

  12. Economic and quality of care evaluation of dialysis service models in remote Australia: protocol for a mixed methods study.

    Science.gov (United States)

    Gorham, Gillian; Howard, Kirsten; Togni, Samantha; Lawton, Paul; Hughes, Jaquelyne; Majoni, Sandawana William; Brown, Sarah; Barnes, Sue; Cass, Alan

    2017-05-03

    Australia's Northern Territory (NT) has the country's highest incidence and prevalence of kidney disease. Indigenous people from remote areas suffer the heaviest disease burden. Concerns regarding cost and sustainability limit the provision of dialysis treatments in remote areas and most Indigenous people requiring dialysis relocate to urban areas. However, this dislocation of people from their family, community and support networks may prove more costly when the broader health, societal and economic consequences for the individual, family and whole of government are considered. The Dialysis Models of Care Study is a large cross organisation mixed methods study. It includes a retrospective (2000-2014) longitudinal data linkage study of two NT cohorts: Renal Cohort 1- comprising approximately 2000 adults who received dialysis and Renal Cohort 2- comprising approximately 400 children of those adults. Linkage of administrative data sets from the Australian and New Zealand Dialysis and Transplant Registry, NT Departments of Health, Housing and Education by a specialist third party (SA/NT Datalink) will enable extraction of activity, financial and outcome data. Interviews with patients, clinicians and service providers, using a snowball technique, will canvass relevant issues and assist in determining the full costs and impacts of the five most used dialysis Models of Care. The study uses a mixed methods approach to investigate the quantitative and qualitative dimensions of the full costs and outcomes associated with the choice of particular dialysis models of care for any given patient. The study includes a large data linkage component that for the first time links health, housing and education data to fully analyse and evaluate the impact on patients, their families and the broader community, resulting from the relocation of people for treatment. The study will generate a large amount of activity, financial and qualitative data that will investigate health costs less

  13. Economic evaluation manual

    Energy Technology Data Exchange (ETDEWEB)

    1975-09-01

    An economic analysis on oil or gas property is generally accompanied by a reservoir analysis which predicts the reserves and the performance of the reservoir, recommends the optimum economic method with which to recover the reserves, and through a performance prediction indicates a time schedule for future investments and income. The requirements for a reservoir evaluation are as follows: (1) good reservoir data; (2) oil in place; (3) reservoir energy, both primary and secondary; and (4) reserve calculation and performance predictions for giving both production schedule and selection of secondary recovery mechanisms. Given the above reservoir evaluation parameters, the following are requirements for a complete economic analysis: (1) lease exploration and purchase costs; (2) capital investments schedule dependent upon a reservoir performance prediction; and (3) factors affecting net income such as anticipated selling price of oil and gas and the availability of a market, operating costs and working interest, royalty schedule, depreciation methods, depletion methods and tax schedule. (71 refs.)

  14. A difficult balancing act: policy actors' perspectives on using economic evaluation to inform health-care coverage decisions under the Universal Health Insurance Coverage scheme in Thailand.

    Science.gov (United States)

    Teerawattananon, Yot; Russell, Steve

    2008-03-01

    In Thailand, policymakers have come under increasing pressure to use economic evaluation to inform health-care resource allocation decisions, especially after the introduction of the Universal Health Insurance Coverage (UC) scheme. This article presents qualitative findings from research that assessed a range of policymakers' perspectives on the acceptability of using economic evaluation for the development of health-care benefit packages in Thailand. The policy analysis examined their opinions about existing decision-making processes for including health interventions in the UC benefit package, their understanding of health economic evaluation, and their attitudes, acceptance, and values relating to the use of the method. Semistructured interviews were conducted with 36 policy actors who play a major role or have some input into health resource allocation decisions within the Thai health-care system. These included 14 senior policymakers at the national level, 5 hospital directors, 10 health professionals, and 7 academics. Policy actors thought that economic evaluation information was relevant for decision-making because of the increasing need for rationing and more transparent criteria for making UC coverage decisions. Nevertheless, they raised several difficulties with using economic evaluation that would pose barriers to its introduction, including distrust in the method, conflicting philosophical positions and priorities compared to that of "health maximization," organizational allegiances, existing decision-making procedures that would be hard to change, and concerns about political pressure and acceptability.

  15. Economic evaluation of reprocessing

    International Nuclear Information System (INIS)

    1979-02-01

    This paper presents a progress report of work undertaken relevant to the economic evaluation of reprocessing. It sets out the assumptions to be made for the preparation of the economic ''phase diagram'' - a plot of fast reactor premium against uranium (U 3 O 8 ) price. The paper discusses the assumptions to be made in respect of present worth methodology, LWR fuel logistics, U 3 O 8 price, enrichment tails, plutonium values, fast reactor premium and proposes a set of reference costs to be used for the preparation of the phase diagram

  16. Economic evaluation of empirical antisecretory therapy versus Helicobacter pylori test for management of dyspepsia: a randomized trial in primary care.

    Science.gov (United States)

    Jarbol, Dorte Ejg; Bech, Mickael; Kragstrup, Jakob; Havelund, Troels; Schaffalitzky de Muckadell, Ove B

    2006-01-01

    An economic evaluation was performed of empirical antisecretory therapy versus test for Helicobacter pylori in the management of dyspepsia patients presenting in primary care. A randomized trial in 106 general practices in the County of Funen, Denmark, was designed to include prospective collection of clinical outcome measures and resource utilization data. Dyspepsia patients (n = 722) presenting in general practice with more than 2 weeks of epigastric pain or discomfort were managed according to one of three initial management strategies: (i) empirical antisecretory therapy, (ii) testing for Helicobacter pylori, or (iii) empirical antisecretory therapy, followed by Helicobacter pylori testing if symptoms improved. Cost-effectiveness and incremental cost-effectiveness ratios of the strategies were determined. The mean proportion of days without dyspeptic symptoms during the 1-year follow-up was 0.59 in the group treated with empirical antisecretory therapy, 0.57 in the H. pylori test-and-eradicate group, and 0.53 in the combination group. After 1 year, 23 percent, 26 percent, and 22 percent, respectively, were symptom-free. Applying the proportion of days without dyspeptic symptoms, the cost-effectiveness for empirical treatment, H. pylori test and the combination were 12,131 Danish kroner (DKK), 9,576 DKK, and 7,301 DKK, respectively. The incremental cost-effectiveness going from the combination strategy to empirical antisecretory treatment or H. pylori test alone was 54,783 DKK and 39,700 DKK per additional proportion of days without dyspeptic symptoms. Empirical antisecretory therapy confers a small insignificant benefit but costs more than strategies based on test for H. pylori and is probably not a cost-effective strategy for the management of dyspepsia in primary care.

  17. Cost-effectiveness of lumbar supports for home care workers with recurrent low back pain: an economic evaluation alongside a randomized controlled trial

    NARCIS (Netherlands)

    Roelofs, P.D.D.M.; Bierma-Zeinstra, S.M.A.; van Poppel, M.N.M.; van Mechelen, W.; Koes, B.W.; van Tulder, M.W.

    2010-01-01

    Study Design.: Economic evaluation from a societal perspective alongside a 12-months randomized-controlled trial. Objective.: To determine the cost-effectiveness of wearing a lumbar support for home care workers with recurrent low back pain (LBP) (secondary prevention). Summary of Background Data.:

  18. Bolivia programme evaluation of a package to reach an underserved population: Community-based maternal and newborn care economic analysis.

    Science.gov (United States)

    Barger, Diana; Pooley, Bertha; Dupuy, Julien Roger; Cardenas, Norma Amparo; Wall, Steve; Owen, Helen; Daviaud, Emmanuelle

    2017-10-01

    To address inequitable access to health services of indigenous communities in the Bolivian highlands, the Bolivian Ministry of Health, with the support of Save the Children-Saving Newborn Lives, conducted operational research to identify, implement and test a package of maternal and newborn interventions using locally recruited, volunteer Community Health Workers (vCHW) between 2008 and 2010. The additional annual economic and financial costs of the intervention were estimated from the perspective of the Bolivian Ministry of Health in two municipalities. The cost of intervention-stimulated increases in facility attendance was estimated with national surveillance data using a pre-post comparison, adjusted for secular trends in facility attendance. Three scale-up scenarios were modelled by varying the levels of coverage and the number (per mother and child pair) and frequency of home visits. Average cost per mother and average cost per home visit are presented in constant 2015 US$. Eighteen per cent of expectant mothers in the catchment area were visited at least once. The annualized additional financial cost of the community-based intervention across both municipalities was $43 449 of which 3% ($1324) was intervention design, 20% ($8474) set-up and 77% ($33 651) implementation. Drivers of additional costs were additional paid staff (68%), 81% of which was for management and support by local implementing partner and 19% of which was for vCHW supervision. The annual financial cost per vCHW was $595. Modelled scale-up scenarios highlight potential efficiency gains. Recognizing local imperatives to reduce inequalities by targeting underserved populations, the observed low coverage by vCHWs resulted in a high cost per mother and child pair ($296). This evaluation raises important questions about this model's ability to achieve its ultimate goals of reducing neonatal mortality and inequalities through behaviour change and increased care seeking and has served to

  19. Health economic evaluation: important principles and methodology.

    Science.gov (United States)

    Rudmik, Luke; Drummond, Michael

    2013-06-01

    To discuss health economic evaluation and improve the understanding of common methodology. This article discusses the methodology for the following types of economic evaluations: cost-minimization, cost-effectiveness, cost-utility, cost-benefit, and economic modeling. Topics include health-state utility measures, the quality-adjusted life year (QALY), uncertainty analysis, discounting, decision tree analysis, and Markov modeling. Economic evaluation is the comparative analysis of alternative courses of action in terms of both their costs and consequences. With increasing health care expenditure and limited resources, it is important for physicians to consider the economic impact of their interventions. Understanding common methodology involved in health economic evaluation will improve critical appraisal of the literature and optimize future economic evaluations. Copyright © 2012 The American Laryngological, Rhinological and Otological Society, Inc.

  20. Health Economic Evaluation of Home and Hospital-Based Care in T2D Patients on Insulin Therapy.

    Science.gov (United States)

    Janati, Ali; Sarabchian, Mohamad Ali; Mohaghegh, Bahram; Aghmohamadzadeh, Naser; Seyedin, Hesam; Gholizadeh, Masumeh; Hasanpoor, Edris

    2017-11-01

    Type 2 Diabetes is a main concern of public health in contemporary world with remarkable mortality, delayed complications and health costs. Governments are obliged to improve the quality of health care and consider appropriate strategies to reduce the costs. An alternative strategy for hospital services is care at home. Therefore, this study was aimed to evaluate the cost-effectiveness of home-based and hospital-based diabetes care. A quasi-experimental, pre-test and post-test design was conducted in Northwest Iran. Sixty subjects who were eligible insulin-treatment type 2 diabetes mellitus were randomly assigned into two equal groups to receive home-based or conventional hospital-based care. Data on glycosylated hemoglobin (HbA1c), hypoglycemia episodes, time needed to achieve glycemic control level, diabetes treatment satisfaction, diabetes knowledge and costs during three months were collected. The cost of home-based care in insulin therapy diabetes was 61% less compared with the hospital-based methods. The former strategy was cost-effective in terms of reduction in HbA1C and the time needed to achieve glycemic control. The patients in home care group were more satisfied and knowledgeable. The care at home approach for type 2 diabetic patients can be introduced and supported as a cost-effective care method in the country.

  1. Health economic evaluation in England.

    Science.gov (United States)

    Raftery, James

    2014-01-01

    The 2010 National Health Service Constitution for England specified rights and responsibilities, including health economic evaluation for the National Institute for Health and Care Excellence (NICE) and the Joint Committee on Vaccinations and Immunisations. The National Screening Committee and the Health Protection Agency also provide advice to the Government based on health economic evaluation. Each agency largely follows the methods specified by NICE. To distinguish the methods from neoclassical economics they have been termed "extra-welfarist". Key differences include measurement and valuation of both benefits (QALYs) and costs (healthcare related). Policy on discounting has also changed over time and by agency. The debate over having NICE's methods align more closely with neoclassical economics has been prominent in the ongoing development of "value based pricing". The political unacceptability of some decisions has led to special funding for technologies not recommended by NICE. These include the 2002 Multiple Sclerosis Risk Sharing Scheme and the 2010 Cancer Drugs Fund as well as special arrangements for technologies linked to the end of life and for innovation. Since 2009 Patient Access Schemes have made price reductions possible which sometimes enables drugs to meet NICE's cost-effectiveness thresholds. As a result, the National Health Service in England has denied few technologies on grounds of cost-effectiveness. Copyright © 2014. Published by Elsevier GmbH.

  2. [Economic aspects of integrated care].

    Science.gov (United States)

    Lange, A; Braun, S; Greiner, W

    2012-05-01

    For more than 10 years integrated care has been an inherent part of the German healthcare system. The aims of selective contracts are to minimize interface problems between outpatient and inpatient sectors, generalist und specialist care as well as to intensify competition. Despite repeated efforts by the legislator, comprehensive integrated healthcare is still limited to a few flagship projects. This is mainly due to low incentives on the part of both suppliers and customers. Therefore, this article focuses on the economic aspects of integrated care. From a theoretical perspective, integrated care improves efficiency in the healthcare sector by reducing interface problems and asymmetric information as well as by intensifying competition. In practice, however, there are a number of obstacles to implementation. Particularly noteworthy are the financial difficulties in addition to problems regarding sectoral budgeting and the long-term nature of investments. However, the political environment and thus the financial arrangements within the statutory health insurance seem to be more important for further development of integrated care in Germany than the financing issues.

  3. 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.

    Science.gov (United States)

    Teerawattananon, Yot; Russell, Steve

    2008-09-26

    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. 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. 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. 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.

  4. 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

    Directory of Open Access Journals (Sweden)

    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.

  5. Using Economic Evaluation to Illustrate Value of Care for Improving Patient Safety and Quality: Choosing the Right Method.

    Science.gov (United States)

    Padula, William V; Lee, Ken K H; Pronovost, Peter J

    2017-08-03

    To scale and sustain successful quality improvement (QI) interventions, it is recommended for health system leaders to calculate the economic and financial sustainability of the intervention. Many methods of economic evaluation exist, and the type of method depends on the audience: providers, researchers, and hospital executives. This is a primer to introduce cost-effectiveness analysis, budget impact analysis, and return on investment calculation as 3 distinct methods for each stakeholder needing a measurement of the value of QI at the health system level. Using cases for the QI of hospital-acquired condition rates (e.g., pressure injuries), this primer proceeds stepwise through each method beginning from the same starting point of constructing a model so that the repetition of steps is minimized and thereby capturing the attention of all intended audiences.

  6. 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.

    Science.gov (United States)

    Gerstl, Sibylle; Sauter, Justin; Kasanda, Joseph; Kinzelbach, Alfred

    2013-01-01

    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. Heads of 552 randomly selected households in 23 clusters in two health zones were interviewed using a standardised questionnaire. 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. 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.

  7. 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.

    Directory of Open Access Journals (Sweden)

    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.

  8. Economic evaluation of reprocessing

    International Nuclear Information System (INIS)

    1978-11-01

    This discussion paper first identifies the main factors which influence the economic assessment of reprocessing. It proposes the use of a diagram - the so-called ''phase diagram'' - which plots the fast reactor premium against the price of uranium. The diagram delineates areas where the once-through fuel cycle, thermal recycle and fast reactor will be the preferred choice from micro-economic considerations. The paper then goes on to consider the circumstances under which a country may or may not wish to introduce thermal recycle or fast reactors. Finally, a procedure for further discussion on economic considerations with WG4 is proposed

  9. Unpaid work in health economic evaluations.

    Science.gov (United States)

    Krol, Marieke; Brouwer, Werner

    2015-11-01

    Given its societal importance, unpaid work should be included in economic evaluations of health care technology aiming to take a societal perspective. However, in practice this does not often appear to be the case. This paper provides an overview of the current place of unpaid work in economic evaluations in theory and in practice. It does so first by summarizing recommendations regarding the inclusion of unpaid labor reported in health economic textbooks and national guidelines for economic evaluations. In total, three prominent health economic text-books were studied and 28 national health economic guidelines. The paper, moreover, provides an overview of the instruments available to measure lost unpaid labor and reports on a review of the place of unpaid labor in applied economic evaluations in the area of rheumatoid arthritis. The review was conducted by examining methodology of evaluations published between 1 March 2008 and 1 March 2013. The results of this study show that little guidance is offered regarding the inclusion of unpaid labor in economic evaluations in textbooks and guidelines. The review identified five productivity costs instruments including questions about unpaid work and 33 economic evaluations of treatments for rheumatoid arthritis of which only one included unpaid work. The results indicate that unpaid work is rarely included in applied economic evaluations of treatments for rheumatoid arthritis, despite this disease expecting to be associated with lost unpaid work. Given the strong effects of certain diseases and treatments on the ability to perform unpaid work, unpaid work currently receives less attention in economic evaluations than it deserves. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    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

  12. Economic evaluation of reprocessing

    International Nuclear Information System (INIS)

    This paper, which also appears as an Appendix to the Final Working Group 4 report, considers the economics of the four basic options available in nuclear programmes namely: the once-through cycle; reprocessing with uranium recycle and plutonium storage; reprocessing with both uranium and plutonium recycle; and the fast reactor. These options are represented by four separate areas on a ''phase diagram'' showing the relationship between relative generating costs and uranium ore price. The basic algebra defining each component of electricity cost is given for each option. The diagram can take different forms depending upon the relative magnitudes of the costs of reprocessing and MOX fuel fabrication and whether the once-through fuel cycle is acceptable or not on grounds other than strictly economic, i.e. environmental grounds. The shortcomings of this form of presentation are also identified

  13. Teaching Health Care in Introductory Economics

    Science.gov (United States)

    Cutler, David M.

    2017-01-01

    Health care is one of the economy's biggest industries, so it is natural that the health care industry should play some role in the teaching of introductory economics. There are many ways that health care can appear in such a context: in the teaching of microeconomics, as a macroeconomic issue, to learn about social welfare, and even to learn how…

  14. Comparative economic evaluation of home-based and hospital-based palliative care for terminal cancer patients.

    Science.gov (United States)

    Kato, Koki; Fukuda, Haruhisa

    2017-11-01

    To quantify the difference between adjusted costs for home-based palliative care and hospital-based palliative care in terminally ill cancer patients. We carried out a case-control study of home-care patients (cases) who had died at home between January 2009 and December 2013, and hospital-care patients (controls) who had died at a hospital between April 2008 and December 2013. Data on patient characteristics were obtained from insurance claims data and medical records. We identified the determinants of home care using a multivariate logistic regression analysis. Cox proportional hazards analysis was used to examine treatment duration in both types of care, and a generalized linear model was used to estimate the reduction in treatment costs associated with home care. The case and control groups comprised 48 and 99 patients, respectively. Home care was associated with one or more person(s) living with the patient (adjusted OR 6.54, 95% CI 1.18-36.05), required assistance for activities of daily living (adjusted OR 3.61, 95% CI 1.12-10.51), non-use of oxygen inhalation therapy (adjusted OR 12.75, 95% CI 3.53-46.02), oral or suppository opioid use (adjusted OR 5.74, 95% CI 1.11-29.54) and transdermal patch opioid use (adjusted OR 8.30, 95% CI 1.97-34.93). The adjusted hazard ratio of home care for treatment duration was not significant (adjusted OR 0.95, 95% CI 0.59-1.53). However, home care was significantly associated with a reduction of $7523 (95% CI $7093-7991, P = 0.015) in treatment costs. Despite similar treatment durations between the groups, treatment costs were substantially lower in the home-care group. These findings might inform the policymaking process for improving the home-care support system. Geriatr Gerontol Int 2017; 17: 2247-2254. © 2017 Japan Geriatrics Society.

  15. Presentation of economic evaluation results.

    Science.gov (United States)

    Chaikledkaew, Usa

    2014-05-01

    The first HTA guidelines for Thailand included a chapter outlining a set of guidelines on how best to report the findings of health economic evaluations, based on a review of best practice and existing guidelines on the presentation of economic evaluation results from around the world. In this second edition of HTA guidelines for Thailand, the recommendations build on the first edition by using a case study to illustrate how the guidelines can be applied in a real research context. The guidelines propose that all reporting include ten key elements: defining the scope of the study, selection of comparator(s), defining the type of economic evaluation, measurement of costs, measurement of clinical effects, handling time in economic evaluation studies, handling uncertainty and sensitivity analysis, presentation of the results, discussion of the results, and disclosure of funding and authors conflict of interest.

  16. Joint recovery programme versus usual care - An economic evaluation of a clinical pathway for joint replacement surgery

    NARCIS (Netherlands)

    Brunenberg, DE; van Steyn, MJ; Sluimer, JC; Bekebrede, LL; Bulstra, SK; Joore, MA

    2005-01-01

    Objective: The objective of the present study was to determine the incremental cost-effectiveness of a clinical pathway for patients undergoing joint replacement, the Joint Recovery Programme (JRP), as compared with usual care. The existing care process was revised to contain costs and shorten

  17. 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.

  18. Economic evaluation of KALIMER

    Energy Technology Data Exchange (ETDEWEB)

    Moon, Kee Hwan

    1997-01-01

    The main results of this study are as follows. To estimate the economic feasibility of KALIMER, the cost estimate model has been developed by using MS Excel software. Two scenarios were considered in this study. Scenario-A is composed of KALIMER options, which have FC1B (first commercial plant with 1 block), FC3B (first commercial plant with 3 blocks), NOAK1B (Nth-of-a-kind plant with 1 block), NOAK3B(Nth-of-a-kind plant with 3 blocks). The size of each block is 333 MWe. Scenario-B is comprised of PWR options, which have existing PWRs and new concepts of advanced PWR (APWR) in order to compare with KALIMER options. According to the results, the specific capital cost ($/kWe) and the levelized busbar cost (mills/kWh) for the NOAK3B option are 11% and 12% lower than that of FC3B option, respectively. These results from learning effects, scaling factors and some reductions of material and labor requirements for the NOAK3B option. And the levelized capital cost of NOAK3B option is 17%, 6% lower than that of existing PWR and APWR option, respectively. These results form shorten of construction times and labor requirements, modularization and design simplications etc. Therefore, decision and policy maker related to KALIMER development must note through the results of this study that multi-blocks design concept for its commercial plant should be considered to get the economy of scale effects. KALIMER has high competitiveness comparing to the existing PWRs and APWR. Therefore, it should be considered as a power supply option in the future in Korea. (author). 7 refs., 17 tabs., 7 figs.

  19. Economic evaluation of KALIMER

    International Nuclear Information System (INIS)

    Moon, Kee Hwan.

    1997-01-01

    The main results of this study are as follows. To estimate the economic feasibility of KALIMER, the cost estimate model has been developed by using MS Excel software. Two scenarios were considered in this study. Scenario-A is composed of KALIMER options, which have FC1B (first commercial plant with 1 block), FC3B (first commercial plant with 3 blocks), NOAK1B (Nth-of-a-kind plant with 1 block), NOAK3B(Nth-of-a-kind plant with 3 blocks). The size of each block is 333 MWe. Scenario-B is comprised of PWR options, which have existing PWRs and new concepts of advanced PWR (APWR) in order to compare with KALIMER options. According to the results, the specific capital cost ($/kWe) and the levelized busbar cost (mills/kWh) for the NOAK3B option are 11% and 12% lower than that of FC3B option, respectively. These results from learning effects, scaling factors and some reductions of material and labor requirements for the NOAK3B option. And the levelized capital cost of NOAK3B option is 17%, 6% lower than that of existing PWR and APWR option, respectively. These results form shorten of construction times and labor requirements, modularization and design simplications etc. Therefore, decision and policy maker related to KALIMER development must note through the results of this study that multi-blocks design concept for its commercial plant should be considered to get the economy of scale effects. KALIMER has high competitiveness comparing to the existing PWRs and APWR. Therefore, it should be considered as a power supply option in the future in Korea. (author). 7 refs., 17 tabs., 7 figs

  20. Health economic evaluation in Greece.

    Science.gov (United States)

    Rovithis, Dimitrios

    2006-01-01

    There is a growing volume of literature on health economic evaluation, with this form of analysis becoming increasingly influential at the decision-making level worldwide. The purpose of this study was to review the current state of health economic evaluation in Greece, with a view to uncovering reasons why its use in this country is limited. A search of the NHS Economic Evaluation Database was undertaken. The search included cost, cost-of-illness, cost-minimization, cost-effectiveness, cost-consequences, cost-utility, and cost-benefit analyses and was narrowed only to Greek authors undertaking solo or joint health economic evaluation in Greece. The search revealed that, in Greece, very little health economic evaluation has been undertaken. The main reason for the lack of interest is that the current chaotic healthcare system structure and financing does not provide the appropriate incentives to stimulate a powerful interest in this type of research. This condition is a result of the lack of a long-term national health policy and the hesitation of the present and past Greek governments to date to proceed to large-scale reforms because of political considerations. The Greek governments have also been content with the good health indicators being achieved. Even if it is accepted that good health prevails in Greece, slower economic growth rates, an ageing population, and the continuous immigration will place increasing pressure on healthcare resources and will necessitate a more rational use of these resources. Health economic evaluation, by weighing benefits against costs, therefore, has an important role to play.

  1. 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.)

  2. 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.

  3. Economic evaluations of homeopathy: a review.

    Science.gov (United States)

    Viksveen, Petter; Dymitr, Zofia; Simoens, Steven

    2014-03-01

    Economic evaluations of commonly used complementary and alternative medicine (CAM) therapies such as homeopathy are needed to contribute to the evidence base on which policy makers, clinicians, health-care payers, as well as patients base their health-care decisions in an era of constrained resources. To review and assess existing economic evaluations of homeopathy. Literature search was made to retrieve relevant publications using AMED, the Cochrane Library, CRD (DARE, NHS EED, HTA), EMBASE, MEDLINE, and the journal Homeopathy (former British Homoeopathic Journal). A hand search of relevant publications was carried out. Homeopathy researchers were contacted. Identified publications were independently assessed by two authors. Fifteen relevant articles reported on 14 economic evaluations of homeopathy. Thirteen studies reported numbers of patients: a total of 3,500 patients received homeopathic treatment (median 97, interquartile range 48-268), and 10 studies reported on control group participants (median 57, IQR 40-362). Eight out of 14 studies found improvements in patients' health together with cost savings. Four studies found that improvements in homeopathy patients were at least as good as in control group patients, at comparable costs. Two studies found improvements similar to conventional treatment, but at higher costs. Studies were highly heterogeneous and had several methodological weaknesses. Although the identified evidence of the costs and potential benefits of homeopathy seemed promising, studies were highly heterogeneous and had several methodological weaknesses. It is therefore not possible to draw firm conclusions based on existing economic evaluations of homeopathy. Recommendations for future research are presented.

  4. [Aspects of economic responsibility in health care].

    Science.gov (United States)

    Hauke, Eugen

    2007-01-01

    According to the final consensus of a panel of intense discussions, the health care system should/can not be excluded from the economic laws of efficiency. Appropriate adaptation of various methods and instruments of economics make these tools applicable for use in the health care system. Due to errors in the implementation of economic methods, though, the question arises who is economically responsible in the health care system. The answer is found at three different levels of the health care system. The physician plays a leading role, both personally and professionally, in being primarily responsible for the direct medical treatment of the patient. The physician's dependence, however, on the health care system reduces his independence, which markedly affects his decision-making and treatment. Management of and in health care institutions is largely independent of the profession learned. Managers and physicians acting as managers must be appropriately and duly educated in the necessary specific talents and knowledge. The organisation of a health care system should also be reserved for trained specialists where the physicians as well as other professionals are obliged to acquire the skills necessary.

  5. MICE or NICE? An economic evaluation of clinical decision rules in the diagnosis of heart failure in primary care.

    Science.gov (United States)

    Monahan, Mark; Barton, Pelham; Taylor, Clare J; Roalfe, Andrea K; Hobbs, F D Richard; Cowie, Martin; Davis, Russell; Deeks, Jon; Mant, Jonathan; McCahon, Deborah; McDonagh, Theresa; Sutton, George; Tait, Lynda

    2017-08-15

    Detection and treatment of heart failure (HF) can improve quality of life and reduce premature mortality. However, symptoms such as breathlessness are common in primary care, have a variety of causes and not all patients require cardiac imaging. In systems where healthcare resources are limited, ensuring those patients who are likely to have HF undergo appropriate and timely investigation is vital. A decision tree was developed to assess the cost-effectiveness of using the MICE (Male, Infarction, Crepitations, Edema) decision rule compared to other diagnostic strategies to identify HF patients presenting to primary care. Data from REFER (REFer for EchocaRdiogram), a HF diagnostic accuracy study, was used to determine which patients received the correct diagnosis decision. The model adopted a UK National Health Service (NHS) perspective. The current recommended National Institute for Health and Care Excellence (NICE) guidelines for identifying patients with HF was the most cost-effective option with a cost of £4400 per quality adjusted life year (QALY) gained compared to a "do nothing" strategy. That is, patients presenting with symptoms suggestive of HF should be referred straight for echocardiography if they had a history of myocardial infarction or if their NT-proBNP level was ≥400pg/ml. The MICE rule was more expensive and less effective than the other comparators. Base-case results were robust to sensitivity analyses. This represents the first cost-utility analysis comparing HF diagnostic strategies for symptomatic patients. Current guidelines in England were the most cost-effective option for identifying patients for confirmatory HF diagnosis. The low number of HF with Reduced Ejection Fraction patients (12%) in the REFER patient population limited the benefits of early detection. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  6. Cost-effectiveness of monitoring glaucoma patients in shared care: an economic evaluation alongside a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Klazinga Niek S

    2010-11-01

    Full Text Available Abstract Background Population aging increases the number of glaucoma patients which leads to higher workloads of glaucoma specialists. If stable glaucoma patients were monitored by optometrists and ophthalmic technicians in a glaucoma follow-up unit (GFU rather than by glaucoma specialists, the specialists' workload and waiting lists might be reduced. We compared costs and quality of care at the GFU with those of usual care by glaucoma specialists in the Rotterdam Eye Hospital (REH in a 30-month randomized clinical trial. Because quality of care turned out to be similar, we focus here on the costs. Methods Stable glaucoma patients were randomized between the GFU and the glaucoma specialist group. Costs per patient year were calculated from four perspectives: those of patients, the Rotterdam Eye Hospital (REH, Dutch healthcare system, and society. The outcome measures were: compliance to the protocol; patient satisfaction; stability according to the practitioner; mean difference in IOP; results of the examinations; and number of treatment changes. Results Baseline characteristics (such as age, intraocular pressure and target pressure were comparable between the GFU group (n = 410 and the glaucoma specialist group (n = 405. Despite a higher number of visits per year, mean hospital costs per patient year were lower in the GFU group (€139 vs. €161. Patients' time and travel costs were similar. Healthcare costs were significantly lower for the GFU group (€230 vs. €251, as were societal costs (€310 vs. €339 (p Conclusion We conclude that this GFU is cost-effective and deserves to be considered for implementation in other hospitals.

  7. Economic evaluation of a multifactorial, interdisciplinary intervention versus usual care to reduce frailty in frail older people.

    Science.gov (United States)

    Fairhall, Nicola; Sherrington, Catherine; Kurrle, Susan E; Lord, Stephen R; Lockwood, Keri; Howard, Kirsten; Hayes, Alison; Monaghan, Noeline; Langron, Colleen; Aggar, Christina; Cameron, Ian D

    2015-01-01

    To compare the costs and cost-effectiveness of a multifactorial interdisciplinary intervention versus usual care for older people who are frail. Cost-effectiveness study embedded within a randomized controlled trial. Community-based intervention in Sydney, Australia. A total of 241 community-dwelling people 70 years or older who met the Cardiovascular Health Study criteria for frailty. A 12-month multifactorial, interdisciplinary intervention targeting identified frailty characteristics versus usual care. Health and social service use, frailty, and health-related quality of life (EQ-5D) were measured over the 12-month intervention period. The difference between the mean cost per person for 12 months in the intervention and control groups (incremental cost) and the ratio between incremental cost and effectiveness were calculated. A total of 216 participants (90%) completed the study. The prevalence of frailty was 14.7% lower in the intervention group compared with the control group at 12 months (95% CI 2.4%-27.0%; P = .02). There was no significant between-group difference in EQ-5D utility scores. The cost for 1 extra person to transition out of frailty was $A15,955 (at 2011 prices). In the "very frail" subgroup (participants met >3 Cardiovascular Health Study frailty criteria), the intervention was both more effective and less costly than the control. A cost-effectiveness acceptability curve shows that the intervention would be cost-effective with 80% certainty if decision makers were willing to pay $A50,000 per extra person transitioning from frailty. In the very frail subpopulation, this reduced to $25,000. For frail older people residing in the community, a 12-month multifactorial intervention provided better value for money than usual care, particularly for the very frail, in whom it has a high probability of being cost saving, as well as effective. Trial registration: ACTRN12608000250336. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care

  8. Economic evaluation of fast breeders

    International Nuclear Information System (INIS)

    Vieider, G.

    1979-03-01

    In order to clarify discrepancies between different contributions to INFCE SG-5A concerning economic assessments of FBRs an independent evaluation is performed with assumptions typical for the current views in Europe and USA. As a result bounding cases are shown for the influence of the natural uranium price on the permitted FBR-capital cost premium for break-even with LWRs

  9. Accountable Care Organizations and Transaction Cost Economics.

    Science.gov (United States)

    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. © The Author(s) 2016.

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

    Science.gov (United States)

    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 sought to establish whether antibiotics (principally amoxicillin) are cost effective in patients with LRTIs, and to explore the implications of taking into account costs associated with resistance. Design and setting Multinational randomised double-blinded trial in 2060 patients with acute cough/LRTIs recruited in 12 European countries. Method A cost-utility analysis from a health system perspective with a time horizon of 28 days was conducted. The primary outcome measure was the quality-adjusted life year (QALY). Hierarchical modelling was used to estimate incremental cost-effectiveness ratios (ICERs). Results Amoxicillin was associated with an ICER of €8216 (£6540) per QALY gained when the cost of resistance was excluded. If the cost of resistance is greater than €11 (£9) per patient, then amoxicillin treatment is no longer cost effective. Including possible estimates of the cost of resistance resulted in ICERs ranging from €14 730 (£11 949) per QALY gained — when only multidrug resistance costs and health care costs are included — to €727 135 (£589 856) per QALY gained when broader societal costs are also included. Conclusion Economic evaluation of antibiotic prescribing strategies that do not include the cost of resistance may provide misleading results that could be of questionable use to policymakers. However, further work is required to estimate robust costs of resistance. PMID:27402969

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

    Science.gov (United States)

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

    2016-09-01

    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. This study sought to establish whether antibiotics (principally amoxicillin) are cost effective in patients with LRTIs, and to explore the implications of taking into account costs associated with resistance. Multinational randomised double-blinded trial in 2060 patients with acute cough/LRTIs recruited in 12 European countries. A cost-utility analysis from a health system perspective with a time horizon of 28 days was conducted. The primary outcome measure was the quality-adjusted life year (QALY). Hierarchical modelling was used to estimate incremental cost-effectiveness ratios (ICERs). Amoxicillin was associated with an ICER of €8216 (£6540) per QALY gained when the cost of resistance was excluded. If the cost of resistance is greater than €11 (£9) per patient, then amoxicillin treatment is no longer cost effective. Including possible estimates of the cost of resistance resulted in ICERs ranging from €14 730 (£11 949) per QALY gained - when only multidrug resistance costs and health care costs are included - to €727 135 (£589 856) per QALY gained when broader societal costs are also included. Economic evaluation of antibiotic prescribing strategies that do not include the cost of resistance may provide misleading results that could be of questionable use to policymakers. However, further work is required to estimate robust costs of resistance. © British Journal of General Practice 2016.

  12. Economic evaluation of stepped-care versus usual care for depression and anxiety in older adults with vision impairment : randomized controlled trial

    NARCIS (Netherlands)

    van der Aa, Hilde P A; van Rens, Ger H M B; Bosmans, Judith E; Comijs, Hannie C; van Nispen, Ruth M A

    2017-01-01

    BACKGROUND: A stepped-care program was found effective in preventing depressive and anxiety disorders in older adults with vision impairment. However, before a decision can be made about implementation, the cost-effectiveness of this program should be investigated. Therefore, we aimed to compare the

  13. Common methodological flaws in economic evaluations.

    Science.gov (United States)

    Drummond, Michael; Sculpher, Mark

    2005-07-01

    Economic evaluations are increasingly being used by those bodies such as government agencies and managed care groups that make decisions about the reimbursement of health technologies. However, several reviews of economic evaluations point to numerous deficiencies in the methodology of studies or the failure to follow published methodological guidelines. This article, written for healthcare decision-makers and other users of economic evaluations, outlines the common methodological flaws in studies, focussing on those issues that are likely to be most important when deciding on the reimbursement, or guidance for use, of health technologies. The main flaws discussed are: (i) omission of important costs or benefits; (ii) inappropriate selection of alternatives for comparison; (iii) problems in making indirect comparisons; (iv) inadequate representation of the effectiveness data; (v) inappropriate extrapolation beyond the period observed in clinical studies; (vi) excessive use of assumptions rather than data; (vii) inadequate characterization of uncertainty; (viii) problems in aggregation of results; (ix) reporting of average cost-effectiveness ratios; (x) lack of consideration of generalizability issues; and (xi) selective reporting of findings. In each case examples are given from the literature and guidance is offered on how to detect flaws in economic evaluations.

  14. An economic evaluation of the ketogenic diet versus care as usual in children and adolescents with intractable epilepsy: An interim analysis.

    Science.gov (United States)

    de Kinderen, Reina J A; Lambrechts, Danielle A J E; Wijnen, Ben F M; Postulart, Debby; Aldenkamp, Albert P; Majoie, Marian H J M; Evers, Silvia M A A

    2016-01-01

    To gain insight into the cost-effectiveness of the ketogenic (KD) diet compared with care as usual (CAU) in children and adolescents with intractable epilepsy, we conducted an economic evaluation from a societal perspective, alongside a randomized controlled trial. Participants from a tertiary epilepsy center were randomized into KD (intervention) group or CAU (control) group. Seizure frequency, quality adjusted life years (QALYs), health care costs, production losses of parents and patient, and family costs were assessed at baseline and during a 4-month study period and compared between the intervention and control groups. The incremental cost-effectiveness ratios (ICERs) (i.e., cost per QALY and cost per responder), and cost-effectiveness acceptability curves (CEACs) were calculated and presented. In total, 48 children were included in the analyses of this study (26 KD group). At 4 months, 50% of the participants in the KD group had a seizure reduction ≥50% from baseline, compared with 18.2 of the participants in the CAU group. The mean costs per patient in the CAU group were €15,245 compared to €20,986 per patient in the KD group, resulting in an ICER of €18,044 per responder. We failed, however, to measure any benefits in terms of QALYs and therefore, the cost per QALY rise high above any acceptable ceiling ratio. It might be that the quality of life instruments used in this study were not sufficiently sensitive to detect changes, or it might be that being a clinical responder is not sufficient to improve a patient's quality of life. Univariate and multivariate sensitivity analyses and nonparametric bootstrapping were performed and demonstrated the robustness of our results. The results show that the KD reduces seizure frequency. The study did not find any improvements in quality of life and, therefore, unfavorable cost per QALY ratio's resulted. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

  15. Mud-Bath Therapy in Addition to Usual Care in Bilateral Knee Osteoarthritis: An Economic Evaluation Alongside a Randomized Controlled Trial.

    Science.gov (United States)

    Ciani, Oriana; Pascarelli, Nicola Antonio; Giannitti, Chiara; Galeazzi, Mauro; Meregaglia, Michela; Fattore, Giovanni; Fioravanti, Antonella

    2017-07-01

    To perform a cost-effectiveness analysis of mud-bath therapy (MBT) in addition to usual treatment compared to usual treatment alone in patients with bilateral knee osteoarthritis (OA). An economic evaluation alongside a randomized controlled trial was conducted. Patients were randomly assigned to receive either a 2-week cycle of MBT in addition to their usual treatment or to continue routine care alone. The EuroQol 5-domain questionnaire was administered at baseline, 2 weeks, and at 3, 6, 9, and 12 months. Direct health care resource consumption data up until 12 months were derived from a daily diary given to patients and returned at prescheduled followup visits. A total of 103 patients were included (n = 53 for MBT patients; n = 50 for controls). Overall, patients in the MBT group accrued mean ± SD 0.835 ± 0.10 quality-adjusted life years (QALYs) compared to 0.753 ± 0.11 in the control group (P < 0.001). Average direct costs per patient (€303 versus €975; P < 0.001) were higher in the control group, primarily because of hospitalization for total knee replacement and use of intraarticular hyaluronic acid. Bootstrapping replications of costs and QALY sample distributions consistently indicated that the MBT therapy combined with standard therapy represents a dominant strategy as compared with standard therapy alone. The probability of MBT being cost-effective at standard cost-effectiveness thresholds (e.g., €20,000/QALY) is 100%. The results of this cost-effectiveness analysis support the use of MBT as midterm complementary therapy in the management of knee OA. © 2016, American College of Rheumatology.

  16. Protocol for the economic evaluation of a community-based intervention to improve growth among children under two in rural India (CARING trial).

    Science.gov (United States)

    Skordis-Worrall, Jolene; Sinha, Rajesh; Kumar Ojha, Amit; Sarangi, Soumendra; Nair, Nirmala; Tripathy, Prasanta; Sachdev, H S; Bhattacharyya, Sanghita; Gope, Rajkumar; Rath, Shibanand; Rath, Suchitra; Srivastava, Aradhana; Batura, Neha; Pulkki-Brännström, Anni-Maria; Costello, Anthony; Copas, Andrew; Saville, Naomi; Prost, Audrey; Haghparast-Bidgoli, Hassan

    2016-11-02

    Undernutrition affects ∼165 million children globally and contributes up to 45% of all child deaths. India has the highest proportion of global undernutrition-related morbidity and mortality. This protocol describes the planned economic evaluation of a community-based intervention to improve growth in children under 2 years of age in two rural districts of eastern India. The intervention is being evaluated through a cluster-randomised controlled trial (cRCT, the CARING trial). A cost-effectiveness and cost-utility analysis nested within a cRCT will be conducted from a societal perspective, measuring programme, provider, household and societal costs. Programme costs will be collected prospectively from project accounts using a standardised tool. These will be supplemented with time sheets and key informant interviews to inform the allocation of joint costs. Direct and indirect costs incurred by providers will be collected using key informant interviews and time use surveys. Direct and indirect household costs will be collected prospectively, using time use and consumption surveys. Incremental cost-effectiveness ratios (ICERs) will be calculated for the primary outcome measure, that is, cases of stunting prevented, and other outcomes such as cases of wasting prevented, cases of infant mortality averted, life years saved and disability-adjusted life years (DALYs) averted. Sensitivity analyses will be conducted to assess the robustness of results. There is a shortage of robust evidence regarding the cost-effectiveness of strategies to improve early child growth. As this economic evaluation is nested within a large scale, cRCT, it will contribute to understanding the fiscal space for investment in early child growth, and the relative (in)efficiency of prioritising resources to this intervention over others to prevent stunting in this and other comparable contexts. The protocol has all necessary ethical approvals and the findings will be disseminated within academia

  17. 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.

  18. Evaluation of community-level interventions to increase early initiation of antenatal care in pregnancy: protocol for the Community REACH study, a cluster randomised controlled trial with integrated process and economic evaluations.

    Science.gov (United States)

    Sawtell, Mary; Sweeney, Lorna; Wiggins, Meg; Salisbury, Cathryn; Eldridge, Sandra; Greenberg, Lauren; Hunter, Rachael; Kaur, Inderjeet; McCourt, Christine; Hatherall, Bethan; Findlay, Gail; Morris, Joanne; Reading, Sandra; Renton, Adrian; Adekoya, Ruth; Green, Belinda; Harvey, Belinda; Latham, Sarah; Patel, Kanta; Vanlessen, Logan; Harden, Angela

    2018-03-05

    The provision of high-quality maternity services is a priority for reducing inequalities in health outcomes for mothers and infants. Best practice includes women having their initial antenatal appointment within the first trimester of pregnancy in order to provide screening and support for healthy lifestyles, well-being and self-care in pregnancy. Previous research has identified inequalities in access to antenatal care, yet there is little evidence on interventions to improve early initiation of antenatal care. The Community REACH trial will assess the effectiveness and cost-effectiveness of engaging communities in the co-production and delivery of an intervention that addresses this issue. The study design is a matched cluster randomised controlled trial with integrated process and economic evaluations. The unit of randomisation is electoral ward. The intervention will be delivered in 10 wards; 10 comparator wards will have normal practice. The primary outcome is the proportion of pregnant women attending their antenatal booking appointment by the 12th completed week of pregnancy. This and a number of secondary outcomes will be assessed for cohorts of women (n = approximately 1450 per arm) who give birth 2-7 and 8-13 months after intervention delivery completion in the included wards, using routinely collected maternity data. Eight hospitals commissioned to provide maternity services in six NHS trusts in north and east London and Essex have been recruited to the study. These trusts will provide anonymised routine data for randomisation and outcomes analysis. The process evaluation will examine intervention implementation, acceptability, reach and possible causal pathways. The economic evaluation will use a cost-consequences analysis and decision model to evaluate the intervention. Targeted community engagement in the research process was a priority. Community REACH aims to increase early initiation of antenatal care using an intervention that is co-produced and

  19. The use of economic evaluation in CAM: an introductory framework.

    Science.gov (United States)

    Ford, Emily; Solomon, Daniela; Adams, Jon; Graves, Nicholas

    2010-11-11

    For CAM to feature prominently in health care decision-making there is a need to expand the evidence-base and to further incorporate economic evaluation into research priorities.In a world of scarce health care resources and an emphasis on efficiency and clinical efficacy, CAM, as indeed do all other treatments, requires rigorous evaluation to be considered in budget decision-making. Economic evaluation provides the tools to measure the costs and health consequences of CAM interventions and thereby inform decision making. This article offers CAM researchers an introductory framework for understanding, undertaking and disseminating economic evaluation. The types of economic evaluation available for the study of CAM are discussed, and decision modelling is introduced as a method for economic evaluation with much potential for use in CAM. Two types of decision models are introduced, decision trees and Markov models, along with a worked example of how each method is used to examine costs and health consequences. This is followed by a discussion of how this information is used by decision makers. Undoubtedly, economic evaluation methods form an important part of health care decision making. Without formal training it can seem a daunting task to consider economic evaluation, however, multidisciplinary teams provide an opportunity for health economists, CAM practitioners and other interested researchers, to work together to further develop the economic evaluation of CAM.

  20. The use of economic evaluation in CAM: an introductory framework

    Science.gov (United States)

    2010-01-01

    Background For CAM to feature prominently in health care decision-making there is a need to expand the evidence-base and to further incorporate economic evaluation into research priorities. In a world of scarce health care resources and an emphasis on efficiency and clinical efficacy, CAM, as indeed do all other treatments, requires rigorous evaluation to be considered in budget decision-making. Methods Economic evaluation provides the tools to measure the costs and health consequences of CAM interventions and thereby inform decision making. This article offers CAM researchers an introductory framework for understanding, undertaking and disseminating economic evaluation. The types of economic evaluation available for the study of CAM are discussed, and decision modelling is introduced as a method for economic evaluation with much potential for use in CAM. Two types of decision models are introduced, decision trees and Markov models, along with a worked example of how each method is used to examine costs and health consequences. This is followed by a discussion of how this information is used by decision makers. Conclusions Undoubtedly, economic evaluation methods form an important part of health care decision making. Without formal training it can seem a daunting task to consider economic evaluation, however, multidisciplinary teams provide an opportunity for health economists, CAM practitioners and other interested researchers, to work together to further develop the economic evaluation of CAM. PMID:21067622

  1. The use of economic evaluation in CAM: an introductory framework

    Directory of Open Access Journals (Sweden)

    Adams Jon

    2010-11-01

    Full Text Available Abstract Background For CAM to feature prominently in health care decision-making there is a need to expand the evidence-base and to further incorporate economic evaluation into research priorities. In a world of scarce health care resources and an emphasis on efficiency and clinical efficacy, CAM, as indeed do all other treatments, requires rigorous evaluation to be considered in budget decision-making. Methods Economic evaluation provides the tools to measure the costs and health consequences of CAM interventions and thereby inform decision making. This article offers CAM researchers an introductory framework for understanding, undertaking and disseminating economic evaluation. The types of economic evaluation available for the study of CAM are discussed, and decision modelling is introduced as a method for economic evaluation with much potential for use in CAM. Two types of decision models are introduced, decision trees and Markov models, along with a worked example of how each method is used to examine costs and health consequences. This is followed by a discussion of how this information is used by decision makers. Conclusions Undoubtedly, economic evaluation methods form an important part of health care decision making. Without formal training it can seem a daunting task to consider economic evaluation, however, multidisciplinary teams provide an opportunity for health economists, CAM practitioners and other interested researchers, to work together to further develop the economic evaluation of CAM.

  2. Organizational economics and health care markets.

    Science.gov (United States)

    Robinson, J C

    2001-04-01

    As health policy emphasizes the use of private sector mechanisms to pursue public sector goals, health services research needs to develop stronger conceptual frameworks for the interpretation of empirical studies of health care markets and organizations. Organizational relationships should not be interpreted exclusively in terms of competition among providers of similar services but also in terms of relationships among providers of substitute and complementary services and in terms of upstream suppliers and downstream distributors. This article illustrates the potential applicability of transactions cost economics, agency theory, and organizational economics more broadly to horizontal and vertical markets in health care. Examples are derived from organizational integration between physicians and hospitals and organizational conversions from nonprofit to for-profit ownership.

  3. Costing bias in economic evaluations.

    Science.gov (United States)

    Frappier, Julie; Tremblay, Gabriel; Charny, Mark; Cloutier, L Martin

    2015-01-01

    Determining the cost-effectiveness of healthcare interventions is key to the decision-making process in healthcare. Cost comparisons are used to demonstrate the economic value of treatment options, to evaluate the impact on the insurer budget, and are often used as a key criterion in treatment comparison and comparative effectiveness; however, little guidance is available to researchers for establishing the costing of clinical events and resource utilization. Different costing methods exist, and the choice of underlying assumptions appears to have a significant impact on the results of the costing analysis. This editorial describes the importance of the choice of the costing technique and it's potential impact on the relative cost of treatment options. This editorial also calls for a more efficient approach to healthcare intervention costing in order to ensure the use of consistent costing in the decision-making process.

  4. Protocol for the economic evaluation of a complex intervention to improve the mental health of maltreated infants and children in foster care in the UK (The BeST? services trial).

    Science.gov (United States)

    Deidda, Manuela; Boyd, Kathleen Anne; Minnis, Helen; Donaldson, Julia; Brown, Kevin; Boyer, Nicole R S; McIntosh, Emma

    2018-03-14

    Children who have experienced abuse and neglect are at increased risk of mental and physical health problems throughout life. This places an enormous burden on individuals, families and society in terms of health services, education, social care and judiciary sectors. Evidence suggests that early intervention can mitigate the negative consequences of child maltreatment, exerting long-term positive effects on the health of maltreated children entering foster care. However, evidence on cost-effectiveness of such complex interventions is limited. This protocol describes the first economic evaluation of its kind in the UK. An economic evaluation alongside the Best Services Trial (BeST?) has been prospectively designed to identify, measure and value key resource and outcome impacts arising from the New Orleans intervention model (NIM) (an infant mental health service) compared with case management (CM) (enhanced social work services as usual). A within-trial economic evaluation and long-term model from a National Health Service/Personal Social Service and a broader societal perspective will be undertaken alongside the National Institute for Health Research (NIHR)-Public Health Research Unit (PHRU)-funded randomised multicentre BeST?. BeST? aims to evaluate NIM compared with CM for maltreated children entering foster care in a UK context. Collection of Paediatric Quality of Life Inventory (PedsQL) and the recent mapping of PedsQL to EuroQol-5-Dimensions (EQ-5D) will facilitate the estimation of quality-adjusted life years specific to the infant population for a cost-utility analysis. Other effectiveness outcomes will be incorporated into a cost-effectiveness analysis (CEA) and cost-consequences analysis (CCA). A long-term economic model and multiple economic evaluation frameworks will provide decision-makers with a comprehensive, multiperspective guide regarding cost-effectiveness of NIM. The long-term population health economic model will be developed to synthesise

  5. Economic and care considerations of Marfan syndrome.

    Science.gov (United States)

    Blankart, Carl Rudolf; Milstein, Ricarda; Rybczynski, Meike; Schüler, Helke; von Kodolitsch, Yskert

    2016-10-01

    Marfan syndrome is a rare multisystem disease of the connective tissue, which affects multiple organ systems. advances in healthcare have doubled the life-expectancy of patients over the past three decades. to date, there is no comprehensive review that consolidates economic considerations and care for marfan patients. Areas covered: Present research suggests that there may be a link between treatment pattern, disease progression and economic costs of Marfan syndrome. It indicates that an early detection of the disease and preventive interventions achieve a dual aim. From a patient perspective, it may reduce the amount of emergency surgery or intervention, and inpatient stays. In addition, it slows disease progression, lowers lifestyle restrictions, reduces psychological stress, and improves health-related quality of life. Expert commentary: Early detection and preventive measures are likely to achieve a dual aim by simultaneously containing costs and reducing the number and length of inpatient stays.

  6. 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

  7. Economic evaluation studies in reproductive medicine: a systematic review of methodologic quality

    NARCIS (Netherlands)

    Moolenaar, Lobke M.; Vijgen, Sylvia M. C.; Hompes, Peter; van der Veen, Fulco; Mol, Ben Willem J.; Opmeer, Brent C.

    2013-01-01

    To evaluate the methodologic quality of economic analyses published in the field of reproductive medicine. Systematic review. Centers for reproductive care. Infertility patients. We performed a Medline search to identify economic evaluation studies in reproductive medicine. We included studies that

  8. The economics of patient-centered care.

    Science.gov (United States)

    David, Guy; Saynisch, Philip A; Smith-McLallen, Aaron

    2018-05-01

    The Patient-Centered Medical Home (PCMH) is a widely-implemented model for improving primary care, emphasizing care coordination, information technology, and process improvements. However, its treatment as an undifferentiated intervention in policy evaluation obscures meaningful variation in implementation. This heterogeneity leads to contracting inefficiencies between insurers and practices and may account for mixed evidence on its success. Using a novel dataset we group practices into meaningful implementation clusters and then link these clusters with detailed patient claims data. We find implementation choice affects performance, suggesting that generally-unobserved features of primary care reorganization influence patient outcomes. Reporting these features may be valuable to insurers and their members. Copyright © 2018 Elsevier B.V. All rights reserved.

  9. Economic Evaluation pf Antibacterial Usage in Ear, Nose and Throat ...

    African Journals Online (AJOL)

    Purpose: To carry out economic evaluation of antibacterial usage for Ear, Nose and Throat infections in a tertiary health care facility in Nigeria. Methods: Antibacterial utilisation evaluation was carried out retrospectively over one year period by reviewing 122 case notes containing 182 prescriptions of patient with Ear Nose ...

  10. Economic and clinical impact of multiple myeloma to managed care.

    Science.gov (United States)

    Cook, Richard

    2008-09-01

    costs are not the only elements to be considered, they are crucial in the management of this already costly disease. All aspects of myeloma treatment and supportive care must be evaluated and analyzed. Cost of pharmaceuticals alone must not be a driving factor in treatment decisions. Economic analyses can be used to demonstrate that the least expensive alternative is not always the most economical, and that it may not produce an optimal outcome for both the health plan and the patient. Although cost containment is clearly an important objective, quality of care is the first priority, and managed care organizations have the challenge of making balanced cost and benefit assessments.

  11. 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...

  12. End-of-Life Care Interventions: An Economic Analysis.

    Science.gov (United States)

    Pham, B; Krahn, M

    2014-01-01

    The annual cost of providing care for patients in their last year of life is estimated to account for approximately 9% of the Ontario health care budget. Access to integrated, comprehensive support and pain/symptom management appears to be inadequate and inequitable. To evaluate the cost-effectiveness of end-of-life (EoL) care interventions included in the EoL care mega-analysis. Multiple sources were used, including systematic reviews, linked health administration databases, survey data, planning documents, expert input, and additional literature searches. We conducted a literature review of cost-effectiveness studies to inform the primary economic analysis. We conducted the primary economic analysis and budget impact analysis for an Ontario cohort of decedents and their families and included interventions pertaining to team-based models of care, patient care planning discussions, educational interventions for patients and caregivers, and supportive interventions for informal caregivers. The time horizon was the last year of life. Costs were in 2013 Canadian dollars. Effectiveness measures included days at home, percentage dying at home, and quality-adjusted life-days. We developed a Markov model; model inputs were obtained from a cohort of Ontario decedents assembled from Institute for Clinical Evaluative Sciences databases and published literature. In-home palliative team care was cost-effective; it increased the chance of dying at home by 10%, increased the average number of days at home (6 days) and quality-adjusted life-days (0.5 days), and it reduced costs by approximately $4,400 per patient. Expanding in-home palliative team care to those currently not receiving such services (approximately 45,000 per year, at an annual cost of $76-108 million) is likely to improve quality of life, reduce the use of acute care resources, and save $191-$385 million in health care costs. Results for the other interventions were uncertain. The cost-effectiveness analysis was

  13. Should economic psychology care about personality structure?

    OpenAIRE

    Brandstätter, Hermann

    1993-01-01

    Since economic psychology is primarily interested in (a) how people in general react to the economic aspects of their environment, and (b) how these reactions change the economic components of their environment, as yet individual differences are not an important issue in economic-psychological research. After a brief look at how economic psychology used to deal with individual differences in the past, some suggestions are given, based on literature from social psychology, economic psychology,...

  14. The community psychiatric nurse in primary care: an economic analysis.

    Science.gov (United States)

    Gournay, K; Brooking, J

    1995-10-01

    Community psychiatric nurses (CPNs) in the United Kingdom are increasingly working in primary health care settings with less serious mental health problems. This paper describes an economic evaluation of their work using a randomized controlled trial in which 231 patients were assigned to continuing general practitioner care or one of two conditions of CPN intervention. This is only the third systematic economic analysis of community mental health nursing in the UK and the first carried out by mental health nurses. Various costs to patients, their families and the health care system were determined. Results showed that patients receiving CPN intervention experienced less absence from work and that this resulted in a net benefit. However, the cost per quality adjusted life year for intervening with this group of patients was probably several times more than for intervening with the seriously mentally ill. Therefore, if one considers both the clinical and economic results of the study, taken together with the recent results of the review of mental health nursing, there seems little justification for CPNs continuing to work in this area.

  15. The economic evaluation of pharmacotherapies for Parkinson's disease.

    Science.gov (United States)

    Coyle, D; Barbeau, M; Guttman, M; Baladi, J-F

    2003-06-01

    As well as the significant clinical effects of Parkinson's disease (PD), the disease places a high economic burden on society. Given the scarcity of health care resources, it is becoming increasingly necessary to demonstrate that new therapies for PD provide value for money in comparison with other potential interventions. This paper outlines the basic techniques of cost-effectiveness analysis and its application to PD. These techniques are illustrated by a recent economic evaluation of entacapone for use in Canada.

  16. 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

  17. 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.

  18. Economic Evaluation of Community-Based HIV Prevention Programs in Ontario: Evidence of Effectiveness in Reducing HIV Infections and Health Care Costs.

    Science.gov (United States)

    Choi, Stephanie K Y; Holtgrave, David R; Bacon, Jean; Kennedy, Rick; Lush, Joanne; McGee, Frank; Tomlinson, George A; Rourke, Sean B

    2016-06-01

    Investments in community-based HIV prevention programs in Ontario over the past two and a half decades are assumed to have had an impact on the HIV epidemic, but they have never been systematically evaluated. To help close this knowledge gap, we conducted a macro-level evaluation of investment in Ontario HIV prevention programs from the payer perspective. Our results showed that, from 1987 to 2011, province-wide community-based programs helped to avert a total of 16,672 HIV infections, saving Ontario's health care system approximately $6.5 billion Canadian dollars (range 4.8-7.5B). We also showed that these community-based HIV programs were cost-saving: from 2005 to 2011, every dollar invested in these programs saved about $5. This study is an important first step in understanding the impact of investing in community-based HIV prevention programs in Ontario and recognizing the impact that these programs have had in reducing HIV infections and health care costs.

  19. 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

    Science.gov (United States)

    2011-01-01

    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 27, 2008] PMID

  20. 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

  1. A framework for including family health spillovers in economic evaluation

    NARCIS (Netherlands)

    H. Al-Janabi (Hareth); N.J.A. van Exel (Job); W.B.F. Brouwer (Werner); J. Coast (Joanna)

    2016-01-01

    textabstractHealth 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

  2. 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......BACKGROUND: Previous studies have demonstrated the effectiveness of Internet-based interventions for depression in comparison with usual care. However, evidence on the cost-effectiveness of these interventions when delivered in outpatient clinics is lacking. The aim of this study was to estimate...... the cost-effectiveness of an Internet-based problem-solving guided self-help intervention in comparison with enhanced usual care for outpatients on a waiting list for face-to-face treatment for major depression. After the waiting list period, participants from both groups received the same treatment...

  3. Belgian guidelines for economic evaluations: second edition.

    Science.gov (United States)

    Thiry, Nancy; Neyt, Mattias; Van De Sande, Stefaan; Cleemput, Irina

    2014-12-01

    The aim of this study was to present the updated methodological guidelines for economic evaluations of healthcare interventions (drugs, medical devices, and other interventions) in Belgium. The update of the guidelines was performed by three Belgian health economists following feedback from users of the former guidelines and personal experience. The updated guidelines were discussed with a multidisciplinary team consisting of other health economists, assessors of reimbursement request files, representatives of Belgian databases and representatives of the drugs and medical devices industry. The final document was validated by three external validators that were not involved in the previous discussions. The guidelines give methodological guidance for the following components of an economic evaluation: literature review, perspective of the evaluation, definition of the target population, choice of the comparator, analytic technique and study design, calculation of costs, valuation of outcomes, definition of the time horizon, modeling, handling uncertainty and discounting. We present a reference case that can be considered as the minimal requirement for Belgian economic evaluations of health interventions. These guidelines will improve the methodological quality, transparency and uniformity of the economic evaluations performed in Belgium. The guidelines will also provide support to the researchers and assessors performing or evaluating economic evaluations.

  4. The behavioral economics of health and health care.

    Science.gov (United States)

    Rice, Thomas

    2013-01-01

    People often make decisions in health care that are not in their best interest, ranging from failing to enroll in health insurance to which they are entitled, to engaging in extremely harmful behaviors. Traditional economic theory provides a limited tool kit for improving behavior because it assumes that people make decisions in a rational way, have the mental capacity to deal with huge amounts of information and choice, and have tastes endemic to them and not open to manipulation. Melding economics with psychology, behavioral economics acknowledges that people often do not act rationally in the economic sense. It therefore offers a potentially richer set of tools than provided by traditional economic theory to understand and influence behaviors. Only recently, however, has it been applied to health care. This article provides an overview of behavioral economics, reviews some of its contributions, and shows how it can be used in health care to improve people's decisions and health.

  5. Comprehensive Health Care Economics Curriculum and Training in Radiology Residency.

    Science.gov (United States)

    Keiper, Mark; Donovan, Timothy; DeVries, Matthew

    2018-06-01

    To investigate the ability to successfully develop and institute a comprehensive health care economics skills curriculum in radiology residency training utilizing didactic lectures, case scenario exercises, and residency miniretreats. A comprehensive health care economics skills curriculum was developed to significantly expand upon the basic ACGME radiology residency milestone System-Based Practice, SBP2: Health Care Economics requirements and include additional education in business and contract negotiation, radiology sales and marketing, and governmental and private payers' influence in the practice of radiology. A health care economics curriculum for radiology residents incorporating three phases of education was developed and implemented. Phase 1 of the curriculum constituted basic education through didactic lectures covering System-Based Practice, SBP2: Health Care Economics requirements. Phase 2 constituted further, more advanced didactic lectures on radiology sales and marketing techniques as well as government and private insurers' role in the business of radiology. Phase 3 applied knowledge attained from the initial two phases to real-life case scenario exercises and radiology department business miniretreats with the remainder of the radiology department. A health care economics skills curriculum in radiology residency is attainable and essential in the education of future radiology residents in the ever-changing climate of health care economics. Institution of more comprehensive programs will likely maximize the long-term success of radiology as a specialty by identifying and educating future leaders in the field of radiology. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  6. Utilities' nuclear fuel economic evaluation methods

    International Nuclear Information System (INIS)

    Sonz, L.A.

    1987-01-01

    This paper presents the typical perceptions, methods, considerations, and procedures used by an operating electric utility in the economic evaluation of nuclear fuel preparation and utilization scenarios. The means given are probably not an exclusive review of those available, but are the author's recollection of systems employed to select and recommend preferable courses of action. Economic evaluation of proposed nuclear fuel scenarios is an important, but not exclusive, means of deciding on corporate action. If the economic evaluation is performed and coordinated with the other corporate considerations, such as technical and operational ability, electrical system operations management, tax effects, capital management, rates impact, etc., then the resultant recommendation may be employed to the benefit of the customers and, consequently, to the corporation

  7. Roadmap to a Caring Economics: Beyond Capitalism and Socialism

    Directory of Open Access Journals (Sweden)

    Riane Eisler

    2017-03-01

    Full Text Available Our unprecedented technological, economic, and environmental challenges call for thinking that goes beyond capitalism and socialism, both of which were developed in early industrial times. This article outlines a caring economics or partnerism that supports not only human survival but also human development. It proposes a full-spectrum economic map and economic policies needed at this time when many jobs are being replaced by automation. It looks at issues generally ignored in the conversation about a new economics, such as intra-household resource allocation, the devaluation of women and the ‘feminine,’ and the view that caring for people, starting in early childhood, is merely reproductive rather than productive work. It examines economic systems in the larger context of societies orienting to either end of the domination-partnership social scale, showing the interaction between social values and economic priorities. It describes new metrics that, unlike GDP and GNP, demonstrate the economic value of caring for people and nature, and proposes other steps toward a caring economics as the basis for a more humane and sustainable future.

  8. The Economics of Medicare Accountable Care Organizations

    Science.gov (United States)

    Blackstone, Erwin A.; Fuhr, Joseph P.

    2016-01-01

    Background Accountable care organizations (ACOs) have been created to improve patient care, enhance population health, and reduce costs. Medicare in particular has focused on ACOs as a primary device to improve quality and reduce costs. Objective To examine whether the current Medicare ACOs are likely to be successful. Discussion Patients receiving care in ACOs have little incentive to use low-cost quality providers. Furthermore, the start-up costs of ACOs for providers are high, contributing to the minimal financial success of ACOs. We review issues such as reducing readmissions, palliative care, and the difficulty in coordinating care, which are major cost drivers. There are mixed incentives facing hospital-controlled ACOs, whereas physician-controlled ACOs could play hospitals against each other to obtain high quality and cost reductions. This discussion also considers whether the current structure of ACOs is likely to be successful. Conclusion The question remains whether Medicare ACOs can achieve the Triple Aim of “improving the experience of care, improving the health of populations, and reducing per capita costs of health care.” Care coordination in ACOs and information technology are proving more complicated and expensive to implement than anticipated. Even if ACOs can decrease healthcare costs and increase quality, it is unclear if the current incentives system can achieve these objectives. A better public policy may be to implement a system that encompasses the best practices of successful private integrated systems rather than promoting ACOs. PMID:27066191

  9. Health Care Economics: A Study Guide for Neuroradiology Fellows, Part 1.

    Science.gov (United States)

    Weiner, S L; Tu, R; Javan, R; Taheri, M R

    2018-01-01

    Few resources are available in the medical literature for a comprehensive review of current health care economics as it relates to radiologists, specifically framed by topics defined by the Accreditation Council for Graduate Medical Education in the evaluation of neuroradiology fellows. Therefore, we present a comprehensive review article as a study guide for fellows to learn from and gain competence in the Accreditation Council for Graduate Medical Education neuroradiology milestones on health care economics. © 2018 by American Journal of Neuroradiology.

  10. Conducting systematic reviews of economic evaluations.

    Science.gov (United States)

    Gomersall, Judith Streak; Jadotte, Yuri Tertilus; Xue, Yifan; Lockwood, Suzi; Riddle, Dru; Preda, Alin

    2015-09-01

    In 2012, a working group was established to review and enhance the Joanna Briggs Institute (JBI) guidance for conducting systematic review of evidence from economic evaluations addressing a question(s) about health intervention cost-effectiveness. The objective is to present the outcomes of the working group. The group conducted three activities to inform the new guidance: review of literature on the utility/futility of systematic reviews of economic evaluations and consideration of its implications for updating the existing methodology; assessment of the critical appraisal tool in the existing guidance against criteria that promotes validity in economic evaluation research and two other commonly used tools; and a workshop. The debate in the literature on the limitations/value of systematic review of economic evidence cautions that systematic reviews of economic evaluation evidence are unlikely to generate one size fits all answers to questions about the cost-effectiveness of interventions and their comparators. Informed by this finding, the working group adjusted the framing of the objectives definition in the existing JBI methodology. The shift is away from defining the objective as to determine one cost-effectiveness measure toward summarizing study estimates of cost-effectiveness and informed by consideration of the included study characteristics (patient, setting, intervention component, etc.), identifying conditions conducive to lowering costs and maximizing health benefits. The existing critical appraisal tool was included in the new guidance. The new guidance includes the recommendation that a tool designed specifically for the purpose of appraising model-based studies be used together with the generic appraisal tool for economic evaluations assessment to evaluate model-based evaluations. The guidance produced by the group offers reviewers guidance for each step of the systematic review process, which are the same steps followed in JBI reviews of other

  11. The Care Economy, Women's Economic Empowerment, and China's ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Over the past three decades, China's economy has grown rapidly, creating ... of care work on women's labour market outcomes and economic empowerment; ... Socially equitable climate action is essential to strengthen the resilience of all ...

  12. Literature review of women's economic empowerment and the care ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2013-07-10

    Jul 10, 2013 ... Literature review of women's economic empowerment and the care ... empowerment, gender equality and growth in low-income countries. ... Mini soap operas foster financial education and inclusion of women in Peru.

  13. Engineering economic evaluations of trash segregation alternatives

    International Nuclear Information System (INIS)

    Collins, H.E.

    1987-01-01

    Health physicists are becoming increasingly involved in the selection of equipment to segregate a contaminated trash from clean trash in the effort to reduce low level waste disposal costs. Although well qualified to evaluate the technical merits of different equipment, health physicists also need to be aware of the elements of economic comparisons of different alternatives that meet all technical requirements

  14. Socio-economic project evaluation in practice

    International Nuclear Information System (INIS)

    Larsen, A.

    1995-01-01

    The theoretical basis for a socio-economic project evaluation can be doubtful and specific analyses can involve quite essential uncertainty. Among serious theoretical problems of the energy sector there should be named the price distortions, due to various taxes. The choice of the presumed calculation interest can be difficult, due to the extremely long-range energy-political planning. (EG) 10 refs

  15. Economic evaluation of reprocessing - Indicative Belgian position

    International Nuclear Information System (INIS)

    1979-05-01

    This paper, which also appears as an Appendix to the final Working Group 4 report, forms part of the overall economic evaluation of reprocessing. The indicative national position and illustrative ''phase diagram'' for Belgium is presented. Other factors which influence the Belgian viewpoint and which are not included on the phase diagram are given

  16. Economic evaluation of a lifestyle intervention in primary care to prevent type 2 diabetes mellitus and cardiovascular diseases : a randomized controlled trial

    NARCIS (Netherlands)

    van Wier, Marieke F; Lakerveld, Jeroen; Bot, Sandra D M; Chinapaw, Mai J M; Nijpels, Giel; van Tulder, Maurits W

    2013-01-01

    BACKGROUND: Cost-effectiveness studies of lifestyle interventions in people at risk for lifestyle-related diseases, addressing 'real-world' implementation, are needed. This study examines the cost-effectiveness of a primary care intervention from a societal perspective, compared with provision of

  17. 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.

  18. An economic evaluation of solar radiation management

    International Nuclear Information System (INIS)

    Aaheim, Asbjørn; Romstad, Bård; Wei, Taoyuan; Kristjánsson, Jón Egill; Muri, Helene; Niemeier, Ulrike; Schmidt, Hauke

    2015-01-01

    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

  19. Economic evaluation of a mentorship and enhanced supervision program to improve quality of integrated management of childhood illness care in rural Rwanda.

    Science.gov (United States)

    Manzi, Anatole; Mugunga, Jean Claude; Iyer, Hari S; Magge, Hema; Nkikabahizi, Fulgence; Hirschhorn, Lisa R

    2018-01-01

    Integrated management of childhood illness (IMCI) can reduce under-5 morbidity and mortality in low-income settings. A program to strengthen IMCI practices through Mentorship and Enhanced Supervision at Health centers (MESH) was implemented in two rural districts in eastern Rwanda in 2010. We estimated cost per improvement in quality of care as measured by the difference in correct diagnosis and correct treatment at baseline and 12 months of MESH. Costs of developing and implementing MESH were estimated in 2011 United States Dollars (USD) from the provider perspective using both top-down and bottom-up approaches, from programmatic financial records and site-level data. Improvement in quality of care attributed to MESH was measured through case management observations (n = 292 cases at baseline, 413 cases at 12 months), with outcomes from the intervention already published. Sensitivity analyses were conducted to assess uncertainty under different assumptions of quality of care and patient volume. The total annual cost of MESH was US$ 27,955.74 and the average cost added by MESH per IMCI patient was US$1.06. Salary and benefits accounted for the majority of total annual costs (US$22,400 /year). Improvements in quality of care after 12 months of MESH implementation cost US$2.95 per additional child correctly diagnosed and $5.30 per additional child correctly treated. The incremental costs per additional child correctly diagnosed and child correctly treated suggest that MESH could be an affordable method for improving IMCI quality of care elsewhere in Rwanda and similar settings. Integrating MESH into existing supervision systems would further reduce costs, increasing potential for spread.

  20. 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. © The Author(s) 2015.

  1. Pressure ulcers management: an economic evaluation.

    Science.gov (United States)

    Foglia, E; Restelli, U; Napoletano, A M; Coclite, D; Porazzi, E; Bonfanti, M; Croce, D

    2012-03-01

    Pressure ulcer management represents a growing problem for medical and social health care systems all over the world, particularly in European Union countries where the incidence of pressure ulcers in older persons (> 60 years of age) is predicted to rise. The aim of this study was to provide evidence for the lower impact on economic resources of using advanced dressings for the treatment of pressure ulcers with respect to conventional simple dressings. Two different models of analysis, derived from Activity Based Costing and Health Technology Assessment, were used to measure, over a 30-day period, the direct costs incurred by pressure ulcer treatment for community-residing patients receiving integrated home care. Although the mean cost per home care visit was higher in the advanced dressings patient group than in the simple dressings patient one (E 22.31 versus E 16.03), analysis of the data revealed that the cost of using advanced dressings was lower due to fewer home care visits (22 versus 11). The results underline the fact that decision-makers need to improve their understanding of the advantages of taking a long-term view with regards to the purchase and use of materials. This could produce considerable savings of resources in addition to improving treatment efficacy for the benefit of patients and the health care system.

  2. Evaluation as institution: a contractarian argument for needs-based economic evaluation.

    Science.gov (United States)

    Rogowski, Wolf H

    2018-06-13

    There is a gap between health economic evaluation methods and the value judgments of coverage decision makers, at least in Germany. Measuring preference satisfaction has been claimed to be inappropriate for allocating health care resources, e.g. because it disregards medical need. The existing methods oriented at medical need have been claimed to disregard non-consequentialist fairness concerns. The aim of this article is to propose a new, contractarian argument for justifying needs-based economic evaluation. It is based on consent rather than maximization of some impersonal unit of value to accommodate the fairness concerns. This conceptual paper draws upon contractarian ethics and constitution economics to show how economic evaluation can be viewed as an institution to overcome societal conflicts in the allocation of scarce health care resources. For this, the problem of allocating scarce health care resources in a society is reconstructed as a social dilemma. Both disadvantaged patients and affluent healthy individuals can be argued to share interests in a societal contract to provide technologies which ameliorate medical need, based on progressive funding. The use of needs-based economic evaluation methods for coverage determination can be interpreted as institutions for conflict resolution as far as they use consented criteria to ensure the social contract's sustainability and avoid implicit rationing or unaffordable contribution rates. This justifies the use of needs-based evaluation methods by Pareto-superiority and consent (rather than by some needs-based value function per se). The view of economic evaluation presented here may help account for fairness concerns in the further development of evaluation methods. This is because it directs the attention away from determining some unit of value to be maximized towards determining those persons who are most likely not to consent and meeting their concerns. Following this direction in methods development is

  3. [The economic-industrial health care complex and the social and economic dimension of development].

    Science.gov (United States)

    Gadelha, Carlos Augusto Grabois; Costa, Laís Silveira; Maldonado, José

    2012-12-01

    The strategic role of health care in the national development agenda has been increasingly recognized and institutionalized. In addition to its importance as a structuring element of the Social Welfare State, health care plays a leading role in the generation of innovation - an essential element for competitiveness in knowledge society. However, health care's productive basis is still fragile, and this negatively affects both the universal provision of health care services and Brazil's competitive inclusion in the globalized environment. This situation suggests the need of a more systematic analysis of the complex relationships among productive, technological and social interests in the scope of health care. Consequently, it is necessary to produce further knowledge about the Economic-Industrial Health Care Complex due to its potential for contributing to a socially inclusive development model. This means reversing the hierarchy between economic and social interests in the sanitary field, thus minimizing the vulnerability of the Brazilian health care policy.

  4. 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: A randomized controlled trial.

    Science.gov (United States)

    Kolovos, Spyros; Kenter, Robin M F; Bosmans, Judith E; Beekman, Aartjan T F; Cuijpers, Pim; Kok, Robin N; van Straten, Annemieke

    2016-08-01

    Previous studies have demonstrated the effectiveness of Internet-based interventions for depression in comparison with usual care. However, evidence on the cost-effectiveness of these interventions when delivered in outpatient clinics is lacking. The aim of this study was to estimate the cost-effectiveness of an Internet-based problem-solving guided self-help intervention in comparison with enhanced usual care for outpatients on a waiting list for face-to-face treatment for major depression. After the waiting list period, participants from both groups received the same treatment at outpatient clinics. 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. 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 that the maximum probability of the intervention being cost-effective in comparison with usual care was 0.57 at a ceiling ratio of €15,000/additional point of improvement in CES-D, and 0.25 and 0.30 for an additional response to treatment and an extra QALY respectively, at a ceiling ratio of €30,000. Sensitivity analysis showed that from a mental healthcare provider perspective the probability of the intervention being cost-effective was 0.68 for a ceiling ratio of 0 €/additional unit of effect for the CES-D score, response to treatment and QALYs. As the ceiling ratio increased this probability decreased, because the mean costs in the intervention group were lower than the mean costs in the usual care group. The patients in the intervention group showed low adherence to the Internet-based treatment

  5. A Health Economics Response to the Review of the Liverpool Care Pathway

    Science.gov (United States)

    Coast, Joanna

    2013-01-01

    Abstract Background: In 2011 the Palliative Care Funding Review highlighted concerns about the funding, provision, and quality of care at the end of life. Two years on, an independent review of the Liverpool Care Pathway—prompted by a storm of negative media coverage— has raised concerns around a lack of funding, availability of support for the dying and their relatives, and patient centered care. There are recommendations to increase funding through a national tariff for palliative care services, address inconsistencies, and replace the Liverpool Care Pathway with individual end-of-life care plans. Objective: This paper explores the economic implications of the review's recommendations and links these to inadequacies with the current economic framework currently recommended for use in the United Kingdom by the National Institute for Health and Care Excellence, before highlighting aspects of ongoing research aimed at addressing these inadequacies. Methods: As well as the published report More Care, Less Pathway, we draw upon preliminary qualitative evidence from 19 semistructured interviews conducted with academics specializing in economics and/or end-of-life care. Conclusions: While there is a need for increased funding in the short term (highlighted in recent reviews), increasing funding to services that have little evidence base appears to be an irresponsible long-term strategy. Hence there should also be increased investment in research and increased emphasis in particular on developing economic tools to evaluate services. PMID:24199790

  6. Health care: economic impact of caring for geriatric patients.

    Science.gov (United States)

    Rich, Preston B; Adams, Sasha D

    2015-02-01

    National health care expenditures constitute a continuously expanding component of the US economy. Health care resources are distributed unequally among the population, and geriatric patients are disproportionately represented. Characterizing this group of individuals that accounts for the largest percentage of US health spending may facilitate the introduction of targeted interventions in key high-impact areas. Changing demographics, an increasing incidence of chronic disease and progressive disability, rapid technological advances, and systemic market failures in the health care sector combine to drive cost. A multidisciplinary approach will become increasingly necessary to balance the delicate relationship between our constrained supply and increasing demand. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Economic framework for information system evaluation

    International Nuclear Information System (INIS)

    King, D.W.; Roderer, N.K.

    1979-01-01

    In the evaluation of complex information systems, it is useful to work within a generalized economic framework. This framework is based on consideration of four evaluation levels, including those associated with the overall system, system functions, products and services, and activities. Measures of cost and output can be defined at each level, with output measures related to volume of activity, performance, effectiveness, and benefit. The description of this framework includes definitions of the terminology used. Examples of the application of the framework to specific information system evaluations are also given. 4 figures

  8. Cost of illness and economic evaluation in rare diseases.

    Science.gov (United States)

    López-Bastida, Julio; Oliva-Moreno, Juan

    2010-01-01

    Rare diseases are a major cause of morbidity and mortality in high income countries and have major repercussions on individuals and health care systems. This chapter examines the health economy of rare diseases from two different perspectives: firstly, the study of the economic impact of rare diseases (Cost of Illness studies); and, secondly, cost-effectiveness evaluation, which evaluates both the costs and results of the health care technologies applied in rare diseases. From the point of view of economics, health resource allocation is based on the principle of scarcity, as there are not - and never will be- sufficient resources for all worthy objectives. Hence, policy makers should balance costs and health outcomes. Rare diseases may well represent a significant societal burden that should rightly receive appropriate prioritisation of health care resources. As new and seemingly expensive health care technologies are developed for rare diseases, it will become increasingly important to evaluate potential and real impact of these new technologies in both dimensions: social costs and health outcomes.

  9. Latin American Clinical Epidemiology Network Series - Paper 4: Economic evaluation of Kangaroo Mother Care: cost utility analysis of results from a randomized controlled trial conducted in Bogotá.

    Science.gov (United States)

    Ruiz, Juan Gabriel; Charpak, Nathalie; Castillo, Mario; Bernal, Astrid; Ríos, John; Trujillo, Tammy; Córdoba, María Adelaida

    2017-06-01

    Although kangaroo mother care (KMC) has been shown to be safe and effective in randomized controlled trials (RCTs), there are no published complete economic evaluations including the three components of the full intervention. A cost utility analysis performed on the results of an RCT conducted in Bogotá, Colombia between 1993 and 1996. Hospital and ambulatory costs were estimated by microcosting in a sample of preterm infants from a University Hospital in Bogotá in 2011 and at a KMC clinic in the same period. Utility scores were assigned by experts by means of (1) direct ordering and scoring discrete health states and (2) constructing a multi-attribute utility function. Ninety-five percent confidence intervals (CIs) for the incremental cost-utility ratios (ICURs) were computed by the Fiellers theorem method. One-way sensitivity analysis on price estimates for valuing costs was performed. ICUR at 1 year of corrected age was $ -1,546 per extra quality-adjusted life year gained using the KMC method (95% CI $ -7,963 to $ 4,910). In Bogotá, the use of KMC is dominant: more effective and cost-saving. Although results from an economic analysis should not be extrapolated to different systems and communities, this dominant result suggests that KMC could be cost-effective in similar low and middle income countries settings. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Economic evaluation of nuclear plant project

    International Nuclear Information System (INIS)

    Tolba, Adel.

    1988-01-01

    The present work is an attempt to prepare a ''fair price'' estimate to serve as bench mark in the course of economic evaluation of bids to construct nuclear power plants. The methodology of determining the present value of all capital investment is used. Running costs of nuclear fuel, operation, and maintenance are also determined. As a result, levelized energy cost is calculated. Sensitivity analysis for different parameters has been conducted, and the results of which are included in this paper

  11. Economic evaluation of reprocessing. Indicative Netherlands position

    International Nuclear Information System (INIS)

    1979-05-01

    The paper, which also appears as an Appendix to the final Working Group 4 report, forms part of the overall economic evaluation of reprocessing. The indicative national position and illustrative ''phase diagram'' for the Netherlands is presented. Two alternative scenarios have been assumed for the variation of uranium price in the future; a 2% per annum price rise and a 5% per annum price rise

  12. 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...

  13. Risks and benefits in health care: the view from economics.

    Science.gov (United States)

    Pauly, Mark V

    2007-01-01

    This paper discusses the meaning of the term risk from the economic perspective. It argues that some consumer decisions about insurance and the use of medical care are consistent with the economic model, but many are not. When decisions are inconsistent, real-world democratic governments' ability to intervene is limited by politicians' desire to please voters. The choice of incomplete insurance coverage in private markets is often said to present a case for governmental intervention, but the choice of insurance design in the Medicare drug benefit shows that the political process also may fail to select insurance that is optimal from an economic viewpoint.

  14. Economic evaluation of bids for nuclear power plants. 1999 edition

    International Nuclear Information System (INIS)

    2000-01-01

    dominant role and lead to long term impact on the bid projects. Furthermore, the licensing of the various concepts has to be checked carefully. In addition to the NPP itself, requirements for fuel fabrication facilities, intermediate storage facilities and final disposal of high level radioactive waste have to be planned carefully in a nuclear programme. Furthermore, access to a storage area for low and medium level radioactive waste must be provided. The respective licensing authorities have to be established and qualified, a process which is normally organized with foreign partners. The main objectives of the economic bid evaluation are to establish the plant costs and to rank the available bids with the help of an economic figure of merit. This requires consideration of the following points: Results of the technical bid evaluation; Capital investment costs; Nuclear fuel cycle costs; Operation and maintenance costs; Owner's costs, Commercial and contractual terms and conditions, Financing proposals, Economic parameters, Domestic participation and technology transfer, Fringe benefits and spin-off effects, Political and socioeconomic aspects. It should be clear to the user of this report that it is not possible to have a fully comprehensive manual for the treatment of all feasible types and combinations of contract approach. However, this report aims at providing the user with the following valuable information: General outline of the bid evaluation process; Detailed description of, and guidelines for, the economic bid evaluation process; Examples of different factors that should be taken into account in the economic bid evaluation; Description of methodologies and analytical tools applicable to the economic bid evaluation; Detailed description of the IAEA account system, which allows great flexibility in the technical and economic bid evaluation process; An economic bid evaluation computer program updated to the state of the art. The structure of the IAEA account system

  15. EVALUATION OF HEALTH CARE QUALITY

    Directory of Open Access Journals (Sweden)

    Zlatko Fras

    2002-12-01

    Full Text Available Background. It is possible to evaluate quality characteristics of different aspects of health care by many different measures. For these purposes, in various countries all over the world authorised institutions and/or agencies developed number of methodological accessories, criteria and tools for selection of more or less appropriately and optimally defined criteria and indicators of quality clinical performance.Conclusions. Recently we have started with activities for gradual introduction of systematic monitoring, assessment and improvement of quality of health care in Slovenia as well. One of the key prerequisites for selection of valid, practicable, efficient and reliable quality indicators is the establishment of continuous and methodologically appropriate system of development and implementation of evidence-based clinical practice guidelines. We started this process within the framework of national Health Sector Management Project, where all potential key stakeholders from health care sector participated. Also the project on Quality in Health Care in Slovenia, started, leaded and performed by the Medical Chamber of Slovenia, represents one of the important parallel starting steps towards assurance of reliable data on development/establishment of appropriate set of quality indicators and standards of health care in our country.

  16. 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

  17. Protocol for an economic evaluation alongside 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

    NARCIS (Netherlands)

    van de Velde, G.; Cote, P.; Bayoumi, A.M.; Cassidy, J.D.; Boyle, E.; Shearer, H.M.; Stupar, M.; Jacobs, C.; Ammendolia, C.; Carette, S.; van Tulder, M.W.

    2011-01-01

    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

  18. Evaluation of Health Economics in Radiation Oncology: A Systematic Review

    Energy Technology Data Exchange (ETDEWEB)

    Nguyen, Timothy K.; Goodman, Chris D. [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada); Boldt, R. Gabriel [London Health Sciences Centre, London, Ontario (Canada); Warner, Andrew; Palma, David A. [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada); Rodrigues, George B. [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada); Department of Epidemiology and Biostatistics, Western University, London, Ontario (Canada); Lock, Michael I. [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada); Mishra, Mark V. [Department of Radiation Oncology, University of Maryland, Baltimore, Maryland (United States); Zaric, Gregory S. [Department of Epidemiology and Biostatistics, Western University, London, Ontario (Canada); Ivey Business School, Western University, London, Ontario (Canada); Louie, Alexander V., E-mail: Dr.alexlouie@gmail.com [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada); Department of Epidemiology and Biostatistics, Western University, London, Ontario (Canada)

    2016-04-01

    Purpose: Despite the rising costs in radiation oncology, the impact of health economics research on radiation therapy practice analysis patterns is unclear. We performed a systematic review of cost-effectiveness analyses (CEAs) and cost-utility analyses (CUAs) to identify trends in reporting quality in the radiation oncology literature over time. Methods and Materials: A systematic review of radiation oncology economic evaluations up to 2014 was performed, using MEDLINE and EMBASE databases. The Consolidated Health Economic Evaluation Reporting Standards guideline informed data abstraction variables including study demographics, economic parameters, and methodological details. Tufts Medical Center CEA registry quality scores provided a basis for qualitative assessment of included studies. Studies were stratified by 3 time periods (1995-2004, 2005-2009, and 2010-2014). The Cochran-Armitage trend test and linear trend test were used to identify trends over time. Results: In total, 102 articles were selected for final review. Most studies were in the context of a model (61%) or clinical trial (28%). Many studies lacked a conflict of interest (COI) statement (67%), a sponsorship statement (48%), a reported study time horizon (35%), and the use of discounting (29%). There was a significant increase over time in the reporting of a COI statement (P<.001), health care payer perspective (P=.019), sensitivity analyses using multivariate (P=.043) or probabilistic methods (P=.011), incremental cost-effectiveness threshold (P<.001), secondary source utility weights (P=.010), and cost effectiveness acceptability curves (P=.049). There was a trend toward improvement in Tuft scores over time (P=.065). Conclusions: Recent reports demonstrate improved reporting rates in economic evaluations; however, there remains significant room for improvement as reporting rates are still suboptimal. As fiscal pressures rise, we will rely on economic assessments to guide our practice decisions

  19. Evaluation of Health Economics in Radiation Oncology: A Systematic Review

    International Nuclear Information System (INIS)

    Nguyen, Timothy K.; Goodman, Chris D.; Boldt, R. Gabriel; Warner, Andrew; Palma, David A.; Rodrigues, George B.; Lock, Michael I.; Mishra, Mark V.; Zaric, Gregory S.; Louie, Alexander V.

    2016-01-01

    Purpose: Despite the rising costs in radiation oncology, the impact of health economics research on radiation therapy practice analysis patterns is unclear. We performed a systematic review of cost-effectiveness analyses (CEAs) and cost-utility analyses (CUAs) to identify trends in reporting quality in the radiation oncology literature over time. Methods and Materials: A systematic review of radiation oncology economic evaluations up to 2014 was performed, using MEDLINE and EMBASE databases. The Consolidated Health Economic Evaluation Reporting Standards guideline informed data abstraction variables including study demographics, economic parameters, and methodological details. Tufts Medical Center CEA registry quality scores provided a basis for qualitative assessment of included studies. Studies were stratified by 3 time periods (1995-2004, 2005-2009, and 2010-2014). The Cochran-Armitage trend test and linear trend test were used to identify trends over time. Results: In total, 102 articles were selected for final review. Most studies were in the context of a model (61%) or clinical trial (28%). Many studies lacked a conflict of interest (COI) statement (67%), a sponsorship statement (48%), a reported study time horizon (35%), and the use of discounting (29%). There was a significant increase over time in the reporting of a COI statement (P<.001), health care payer perspective (P=.019), sensitivity analyses using multivariate (P=.043) or probabilistic methods (P=.011), incremental cost-effectiveness threshold (P<.001), secondary source utility weights (P=.010), and cost effectiveness acceptability curves (P=.049). There was a trend toward improvement in Tuft scores over time (P=.065). Conclusions: Recent reports demonstrate improved reporting rates in economic evaluations; however, there remains significant room for improvement as reporting rates are still suboptimal. As fiscal pressures rise, we will rely on economic assessments to guide our practice decisions

  20. 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.

  1. Economic evaluation of reprocessing - Indicative Canadian position

    International Nuclear Information System (INIS)

    1979-05-01

    This paper, which also appears as an Appendix to the final Working Group 4 report, forms part of the overall economic evaluation of reprocessing. The indicative national position and illustrative ''phase diagram'' for Canada is presented. Three fuel cycles are considered. (1) CANDU operating on the natural uranium, once-through fuel cycle. (2) CANDU operating with low enrichment (1.2%) once-through fuel cycle. (3) CANDU operating with recycle of plutonium and depleted uranium which has been extracted from spent CANDU natural uranium fuel. The diagrams show that reprocessing and recycle of fuel can be used to reduce further the sensitivity of CANDU fuelling costs to increasing uranium ore price

  2. Desalination Economic Evaluation Program (DEEP). User's manual

    International Nuclear Information System (INIS)

    2000-01-01

    DEEP (formerly named ''Co-generation and Desalination Economic Evaluation'' Spreadsheet, CDEE) has been developed originally by General Atomics under contract, and has been used in the IAEA's feasibility studies. For further confidence in the software, it was validated in March 1998. After that, a user friendly version has been issued under the name of DEEP at the end of 1998. DEEP output includes the levelised cost of water and power, a breakdown of cost components, energy consumption and net saleable power for each selected option. Specific power plants can be modelled by adjustment of input data including design power, power cycle parameters and costs

  3. Health care prices, the federal budget, and economic growth.

    Science.gov (United States)

    Monaco, R M; Phelps, J H

    1995-01-01

    Rising health care spending, led by rising prices, has had an enormous impact on the economy, especially on the federal budget. Our work shows that if rapid growth in health care prices continues, under current institutional arrangements, real economic growth and employment will be lower during the next two decades than if health price inflation were somehow reduced. How big the losses are and which sectors bear the brunt of the costs vary depending on how society chooses to fund the federal budget deficit that stems from the rising cost of federal health care programs.

  4. The economic burden of personality disorders in mental health care

    NARCIS (Netherlands)

    Soeteman, D.I.; Hakkaart-van Roijen, L.; Verheul, R.; Busschbach, J.J.V.

    2008-01-01

    Objective: Some evidence suggests that personality disorders are associated with a high economic burden due to, for example, a high demand on psychiatric, health, and social care services. However, state-of-the-art cost studies for the broad range of personality disorder diagnoses are lacking. The

  5. Economic evaluations and Randomized trials in spinal disorders: Principles and methods

    DEFF Research Database (Denmark)

    Korthals-de Bos, I; Van Tulder, M; Van Dieten, H

    2004-01-01

    Study Design. Descriptive methodologic recommendations. Objective. To help researchers designing, conducting, and reporting economic evaluations in the field of back and neck pain. Summary of Background Data. Economic evaluations of both existing and new therapeutic interventions are becoming...... increasingly important. There is a need to improve the methods of economic evaluations in the field of spinal disorders. Materials and Methods. To improve the methods of economic evaluations in the field of spinal disorders, this article describes the various steps in an economic evaluation, using as example...... a study on the cost-effectiveness of manual therapy, physiotherapy, and usual care provided by the general practitioner for patients with neck pain. Results. An economic evaluation is a study in which two or more interventions are systematically compared with regard to both costs and effects...

  6. Payment and Economic Evaluation of Integrated Care

    NARCIS (Netherlands)

    A. Tsiachristas (Apostolos)

    2015-01-01

    markdownabstract__Abstract__ The rapid growth and ageing of global population accompanied by unhealthy health behaviour (i.e. smoking, physical inactivity, unhealthy diet and harmful use of alcohol) lead to increasing prevalence of chronic diseases. Worldwide, non-communicable diseases (NCDs)

  7. Research priorities in health economics and funding for palliative care: views of an international think tank.

    Science.gov (United States)

    Harding, Richard; Gomes, Barbara; Foley, Kathleen M; Higginson, Irene J

    2009-07-01

    At the conclusion of the November 2007 meeting, the assembled international expert group identified the research agenda. The adoption of this agenda would take forward health economic research in palliative care, and generate the necessary data for improved funding decision making, and resource allocation. Recommendations for study included international comparative research into the components of care and settings, evaluative studies, methodologic development and strategies to initiate studies, and make better use of data.

  8. Indonesian heath care and the economic crisis: is managed care the needed reform?

    Science.gov (United States)

    Hotchkiss, D R; Jacobalis, S

    1999-03-01

    The ramifications of the current economic crisis are being felt throughout Asia, but problems are particularly acute in Indonesia; in the midst of high inflation and unemployment the government is considering expanding managed care reform. In this paper, we discuss the impact of the recent economic crisis on the health sector in Indonesia, and analyze the potential for implementing effective reform following the managed care model. The health sector is discussed, highlighting pre-existing problems in the health care supply environment. The determinants of the economic crisis are summarized, and the broad impacts of the crisis to date on the health sector are assessed. Next the prospects for success of current managed-care reform proposals are examined in some detail: viability of expanded managed care reform measures are assessed in light of the continuing crisis and its likely impacts on the consumers and suppliers of health care. Analysis of the potential impact of the continuing crisis focuses on key participants in health care reform: households, the government, and private health care providers. In conclusion the potential viability of managed care appears poor, given the current economic, political, and institutional conditions and likely future impacts, and suggest some alternative reform measures.

  9. Economic Evaluation and Impact Analysis of SMART

    International Nuclear Information System (INIS)

    Jeong, K. H.; Kim, J. H.; Boo, K. D.; Park, S. B.

    2010-07-01

    The objective of this study is to analyze the economic value and contribution to the national economy of the SMART project. This study tries to evaluate three kinds of values of the project separately; national economy contribution, the financial cost-benefit analysis and intangible social benefit of the project. The research methods are Net Present Valuation (NPT) for the first analysis, Input-Output (IO) model for the second analysis and Contingent Valuation Method(CVM) for the last analysis. This study tries to answer for the following questions: (1) how much does the project affect on Korean national economy in area of construction, electricity generation and export? (2) what is the financial cost - benefit assessment of the SMART project which is of the most interest to the private sector constructing the reactor? (3) how much is the project's intangible social gains in that it brings Korea's scientific development in area of nuclear generation and improves Korea's global standing? Main Results of Research are (1) Domestic Construction and Electricity Generation of the 1st Reactor A. Contribution to the National Economy Production inducing effect by the domestic construction and generation of the 1st reactor amounts to 1,801 ∼2,059 billion won, value added inducing effect amounts to 789∼919 billion won, and employment inducing effect amounts to 11,015∼12, 856 men. B. Financial Cost-Benefit Assessment Financial cost - benefit of the domestic construction and generation of the 1st reactor turns out to be economically non-profitable from the point of view of private companies participating the project, by having economic loss over all scenarios of construction costs. C. Combining Financial Cost-Benefit Assessment and Contribution to the National Economy's Value-Added Combining financial cost - benefit and value added inducing effect of the domestic construction and generation of the 1st reactor turns out to be economically valid from the point of view of

  10. Applying the AHP in Health Economic Evaluations of New Technology.

    NARCIS (Netherlands)

    Hummel, J. Marjan; Steuten, Lotte Maria Gertruda; Groothuis-Oudshoorn, Catharina Gerarda Maria; IJzerman, Maarten Joost

    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

  11. Health Care Economics: A Study Guide for Neuroradiology Fellows, Part 2.

    Science.gov (United States)

    Weiner, S L; Tu, R; Javan, R; Taheri, M R

    2018-01-01

    In this second article, we continue the review of current health care economics as it relates to radiologists, specifically framed by topics defined by the Accreditation Council for Graduate Medical Education in the evaluation of neuroradiology fellows. The discussion in this article is focused on topics pertaining to levels 4 and 5, which are the more advanced levels of competency defined by the Accreditation Council for Graduate Medical Education Neuroradiology Milestones on Health Care Economics and System Based Practice. © 2018 by American Journal of Neuroradiology.

  12. Operational Contract Support: Economic Impact Evaluation and Measures of Effectiveness

    Science.gov (United States)

    2017-12-01

    NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA MBA PROFESSIONAL REPORT OPERATIONAL CONTRACT SUPPORT: ECONOMIC IMPACT EVALUATION AND MEASURES...DATES COVERED MBA professional report 4. TITLE AND SUBTITLE OPERATIONAL CONTRACT SUPPORT: ECONOMIC IMPACT EVALUATION AND MEASURES OF EFFECTIVENESS 5...evaluation, expeditionary economics , operational contract support, measure of effectiveness 15. NUMBER OF PAGES 89 16. PRICE CODE 17. SECURITY

  13. Social Wealth Economic Indicators for a Caring Economy

    Directory of Open Access Journals (Sweden)

    Indradeep Ghosh

    2015-06-01

    Full Text Available This essay introduces the reader to an entirely new set of measures that are urgently needed by policymakers and business leaders to foster personal, business, and national economic success. Social Wealth Economic Indicators are measures suggested by a partnership model of society, and they inform us that care work matters tremendously but is grossly undervalued. In our contemporary knowledge-service economy, the essential ingredient for social and economic progress is high-quality human capital, and the way to build such human capital is to support the work of caring and caregiving, traditionally considered “women’s work.” The data presented in this essay clearly show that early childhood care and education, family-friendly workplace practices, and the status of women are key determinants of economic success. But they are also necessary for healthy, creative, and cohesive societies in which members work in partnership with each other and with the natural environment to improve living conditions for all. This is the true meaning of social wealth.

  14. Economic evaluation of losses: technique and use of data

    Energy Technology Data Exchange (ETDEWEB)

    Robinson, T.K.; Drury, A.K.

    1992-01-01

    The paper reviews a major energy company's experience of the evaluation of the economic effects of accidents, discusses techniques for measurement and gives examples of current management use of the data. In 1988, British Petroleum carried out a pilot study at one of its coal mines in Illinois to investigate the direct cost of losses due to accidents to people, plant and equipment. It was found that the costs of losses were large (and in the case of the oil related studies the potential for loss was very large) and relatively easy to measure. However the use of the data to assist the effective management of operations required careful consideration. The paper concludes that measurement of the economic effect of accidents could be helpful to coal mining operations, but the correct organisational environment must be in place first. 3 figs., 6 tabs.

  15. Leveraging Behavioral Economics to Improve Heart Failure Care and Outcomes.

    Science.gov (United States)

    Chang, Leslie L; DeVore, Adam D; Granger, Bradi B; Eapen, Zubin J; Ariely, Dan; Hernandez, Adrian F

    2017-08-22

    Behavioral challenges are often present in human illness, so behavioral economics is increasingly being applied in healthcare settings to better understand why patients choose healthy or unhealthy behaviors. The application of behavioral economics to healthcare settings parallels recent shifts in policy and reimbursement structures that hold providers accountable for outcomes that are dependent on patient behaviors. Numerous studies have examined the application of behavioral economics principles to policy making and health behaviors, but there are limited data on applying these concepts to the management of chronic conditions, such as heart failure (HF). Given its increasing prevalence and high associated cost of care, HF is a paradigm case for studying novel approaches to improve health care; therefore, if we can better understand why patients with HF make the choices they do, then we may be more poised to help them manage their medications, influence daily behaviors, and encourage healthy decision making. In this article, we will give a brief explanation of the core behavioral economics concepts that apply to patients with HF. We will also examine how to craft these concepts into tools such as financial incentives and social networks that may improve the management of patients with HF. We believe that behavioral economics can help us understand barriers to change, encourage positive behaviors, and offer additional approaches to improving the outcomes of patients with HF. © 2017 American Heart Association, Inc.

  16. Economic evaluation of nurse practitioner and clinical nurse specialist roles: A methodological review.

    Science.gov (United States)

    Lopatina, Elena; Donald, Faith; DiCenso, Alba; Martin-Misener, Ruth; Kilpatrick, Kelley; Bryant-Lukosius, Denise; Carter, Nancy; Reid, Kim; Marshall, Deborah A

    2017-07-01

    Advanced practice nurses (e.g., nurse practitioners and clinical nurse specialists) have been introduced internationally to increase access to high quality care and to tackle increasing health care expenditures. While randomised controlled trials and systematic reviews have demonstrated the effectiveness of nurse practitioner and clinical nurse specialist roles, their cost-effectiveness has been challenged. The poor quality of economic evaluations of these roles to date raises the question of whether current economic evaluation guidelines are adequate when examining their cost-effectiveness. To examine whether current guidelines for economic evaluation are appropriate for economic evaluations of nurse practitioner and clinical nurse specialist roles. Our methodological review was informed by a qualitative synthesis of four sources of information: 1) narrative review of literature reviews and discussion papers on economic evaluation of advanced practice nursing roles; 2) quality assessment of economic evaluations of nurse practitioner and clinical nurse specialist roles alongside randomised controlled trials; 3) review of guidelines for economic evaluation; and, 4) input from an expert panel. The narrative literature review revealed several challenges in economic evaluations of advanced practice nursing roles (e.g., complexity of the roles, variability in models and practice settings where the roles are implemented, and impact on outcomes that are difficult to measure). The quality assessment of economic evaluations of nurse practitioner and clinical nurse specialist roles alongside randomised controlled trials identified methodological limitations of these studies. When we applied the Guidelines for the Economic Evaluation of Health Technologies: Canada to the identified challenges and limitations, discussed those with experts and qualitatively synthesized all findings, we concluded that standard guidelines for economic evaluation are appropriate for economic

  17. 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.

  18. Handling time in economic evaluation studies.

    Science.gov (United States)

    Permsuwan, Unchalee; Guntawongwan, Kansinee; Buddhawongsa, Piyaluk

    2014-05-01

    The discount rates and time horizons used in a health technology assessment (HTA) can have a significant impact on the results, and thus the prioritization of technologies. Therefore, it is important that clear guidance be provided on the appropriate discount rates for cost and health effect and appropriate time horizons. In this paper we conduct a review of relevant case studies and guidelines and provide guidance for all researchers conducting economic evaluations of health technologies in the Thai context. A uniform discount rate of 3% is recommended for both costs and health effects in base case analyses. A sensitivity analysis should also be conducted, with a discount range of 0-6%. For technologies where the effects are likely to sustain for at least 30y ears, a rate of 4% for costs and 2% for health effects is recommended. The time horizon should be long enough to capture the full costs and effects of the programs.

  19. Cost-utility of cognitive behavioral therapy versus U.S. Food and Drug Administration recommended drugs and usual care in the treatment of patients with fibromyalgia: an economic evaluation alongside a 6-month randomized controlled trial.

    Science.gov (United States)

    Luciano, Juan V; D'Amico, Francesco; Cerdà-Lafont, Marta; Peñarrubia-María, María T; Knapp, Martin; Cuesta-Vargas, Antonio I; Serrano-Blanco, Antoni; García-Campayo, Javier

    2014-10-01

    Cognitive behavioral therapy (CBT) and U.S. Food and Drug Administration (FDA)-recommended pharmacologic treatments (RPTs; pregabalin, duloxetine, and milnacipran) are effective treatment options for fibromyalgia (FM) syndrome and are currently recommended by clinical guidelines. We compared the cost-utility from the healthcare and societal perspectives of CBT versus RPT (combination of pregabalin + duloxetine) and usual care (TAU) groups in the treatment of FM. The economic evaluation was conducted alongside a 6-month, multicenter, randomized, blinded, parallel group, controlled trial. In total, 168 FM patients from 41 general practices in Zaragoza (Spain) were randomized to CBT (n = 57), RPT (n = 56), or TAU (n = 55). The main outcome measures were Quality-Adjusted Life Years (QALYs, assessed by using the EuroQoL-5D questionnaire) and improvements in health-related quality of life (HRQoL, assessed by using EuroQoL-5D visual analogue scale, EQ-VAS). The costs of healthcare use were estimated from patient self-reports (Client Service Receipt Inventory). Cost-utility was assessed by using the net-benefit approach and cost-effectiveness acceptability curves (CEACs). On average, the total costs per patient in the CBT group (1,847 €) were significantly lower than those in patients receiving RPT (3,664 €) or TAU (3,124 €). Patients receiving CBT reported a higher quality of life (QALYs and EQ-VAS scores); the differences between groups were significant only for EQ-VAS. From a complete case-analysis approach (base case), the point estimates of the cost-effectiveness ratios resulted in dominance for the CBT group in all of the comparisons performed, by using both QALYs and EQ-VAS as outcomes. These findings were confirmed by bootstrap analyses, net-benefit curves, and CEACs. Two additional sensitivity analyses (intention-to-treat analysis and per-protocol analysis) indicated that the results were robust. The comparison of RPT with TAU yielded no clear preference for

  20. 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

    OpenAIRE

    van der Velde Gabrielle; Côté Pierre; Bayoumi Ahmed M; Cassidy J David; Boyle Eleanor; Shearer Heather M; Stupar Maja; Jacobs Craig; Ammendolia Carlo; Carette Simon; van Tulder Maurits

    2011-01-01

    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 st...

  1. Economic Evaluation of Pediatric Telemedicine Consultations to Rural Emergency Departments.

    Science.gov (United States)

    Yang, Nikki H; Dharmar, Madan; Yoo, Byung-Kwang; Leigh, J Paul; Kuppermann, Nathan; Romano, Patrick S; Nesbitt, Thomas S; Marcin, James P

    2015-08-01

    Comprehensive economic evaluations have not been conducted on telemedicine consultations to children in rural emergency departments (EDs). We conducted an economic evaluation to estimate the cost, effectiveness, and return on investment (ROI) of telemedicine consultations provided to health care providers of acutely ill and injured children in rural EDs compared with telephone consultations from a health care payer prospective. We built a decision model with parameters from primary programmatic data, national data, and the literature. We performed a base-case cost-effectiveness analysis (CEA), a probabilistic CEA with Monte Carlo simulation, and ROI estimation when CEA suggested cost-saving. The CEA was based on program effectiveness, derived from transfer decisions following telemedicine and telephone consultations. The average cost for a telemedicine consultation was $3641 per child/ED/year in 2013 US dollars. Telemedicine consultations resulted in 31% fewer patient transfers compared with telephone consultations and a cost reduction of $4662 per child/ED/year. Our probabilistic CEA demonstrated telemedicine consultations were less costly than telephone consultations in 57% of simulation iterations. The ROI was calculated to be 1.28 ($4662/$3641) from the base-case analysis and estimated to be 1.96 from the probabilistic analysis, suggesting a $1.96 return for each dollar invested in telemedicine. Treating 10 acutely ill and injured children at each rural ED with telemedicine resulted in an annual cost-savings of $46,620 per ED. Telephone and telemedicine consultations were not randomly assigned, potentially resulting in biased results. From a health care payer perspective, telemedicine consultations to health care providers of acutely ill and injured children presenting to rural EDs are cost-saving (base-case and more than half of Monte Carlo simulation iterations) or cost-effective compared with telephone consultations. © The Author(s) 2015.

  2. 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.

  3. Evaluating care from a care ethical perspective:: A pilot study.

    Science.gov (United States)

    Kuis, Esther E; Goossensen, Anne

    2017-08-01

    Care ethical theories provide an excellent opening for evaluation of healthcare practices since searching for (moments of) good care from a moral perspective is central to care ethics. However, a fruitful way to translate care ethical insights into measurable criteria and how to measure these criteria has as yet been unexplored: this study describes one of the first attempts. To investigate whether the emotional touchpoint method is suitable for evaluating care from a care ethical perspective. An adapted version of the emotional touchpoint interview method was used. Touchpoints represent the key moments to the experience of receiving care, where the patient recalls being touched emotionally or cognitively. Participants and research context: Interviews were conducted at three different care settings: a hospital, mental healthcare institution and care facility for older people. A total of 31 participants (29 patients and 2 relatives) took part in the study. Ethical considerations: The research was found not to be subject to the (Dutch) Medical Research Involving Human Subjects Act. A three-step care ethical evaluation model was developed and described using two touchpoints as examples. A focus group meeting showed that the method was considered of great value for partaking institutions in comparison with existing methods. Reflection and discussion: Considering existing methods to evaluate quality of care, the touchpoint method belongs to the category of instruments which evaluate the patient experience. The touchpoint method distinguishes itself because no pre-defined categories are used but the values of patients are followed, which is an essential issue from a care ethical perspective. The method portrays the insider perspective of patients and thereby contributes to humanizing care. The touchpoint method is a valuable instrument for evaluating care; it generates evaluation data about the core care ethical principle of responsiveness.

  4. Methodology for evaluation of economic security of industrial enterprises

    OpenAIRE

    Kopytko Marta Ivanovna

    2014-01-01

    This paper investigates the features of evaluation of ensuring economic security of industrial enterprises and the algorithm of complex evaluation of the economic security of industrial enterprises over time and the system of criteria and their limit values ​​and the dynamics of change to determine the level of economic security industrial enterprise in terms of its components.

  5. Simulation of electric power conservation strategies: model of economic evaluation

    International Nuclear Information System (INIS)

    Pinhel, A.C.C.

    1992-01-01

    A methodology for the economic evaluation model for energy conservation programs to be executed by the National Program of Electric Power Conservation is presented. From data as: forecasting of conserved energy, tariffs, energy costs and budget, the model calculates the economic indexes for the programs, allowing the evaluation of economic impacts in the electric sector. (C.G.C.)

  6. Economic Evaluation of Concise Cognitive Behavioural Therapy and/or Pharmacotherapy for Depressive and Anxiety Disorders.

    Science.gov (United States)

    Meuldijk, Denise; Carlier, Ingrid V E; van Vliet, Irene M; van Hemert, Albert M; Zitman, Frans G; van den Akker-van Marle, M Elske

    2015-12-01

    Depressive and anxiety disorders cause great suffering and disability and are associated with high health care costs. In a previous conducted pragmatic randomised controlled trial, we have shown that a concise format of cognitive behavioural- and/or pharmacotherapy is as effective as standard care in reducing depressive and anxiety symptoms and in improving subdomains of general health and quality of life in secondary care psychiatric outpatients. In this economic evaluation, we examined whether a favourable cost-utility of concise care compared to standard care was attained. The economic evaluation was performed alongside a pragmatic randomised controlled trial. Health-related quality of life was measured using the Short-Form (SF-36) questionnaire. Cost of healthcare utilization and productivity loss (absenteeism and presenteeism) were assessed using the Trimbos/iMTA questionnaire for Costs associated with Psychiatric Illness (TiC-P). A cost-utility analysis, using cost-effectiveness acceptability curves, comparing differences in societal costs and Quality-Adjusted Life Years (QALYs) at 1 year was performed. One year after study entry, the difference in mean cost per patient of the two primary treatments was not significant between both groups. No significant differences in other healthcare and non- healthcare costs could be detected between patients receiving concise care and standard care. Also, QALYs were not statistically different between the groups during the study period. From both the societal and healthcare perspective, the probability that concise care is more cost-effective compared to standard care remains below the turning point of 0.5 for all acceptable values of the willingness to pay for a QALY. The economic evaluation suggests that concise care is unlikely to be cost-effective compared to standard care in the treatment for depressive- and anxiety disorders in secondary mental health care during a one year follow up period. Total costs and QALYs

  7. Practising Political Care Ethics: Can Responsive Evaluation Foster Democratic Care?

    NARCIS (Netherlands)

    Visse, M.A.; Abma, T.; Widdershoven, G.

    2015-01-01

    This paper examines if and how responsive evaluation as a deliberative approach can serve as a guide for a politically oriented care ethics. A political care ethics puts the assignment of responsibilities and the inclusion of multiple perspectives of people at the centre of care. It honours the

  8. Social and economic value of Portuguese community pharmacies in health care.

    Science.gov (United States)

    Félix, Jorge; Ferreira, Diana; Afonso-Silva, Marta; Gomes, Marta Vargas; Ferreira, César; Vandewalle, Björn; Marques, Sara; Mota, Melina; Costa, Suzete; Cary, Maria; Teixeira, Inês; Paulino, Ema; Macedo, Bruno; Barbosa, Carlos Maurício

    2017-08-29

    Community pharmacies are major contributors to health care systems across the world. Several studies have been conducted to evaluate community pharmacies services in health care. The purpose of this study was to estimate the social and economic benefits of current and potential future community pharmacies services provided by pharmacists in health care in Portugal. The social and economic value of community pharmacies services was estimated through a decision-model. Model inputs included effectiveness data, quality of life (QoL) and health resource consumption, obtained though literature review and adapted to Portuguese reality by an expert panel. The estimated economic value was the result of non-remunerated pharmaceutical services plus health resource consumption potentially avoided. Social and economic value of community pharmacies services derives from the comparison of two scenarios: "with service" versus "without service". It is estimated that current community pharmacies services in Portugal provide a gain in QoL of 8.3% and an economic value of 879.6 million euros (M€), including 342.1 M€ in non-remunerated pharmaceutical services and 448.1 M€ in avoided expense with health resource consumption. Potential future community pharmacies services may provide an additional increase of 6.9% in QoL and be associated with an economic value of 144.8 M€: 120.3 M€ in non-remunerated services and 24.5 M€ in potential savings with health resource consumption. Community pharmacies services provide considerable benefit in QoL and economic value. An increase range of services including a greater integration in primary and secondary care, among other transversal services, may add further social and economic value to the society.

  9. Welfare Evaluation and the Economic Impacts of Climate Change on ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Welfare Evaluation and the Economic Impacts of Climate Change on Water Supply ... In a context of positive economic growth, demand for water is expected to ... Socially equitable climate action is essential to strengthen the resilience of all ...

  10. A call to arms: economic barriers to optimal dialysis care.

    Science.gov (United States)

    McFarlane, P A; Mendelssohn, D C

    2000-01-01

    Epidemic growth rates and the enormous cost of dialysis pressure end-stage renal disease (ESRD) delivery systems around the world. Payers of dialysis services can constrain costs through (1) limiting access to dialysis, (2) reducing the quality of dialysis, and (3) placing constraints on modality distribution. In order to secure the necessary resources for ESRD care, we propose that the nephrology community consider the following suggestions: First, future leaders in dialysis should acquire additional advanced training in innovative pathways such as health care economics, business and health care administration, and health care policy. Second, the international nephrology community must strongly engage in ongoing advocacy for accessible, high quality, cost-effective care.Third, efforts should be made to better define and then implement optimal dialysis modality distributions that maximize patient outcomes but limit unnecessary costs. Fourth, industry should be encouraged to lower the unit cost of dialysis, allowing for improved access to dialysis, especially in developing countries. Fifth, research should be encouraged that seeks to identify measures that will reduce dialysis costs but will not impair quality of care. Finally, early referral of patients with progressive renal disease to nephrology clinics, empowerment of informed patient choice of dialysis modality, and proper and timely access creation should be encouraged and can be expected to help limit overall expenditures. Ongoing efforts in these areas by the nephrology community will be essential if we are to overcome the challenges of ESRD growth in this new decade.

  11. 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.

  12. Economic evaluation of bids for nuclear power plants

    International Nuclear Information System (INIS)

    1976-01-01

    The purpose of the guidebook is to assist an organisation responsible for a nuclear power project in evaluating and establishing an economic order of merit among competing bids. An approximate overall time schedule for a first nuclear power plant project is provided. A schematic outline of technical bid evaluation is given. The basic procedure of economic bid evaluation is outlined, e.g. evaluation of the present worth of all cost items of plant capital investment, of the nuclear cycle, of O and M costs (operation and maintenance costs), and of economic corrections. All these cost items are evaluated for the economic life of the plant and corrected for escalation where applicable

  13. 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.

  14. Economic evaluations in pain management: principles and methods.

    Science.gov (United States)

    Asche, Carl V; Seal, Brian; Jackson, Kenneth C; Oderda, Gary M

    2006-01-01

    This paper describes how investigators may design, conduct, and report economic evaluations of pharmacotherapy for pain and symptom management. Because economic evaluation of therapeutic interventions is becoming increasingly important, there is a need for guidance on how economic evaluations can be optimally conducted. The steps required to conduct an economic evaluation are described to provide this guidance. Economic evaluations require two or more therapeutic interventions to be compared in relation to costs and effects. There are five types of economic evaluations, based on analysis of: (1) cost-effectiveness, (2) cost-utility, (3) cost-minimization, (4) cost-consequence, and (5) cost-benefit analyses. The six required steps are: identify the perspective of the study; identify the alternatives that will be compared; identify the relevant costs and effects; determine how to collect the cost and effect data; determine how to perform calculation for cost and effects data; and determine the manner in which to depict the results and draw comparisons.

  15. 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.

  16. Improving early cycle economic evaluation of diagnostic technologies

    NARCIS (Netherlands)

    Steuten, Lotte Maria Gertruda; 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

  17. Economic Evidence and Point-of-Care Testing

    Science.gov (United States)

    St John, Andrew; Price, Christopher P

    2013-01-01

    Health economics has been an established feature of the research, policymaking, practice and management in the delivery of healthcare. However its role is increasing as the cost of healthcare begins to drive changes in most healthcare systems. Thus the output from cost effectiveness studies is now being taken into account when making reimbursement decisions, e.g. in Australia and the United Kingdom. Against this background it is also recognised that the health economic tools employed in healthcare, and particularly the output from the use of these tools however, are not always employed in the routine delivery of services. One of the notable consequences of this situation is the poor record of innovation in healthcare with respect to the adoption of new technologies, and the realisation of their benefits. The evidence base for the effectiveness of diagnostic services is well known to be limited, and one consequence of this has been a very limited literature on cost effectiveness. One reason for this situation is undoubtedly the reimbursement strategies employed in laboratory medicine for many years, simplistically based on the complexity of the test procedure, and the delivery as a cost-per-test service. This has proved a disincentive to generate the required evidence, and little effort to generate an integrated investment and disinvestment business case, associated with care pathway changes. Point-of-care testing creates a particularly challenging scenario because, on the one hand, the unit cost-per-test is larger through the loss of the economy of scale offered by automation, whilst it offers the potential of substantial savings through enabling rapid delivery of results, and reduction of facility costs. This is important when many health systems are planning for complete system redesign. We review the literature on economic assessment of point-of-care testing in the context of these developments. PMID:24151342

  18. Physical activity counseling in primary care: Insights from public health and behavioral economics.

    Science.gov (United States)

    Shuval, Kerem; Leonard, Tammy; Drope, Jeffrey; Katz, David L; Patel, Alpa V; Maitin-Shepard, Melissa; Amir, On; Grinstein, Amir

    2017-05-06

    Physical inactivity has reached epidemic proportions in modern society. Abundant evidence points to a causal link between physical inactivity and increased risk for numerous noncommunicable diseases, such as some types of cancer and heart disease, as well as premature mortality. Yet, despite this overwhelming evidence, many individuals do not meet the recommended amount of physical activity required to achieve maximum health benefits. Because primary care physicians' advice is highly regarded, clinicians have the unique opportunity to play an important role in enabling patients to modify their behavior at the point of care with the goal of guiding patients to adopt and maintain an active lifestyle. In the current study, the authors evaluate pertinent literature from the fields of medicine/public health and economics/psychology to suggest a comprehensive approach to physical activity counseling at the primary care level. They first examine the public health approach to physical activity counseling, and then proceed to offer insights from behavioral economics, an emerging field that combines principles from psychology and economics. The application of key behavioral economics tools (eg, precommitment contracts, framing) to physical activity counseling in primary care is elaborated. CA Cancer J Clin 2017;67:233-244. © 2017 American Cancer Society. © 2017 American Cancer Society.

  19. Economic analyses in health care: an introduction to the methodology with an emphasis on radiation therapy

    International Nuclear Information System (INIS)

    Hayman, James; Weeks, Jane; Mauch, Peter

    1996-01-01

    Payers are increasingly interested in knowing whether they are receiving value for the dollars they spend on health care. Because economic analyses will be used as a means of evaluating radiation therapy, it is important that radiation oncologists understand the basic methodology employed in such analyses. This review article describes the four basic types of economic analyses: cost minimization, cost effectiveness, cost utility, and cost benefit. Specification of alternative therapies, choice of perspective of the analysis, measurements of costs and benefits, and the role of discounting and sensitivity analyses are discussed. Published economic analyses that pertain directly to treatment with radiation therapy are reviewed. Finally, we close with a brief discussion of the potential areas for future economic outcomes research in radiation oncology

  20. Introduction course on the economical evaluation of energy projects

    International Nuclear Information System (INIS)

    Jansen, J.C.

    1992-06-01

    A theoretical course on the financial and economical evaluation of energy projects is presented. The course was organized by the Banque Mondiale in Bujumbura, Burundi, from 11 to 16 November 1991. Subsequently attention is paid to the basics of economic analysis, the financial and the economical analysis of an investment project, and finally the prices of energy products. 4 figs., 13 refs

  1. Economic evaluation of reprocessing - Indicative German position

    International Nuclear Information System (INIS)

    1979-05-01

    This paper, which also appears as an Appendix to the final Working Group 4 report, forms part of the overall economic assessment of reprocessing. The indicative national position and illustrative ''phase diagram'' for the Federal Republic of Germany is presented. Advantages to be gained from the recycling of plutonium in thermal reactors are identified and it is concluded that many of these are not explicitly taken into account in the ''phase diagram''. Under the conditions pertaining in the Federal Republic of Germany thermal recycle will be economic under present day uranium prices. On the other hand the fast breeder reactor might become commercially economic around the year 2000

  2. Evaluation of economic rent of hydropower projects

    International Nuclear Information System (INIS)

    Shrestha, Ram M.; Abeygunawardana, A.M.A.K.

    2009-01-01

    Existing studies have mostly estimated the ex post economic rent of hydropower for the hydroelectric system of a province or a country as a whole and have ignored the site- or project-specific variations in the economic rent of hydropower plants. Further, most of the existing studies have used simplified methods to calculate the rent ex post. This paper presents a rigorous methodology for estimation of site-specific (i.e., project specific) economic rent of hydropower ex ante. It applies the methodology in the case of a hydropower project and analyzes the sensitivity of the rent to variations in some key parameters.

  3. Economic evaluation of reprocessing. Indicative UK position

    International Nuclear Information System (INIS)

    1979-05-01

    This paper, which also appears as an Appendix to the final Working Group 4 report, forms part of the overall economic assessment of reprocessing. The indicative national position and illustrative ''phase diagram'' for the United Kingdom is presented. Under conditions pertaining in the United Kingdom the diagram suggests that: if uranium prices rise rapidly the fast reactor would become economic in the decade 1990-2000, if uranium prices rise more slowly, the fast reactor would become economic in the decade 2000-2010

  4. [Basic principles and methodological considerations of health economic evaluations].

    Science.gov (United States)

    Loza, Cesar; Castillo-Portilla, Manuel; Rojas, José Luis; Huayanay, Leandro

    2011-01-01

    Health Economics is an essential instrument for health management, and economic evaluations can be considered as tools assisting the decision-making process for the allocation of resources in health. Currently, economic evaluations are increasingly being used worldwide, thus encouraging evidence-based decision-making and seeking efficient and rational alternatives within the framework of health services activities. In this review, we present an overview and define the basic types of economic evaluations, with emphasis on complete Economic Evaluations (EE). In addition, we review key concepts regarding the perspectives from which EE can be conducted, the types of costs that can be considered, the time horizon, discounting, assessment of uncertainty and decision rules. Finally, we describe concepts about the extrapolation and spread of economic evaluations in health.

  5. [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.

  6. Economic evaluation of coalbed methane production in China

    International Nuclear Information System (INIS)

    Luo Dongkun; Dai Youjin

    2009-01-01

    Roaring natural gas demand, energy security and environment protection concerns coupled with stringent emission reduction requirement have made China's abundant coalbed methane (CBM) resource an increasingly valuable energy source. However, not all of China's CBM resource is economic to develop under current technological condition and economic situation. In order to locate the CBM resource with economic viability to develop in China, economic evaluation of CBM production is conducted by applying net present value (NPV) method. The results indicate that more than half of CBM resource in China is economic to develop. It shows that CBM price, production rate and operating costs are the three major factors with most impact on the economic viability of the CBM development in target areas in China. The result also demonstrates that the economic limit production is roughly 1200 cubic meters per day. These economic evaluation results provide important information for both CBM companies and China government.

  7. Implementing economic evaluation in simulation-based medical education: challenges and opportunities.

    Science.gov (United States)

    Lin, Yiqun; Cheng, Adam; Hecker, Kent; Grant, Vincent; Currie, Gillian R

    2018-02-01

    Simulation-based medical education (SBME) is now ubiquitous at all levels of medical training. Given the substantial resources needed for SBME, economic evaluation of simulation-based programmes or curricula is required to demonstrate whether improvement in trainee performance (knowledge, skills and attitudes) and health outcomes justifies the cost of investment. Current literature evaluating SBME fails to provide consistent and interpretable information on the relative costs and benefits of alternatives. Economic evaluation is widely applied in health care, but is relatively scarce in medical education. Therefore, in this paper, using a focus on SBME, we define economic evaluation, describe the key components, and discuss the challenges associated with conducting an economic evaluation of medical education interventions. As a way forward to the rigorous and state of the art application of economic evaluation in medical education, we outline the steps to gather the necessary information to conduct an economic evaluation of simulation-based education programmes and curricula, and describe the main approaches to conducting an economic evaluation. A properly conducted economic evaluation can help stakeholders (i.e., programme directors, policy makers and curriculum designers) to determine the optimal use of resources in selecting the modality or method of assessment in simulation. It also helps inform broader decision making about allocation of scarce resources within an educational programme, as well as between education and clinical care. Economic evaluation in medical education research is still in its infancy, and there is significant potential for state-of-the-art application of these methods in this area. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

  8. New York State Technical & Economic MAGLEV Evaluation

    Science.gov (United States)

    1991-06-01

    The New York State Energy Research and Development Authority, with the : assistance of the Departments of Transportation, Economic Development, Environmental Conservation, and the New York State Thruway Authority, is undertaking a comprehensive, syst...

  9. Economic evaluation of reprocessing. Indicative US position

    International Nuclear Information System (INIS)

    1979-05-01

    This paper, which also appears as an Appendix to the final Working Group 4 report, forms part of the overall economic assessment of reprocessing. The indicative national position and illustrative ''phase diagram'' for the United States is presented. The prospective costs of nuclear power are given for four equilibrium modes of LWR operation: once-through, 15% and 25% improved once-through and thermal recycle. For a particular representative choice of fuel cycle parameters the economic cross over at which thermal recycle becomes economic relative to a 15% improved once-through cycle is above 100/lb U 3 O 8 . Thus the US believes that for the next several decades there is no economic incentive for thermal recycle. As a planning guide the US considers that the fast reactor will not become commercialised in the US before the year 2020

  10. 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.)

  11. Patient evaluations of primary care.

    NARCIS (Netherlands)

    Schäfer, W.L.A.; Boerma, W.G.W.; Schellevis, F.G.; Groenewegen, P.P.

    2012-01-01

    Background: So far, studies about people’s appreciation of primary care services has shown that patient satisfaction seems to be lower in health care systems with regulated access to specialist services by gate keeping. Nevertheless, international comparative research about patients’ expectations

  12. Economic evaluations and randomized trials in spinal disorders: principles and methods.

    Science.gov (United States)

    Korthals-de Bos, Ingeborg; van Tulder, Maurits; van Dieten, Hiske; Bouter, Lex

    2004-02-15

    Descriptive methodologic recommendations. To help researchers designing, conducting, and reporting economic evaluations in the field of back and neck pain. Economic evaluations of both existing and new therapeutic interventions are becoming increasingly important. There is a need to improve the methods of economic evaluations in the field of spinal disorders. To improve the methods of economic evaluations in the field of spinal disorders, this article describes the various steps in an economic evaluation, using as example a study on the cost-effectiveness of manual therapy, physiotherapy, and usual care provided by the general practitioner for patients with neck pain. An economic evaluation is a study in which two or more interventions are systematically compared with regard to both costs and effects. There are four types of economic evaluations, based on analysis of: (1) cost-effectiveness, (2) cost-utility, (3) cost-minimization, and (4) cost-benefit. The cost-utility analysis is a special case of cost-effectiveness analysis. The first step in all these economic evaluations is to identify the perspective of the study. The choice of the perspective will have consequences for the identification of costs and effects. Secondly, the alternatives that will be compared should be identified. Thirdly, the relevant costs and effects should be identified. Economic evaluations are usually performed from a societal perspective and include consequently direct health care costs, direct nonhealth care costs, and indirect costs. Fourthly, effect data are collected by means of questionnaires or interviews, and relevant cost data with regard to effect measures and health care utilization, work absenteeism, travel expenses, use of over-the-counter medication, and help from family and friends, are collected by means of cost diaries, questionnaires, or (telephone) interviews. Fifthly, real costs are calculated, or the costs are estimated on the basis of real costs, guideline prices

  13. Health care in the developing world: the role of economists and economics.

    Science.gov (United States)

    Lee, K

    1983-01-01

    This paper does not address itself to high theory or to complex methodologies; nor does it offer any detailed illumination of key economic concepts. Rather, it focuses on the role of economists and economics (not the same thing) in the formulation of health policies, and in influencing an evaluation of health strategies appropriate to the requirements of the developing world. The paper argues that the 'climate' has changed sufficiently in the developing world to promote a close interest in the economics of health and health care. Evidence exists of a growing willingness to employ economists and economic analysis to resource allocation issues within the health sector. Accordingly, a glossary of economic concepts in presented to demonstrate that economics does possess certain ideas, distinct from other disciplines, which can be of considerable value to health planners and health managers alike. The text also sets out, in tabular form, many of the key questions that should be of close interest to policy-makers, and indicates the economic concepts and techniques that can be applied. At the same time, it is noted that there are very real conceptual and methodological problems likely to be faced by those wishing to apply economic reasoning to the health sector. The paper then moves on from analysis to consider implementation, and investigates the political constraints and institutional barriers to the acceptance of economic analysis in the health sector. In the past, the nature of the economics of health has sometimes been considered improper, i.e. views have been expressed that services should be made available to those for whom they may be beneficial, as a matter of right without regard to economics.(ABSTRACT TRUNCATED AT 250 WORDS)

  14. The economics of health care quality and medical errors.

    Science.gov (United States)

    Andel, Charles; Davidow, Stephen L; Hollander, Mark; Moreno, David A

    2012-01-01

    Hospitals have been looking for ways to improve quality and operational efficiency and cut costs for nearly three decades, using a variety of quality improvement strategies. However, based on recent reports, approximately 200,000 Americans die from preventable medical errors including facility-acquired conditions and millions may experience errors. In 2008, medical errors cost the United States $19.5 billion. About 87 percent or $17 billion were directly associated with additional medical cost, including: ancillary services, prescription drug services, and inpatient and outpatient care, according to a study sponsored by the Society for Actuaries and conducted by Milliman in 2010. Additional costs of $1.4 billion were attributed to increased mortality rates with $1.1 billion or 10 million days of lost productivity from missed work based on short-term disability claims. The authors estimate that the economic impact is much higher, perhaps nearly $1 trillion annually when quality-adjusted life years (QALYs) are applied to those that die. Using the Institute of Medicine's (IOM) estimate of 98,000 deaths due to preventable medical errors annually in its 1998 report, To Err Is Human, and an average of ten lost years of life at $75,000 to $100,000 per year, there is a loss of $73.5 billion to $98 billion in QALYs for those deaths--conservatively. These numbers are much greater than those we cite from studies that explore the direct costs of medical errors. And if the estimate of a recent Health Affairs article is correct-preventable death being ten times the IOM estimate-the cost is $735 billion to $980 billion. Quality care is less expensive care. It is better, more efficient, and by definition, less wasteful. It is the right care, at the right time, every time. It should mean that far fewer patients are harmed or injured. Obviously, quality care is not being delivered consistently throughout U.S. hospitals. Whatever the measure, poor quality is costing payers and

  15. 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

  16. Use of economic evaluation in decision making: evidence and recommendations for improvement.

    Science.gov (United States)

    Simoens, Steven

    2010-10-22

    Information about the value for money of a medicine as derived from an economic evaluation can be used for decision-making purposes by policy makers, healthcare payers, healthcare professionals and pharmaceutical companies. This article illustrates the use of economic evaluation by decision makers and formulates a number of recommendations to enhance the use of such evaluations for decision-making purposes. Over the last decades, there has been a substantial increase in the number of economic evaluations assessing the value for money of medicines. Economic evaluation is used by policy makers and healthcare payers to inform medicine pricing/reimbursement decisions in more and more countries. It is a suitable tool to evaluate medicines and to present information about their value for money to decision makers in a familiar format. In order to fully exploit the use of economic evaluation for decision-making purposes, researchers need to take care to conduct such economic evaluations according to methodologically sound principles. Additionally, researchers need to take into account the decision-making context. They need to identify the various objectives that decision makers pursue and discuss how decision makers can use study findings to attain these objectives. These issues require further attention from researchers, policy makers, healthcare payers, healthcare professionals and pharmaceutical companies with a view to optimizing the use of economic evaluation in decision making.

  17. Accessing diabetes care in rural Uganda: Economic and social resources.

    Science.gov (United States)

    Nielsen, Jannie; Bahendeka, Silver K; Bygbjerg, Ib C; Meyrowitsch, Dan W; Whyte, Susan R

    2017-07-01

    Non-communicable diseases including type 2 diabetes (T2D) are increasing rapidly in most Sub-Saharan African (SSA) countries like Uganda. Little attention has been given to how patients with T2D try to achieve treatment when the availability of public health care for their disease is limited, as is the case in most SSA countries. In this paper we focus on the landscape of availability of care and the therapeutic journeys of patients within that landscape. Based on fieldwork in south-western Uganda including 10 case studies, we explore the diabetes treatment options in the area and what it takes to access the available treatment. We analyse the resources patients need to use the available treatment options, and demonstrate that the patients' journeys to access and maintain treatment are facilitated by the knowledge and support of their therapy management groups. Patients access treatment more effectively, if they and their family have money, useful social relations, and knowledge, together with the capacity to communicate with health staff. Patients coming from households with high socio-economic status (SES) are more likely to have all of these resources, while for patients with low or medium SES, lack of economic resources increases the importance of connections within the health system.

  18. Environmental Economics And Policy: Course Evaluation Survey

    Directory of Open Access Journals (Sweden)

    Petr Šauer

    2013-09-01

    Full Text Available The main objective of this paper is to outline the educational aspects of environmental economics referring to an example of a course taught at The University of Economics, Prague. A quantitative survey among students was conducted to describe their perceptions of the environmental topics and the diverse components of the course. This learners’ perspective is compared with students’ examination results and their level of activity in seminars. One of the main questions asked in this text is: do students interested in economic policy and regional economics consider the environmental orientation of the course important? And if yes what aspects of the course do they value, what benefits do they get from the course, what are their learning strategies and what role does this play with regards to students’ concern for environmental issues? Probably the most important finding of the research is the students’ advocacy of environmental economics as a beneficial part of curriculum both by those clustered as ‘environmentalists’ and ‘non-environmentalists’ (or even ‘anti-environmentalists’. Students appreciate having a chance to participate actively in the course. A well balanced proportion of lectures and seminars with enough space for deep discussion seem to be crucial for retaining students’ interest. The data doesn’t equip us with sufficient information to construct regression models with reasonable predictive power concerning exam results. A challenge for further research is to work with a better informed analysis of students’ learning strategies.

  19. Economic evaluation of preconcentration of uranium ores

    International Nuclear Information System (INIS)

    1981-04-01

    The economics of two options for the preconcentration of low-grade uranium ores prior to hydrochloric acid leaching were studied. The first option uses flotation followed by wet high-intensity magnetic separation. The second option omits the flotation step. In each case it was assumed that most of the pyrite in the ore would be recovered by froth flotation, dewatered, and roasted to produce sulphuric acid and a calcine suitable for acid leaching. Savings in operating costs from preconcentration are offset by the value of uranium losses. However, a capital saving of approximately 6 million dollars is indicated for each preconcentration option. As a result of the capital saving, preconcentration appears to be economically attractive when combined with hydrochloric acid leaching. There appears to be no economic advantage to preconcentration in combination with sulphuric acid leaching of the ore

  20. Economic evaluation of intermediate operations in oak stands

    Science.gov (United States)

    Henry H. Webster; John C., Jr. Meadows

    1971-01-01

    Economic evaluation of forest-management opportunities is a vital ingredient of effective forestry programs. Choices among management opportunities are necessary because opportunities inevitably exceed funds available, and they are important because opportunities commonly range from highly productive to decidedly unproductive. Economic evaluation in oak stands shows a...

  1. Preliminary economic evaluation of the Alkox process

    International Nuclear Information System (INIS)

    Silva, L.J.; Lilga, M.A.; Camaioni, D.M.; Snowden, L.J.

    1991-09-01

    A new chemical process has been invented at Battelle Pacific Northwest Laboratories for converting alkanes to alcohols. This new chemistry has been named the ''Alkox Process.'' Pacific Northwest Laboratory prepared a preliminary economic analysis for converting cyclohexane to cyclohexanol, which may be one of the most attractive applications of the Alkox process. A process flow scheme and a material balance were prepared to support rough equipment sizing and costing. The results from the economic analysis are presented in the non-proprietary section of this report. The process details, including the flow diagram and material balance, are contained in separate section of this report that is proprietary to Battelle. 7 refs., 4 tabs

  2. Cost-effectiveness of an intensive group training protocol compared to physiotherapy guideline care for sub-acute and chronic low back pain: design of a randomised controlled trial with an economic evaluation. [ISRCTN45641649

    Directory of Open Access Journals (Sweden)

    Franken Willemien K

    2004-11-01

    Full Text Available Abstract Background Low back pain is a common disorder in western industrialised countries and the type of treatments for low back pain vary considerably. Methods In a randomised controlled trial the cost-effectiveness and cost-utility of an intensive group training protocol versus physiotherapy guideline care for sub-acute and chronic low back pain patients is evaluated. Patients with back pain for longer than 6 weeks who are referred to physiotherapy care by their general practitioner or medical specialist are included in the study. The intensive group training protocol combines exercise therapy with principles of behavioural therapy ("graded activity" and back school. This training protocol is compared to physiotherapy care according to the recently published Low Back Pain Guidelines of the Royal Dutch College for Physiotherapy. Primary outcome measures are general improvement, pain intensity, functional status, work absenteeism and quality of life. The direct and indirect costs will be assessed using cost diaries. Patients will complete questionnaires at baseline and 6, 13, 26 and 52 weeks after randomisation. Discussion No trials are yet available that have evaluated the effect of an intensive group training protocol including behavioural principles and back school in a primary physiotherapy care setting and no data on cost-effectiveness and cost-utility are available.

  3. Economic evaluation of a coal fired boiler

    International Nuclear Information System (INIS)

    Briem, J.J.

    1983-01-01

    This paper provides basic information on boiler economics which will assist steam users in analyzing the feasibility of using coal to generate steam - in either new or existing facilities. The information presented covers boilers ranging in size from 10,000 to 100,000 pounds per hour steaming capacity

  4. Economics of residue harvest: Regional partnership evaluation

    Science.gov (United States)

    Economic analyses on the viability of corn (Zea mays, L.) stover harvest for bioenergy production have largely been based on simulation modeling. While some studies have utilized field research data, most field-based analyses have included a limited number of sites and a narrow geographic distributi...

  5. Economic evaluation of tokamak power plants

    International Nuclear Information System (INIS)

    Reid, R.L.; Steiner, D.

    1977-01-01

    This study reports the impact of plasma operating characteristics, engineering options, and technology on the capital cost trends of tokamak power plants. Tokamak power systems are compared to other advanced energy systems and found to be economically competitive. A three-phase strategy for demonstrating commercial feasibility of fusion power, based on a common-site multiple-unit concept, is presented

  6. Economic evaluation of investment in electricity conservation

    International Nuclear Information System (INIS)

    Becker, Nir; Fishman, Yaron; Lavee, Doron

    2008-01-01

    The paper presents an economic study of the potential for energy conservation in Israel. We analyze energy conservation policies targeted at the household sector, focusing on the economic feasibility of scrapping old household electrical appliances, and considering the effect of such policies at both the household and the macro-economic level. The results of our analysis show that the appliance that provides the most potential conservation is the air conditioner (used for both heating and cooling). A scrapping program for old air conditioners passes a cost benefit analysis (CBA) even when external benefits are excluded from the calculation. When external benefits are included, scrapping programs for both washing machines and dishwashers pass the test as well. According to our findings, the annual economic benefit of a program involving the scrapping of 100,000 air conditioners, 45,000 washing machines and 15,000 dishwashers per annum over 10 years ranges from 246 million New Israeli Shekels (NIS) in the first year of implementation to 693 million in the tenth year. Most of the savings are derived from the scrapping of air conditioners

  7. Experimental and economical evaluation of a novel biogas digester

    International Nuclear Information System (INIS)

    Rajendran, Karthik; Aslanzadeh, Solmaz; Johansson, Fredrik; Taherzadeh, Mohammad J.

    2013-01-01

    Highlights: • Textile biogas digester was tested with synthetic nutrients and MSW. • Economical evaluation was made with replacement of LPG and kerosene. • The investment is positive until the price of fuel goes down. • Sensitivity analysis was performed to check the stability of the digester. - Abstract: Many developing countries face an energy demand to satisfy the daily needs of the people. Household biogas digesters are among the interesting solutions to meet the energy demands for cooking and lighting, and at the same time taking care of the kitchen wastes. In this study, a novel textile-based biogas digester was developed. The digester was evaluated for biogas production from a synthetic nutrient and an organic fraction of municipal solid waste (OFMSW) as substrates for more than a year. The obtained biogas productivity in both experiments was 570 L/kgVS/day, which indicates that the digester is as efficient in handling of OFMSW as the synthetic nutrients. Based on the obtained biogas production data, the techno-economic evaluation and sensitivity analysis for the process were performed, replacing LPG and kerosene consumption with biogas in households. A 2-m 3 digester can supply the fuel needed for cooking for a family of 4–6 people. The sum of investment and 15-years operational costs of this digester was 656 USD, which can be compared with 1455 USD for subsidized-LPG and 975 USD for kerosene, respectively. The results from the sensitivity analysis show that it was a positive investment, unless the price of kerosene goes down to less than 0.18 USD/L

  8. The scope of costs in alcohol studies: Cost-of-illness studies differ from economic evaluations

    Directory of Open Access Journals (Sweden)

    Tariq Luqman

    2010-07-01

    Full Text Available Abstract Background Alcohol abuse results in problems on various levels in society. In terms of health, alcohol abuse is not only an important risk factor for chronic disease, but it is also related to injuries. Social harms which can be related to drinking include interpersonal problems, work problems, violent and other crimes. The scope of societal costs related to alcohol abuse in principle should be the same for both economic evaluations and cost-of-illness studies. In general, economic evaluations report a small part of all societal costs. To determine the cost- effectiveness of an intervention it is necessary that all costs and benefits are included. The purpose of this study is to describe and quantify the difference in societal costs incorporated in economic evaluations and cost-of-illness studies on alcohol abuse. Method To investigate the economic costs attributable to alcohol in cost-of-illness studies we used the results of a recent systematic review (June 2009. We performed a PubMed search to identify economic evaluations on alcohol interventions. Only economic evaluations in which two or more interventions were compared from a societal perspective were included. The proportion of health care costs and the proportion of societal costs were estimated in both type of studies. Results The proportion of healthcare costs in cost-of-illness studies was 17% and the proportion of societal costs 83%. In economic evaluations, the proportion of healthcare costs was 57%, and the proportion of societal costs was 43%. Conclusions The costs included in economic evaluations performed from a societal perspective do not correspond with those included in cost-of-illness studies. Economic evaluations on alcohol abuse underreport true societal cost of alcohol abuse. When considering implementation of alcohol abuse interventions, policy makers should take into account that economic evaluations from the societal perspective might underestimate the total

  9. The scope of costs in alcohol studies: Cost-of-illness studies differ from economic evaluations.

    Science.gov (United States)

    van Gils, Paul F; Hamberg-van Reenen, Heleen H; van den Berg, Matthijs; Tariq, Luqman; de Wit, G Ardine

    2010-07-06

    Alcohol abuse results in problems on various levels in society. In terms of health, alcohol abuse is not only an important risk factor for chronic disease, but it is also related to injuries. Social harms which can be related to drinking include interpersonal problems, work problems, violent and other crimes. The scope of societal costs related to alcohol abuse in principle should be the same for both economic evaluations and cost-of-illness studies. In general, economic evaluations report a small part of all societal costs. To determine the cost- effectiveness of an intervention it is necessary that all costs and benefits are included. The purpose of this study is to describe and quantify the difference in societal costs incorporated in economic evaluations and cost-of-illness studies on alcohol abuse. To investigate the economic costs attributable to alcohol in cost-of-illness studies we used the results of a recent systematic review (June 2009). We performed a PubMed search to identify economic evaluations on alcohol interventions. Only economic evaluations in which two or more interventions were compared from a societal perspective were included. The proportion of health care costs and the proportion of societal costs were estimated in both type of studies. The proportion of healthcare costs in cost-of-illness studies was 17% and the proportion of societal costs 83%. In economic evaluations, the proportion of healthcare costs was 57%, and the proportion of societal costs was 43%. The costs included in economic evaluations performed from a societal perspective do not correspond with those included in cost-of-illness studies. Economic evaluations on alcohol abuse underreport true societal cost of alcohol abuse. When considering implementation of alcohol abuse interventions, policy makers should take into account that economic evaluations from the societal perspective might underestimate the total effects and costs of interventions.

  10. Perception of the economic value of primary care services: a Willingness to Pay study.

    Science.gov (United States)

    Martín-Fernández, Jesús; Gómez-Gascón, Tomás; Oliva-Moreno, Juan; del Cura-González, María Isabel; Domínguez-Bidagor, Julia; Beamud-Lagos, Milagros; Sanz-Cuesta, Teresa

    2010-03-01

    Identify the economic value the user attributes to the visit to the family physician, in a setting of a National Health System, by the Willingness to Pay (WTP) expressed. Economic evaluation study, by the contingent valuation method. Questions were asked about WTP using a payment card format. Interviews were conducted with 451 subjects, in areas with different socioeconomic characteristics. An ordered probit was used to evaluate model's validity. Median WTP expressed was euro18 (interquartile range euro8-28), not including "zero-answers" of thirty-four subjects (7.5%). This value represents 2% of average adjusted family incomes. Patients with higher incomes or with chronic illnesses presented a probability of 5-14 percentage points of expressing a high WTP. For every point of increase of patient satisfaction, the probability of presenting a WTP in the lowest range decreases 7.0 percentage points. Subjects with a low education level and those older than 65 expressed a lower WTP. Accessibility, risk perception, nationality and having private insurance were not related to the WTP expressed. Users of primary care have a clear perception of the economic value of care received from the family physician, even in a framework of providing services financed by taxes and without cost at the moment of use. This value increases in subjects with higher incomes, with greater need for care, or more satisfied.

  11. Economic evaluation of vaccines in Canada: A systematic review.

    Science.gov (United States)

    Chit, Ayman; Lee, Jason K H; Shim, Minsup; Nguyen, Van Hai; Grootendorst, Paul; Wu, Jianhong; Van Exan, Robert; Langley, Joanne M

    2016-05-03

    Economic evaluations should form part of the basis for public health decision making on new vaccine programs. While Canada's national immunization advisory committee does not systematically include economic evaluations in immunization decision making, there is increasing interest in adopting them. We therefore sought to examine the extent and quality of economic evaluations of vaccines in Canada. We conducted a systematic review of economic evaluations of vaccines in Canada to determine and summarize: comprehensiveness across jurisdictions, studied vaccines, funding sources, study designs, research quality, and changes over time. Searches in multiple databases were conducted using the terms "vaccine," "economics" and "Canada." Descriptive data from eligible manuscripts was abstracted and three authors independently evaluated manuscript quality using a 7-point Likert-type scale scoring tool based on criteria from the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). 42/175 articles met the search criteria. Of these, Canada-wide studies were most common (25/42), while provincial studies largely focused on the three populous provinces of Ontario, Quebec and British Columbia. The most common funding source was industry (17/42), followed by government (7/42). 38 studies used mathematical models estimating expected economic benefit while 4 studies examined post-hoc data on established programs. Studies covered 10 diseases, with 28/42 addressing pediatric vaccines. Many studies considered cost-utility (22/42) and the majority of these studies reported favorable economic results (16/22). The mean quality score was 5.9/7 and was consistent over publication date, funding sources, and disease areas. We observed diverse approaches to evaluate vaccine economics in Canada. Given the increased complexity of economic studies evaluating vaccines and the impact of results on public health practice, Canada needs improved, transparent and consistent processes

  12. Pharmaceutical priority setting and the use of health economic evaluations: a systematic literature review.

    Science.gov (United States)

    Erntoft, Sandra

    2011-06-01

    To investigate which factors and criteria are used in priority setting of pharmaceuticals, in what contexts health economic evaluations are used, and barriers to the use of health economic evaluations at micro, meso, and macro health-care levels. The search for empirical articles was based on the MeSH index (Medical Substance Heading), including the search terms "economic evaluation," "cost-effectiveness analysis," "cost-utility analysis," "cost-benefit analysis," "pharmacoeconomic," AND "drug cost(s)," AND "eligibility determination," AND "decision-making," AND "rationing," AND formulary. The following databases were searched: PubMed, EconLit, Cochrane, Web of Science, CINAHL, and PsycINFO. More than 3100 studies were identified, 31 of which were included in this review. The use of health economic evaluations at all three health-care levels was investigated in three countries (United States [US], United Kingdom [UK], and Sweden). Postal and telephone survey methods dominated (n = 17) followed by interviews (n = 13), document analysis (n = 10), and observations of group deliberations (n = 9). The cost-effectiveness criterion was most important at the macro level. A number of contextual uses of health economic evaluations were identified, including importantly the legitimizing of decisions, structuring the priority-setting process, and requesting additional budgets to finance expensive pharmaceuticals. Factors that seem to support the increased use of health economic evaluations are well-developed frameworks for evaluations, the presence of health economic skills, and an explicit priority-setting process. Differences in how economic evaluations are used at macro, meso, and micro levels are attributed to differences in the preconditions at each level. Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  13. Acknowledging patient heterogeneity in economic evaluation : a systematic literature review.

    Science.gov (United States)

    Grutters, Janneke P C; Sculpher, Mark; Briggs, Andrew H; Severens, Johan L; Candel, Math J; Stahl, James E; De Ruysscher, Dirk; Boer, Albert; Ramaekers, Bram L T; Joore, Manuela A

    2013-02-01

    Patient heterogeneity is the part of variability that can be explained by certain patient characteristics (e.g. age, disease stage). Population reimbursement decisions that acknowledge patient heterogeneity could potentially save money and increase population health. To date, however, economic evaluations pay only limited attention to patient heterogeneity. The objective of the present paper is to provide a comprehensive overview of the current knowledge regarding patient heterogeneity within economic evaluation of healthcare programmes. A systematic literature review was performed to identify methodological papers on the topic of patient heterogeneity in economic evaluation. Data were obtained using a keyword search of the PubMed database and manual searches. Handbooks were also included. Relevant data were extracted regarding potential sources of patient heterogeneity, in which of the input parameters of an economic evaluation these occur, methods to acknowledge patient heterogeneity and specific concerns associated with this acknowledgement. A total of 20 articles and five handbooks were included. The relevant sources of patient heterogeneity (demographics, preferences and clinical characteristics) and the input parameters where they occurred (baseline risk, treatment effect, health state utility and resource utilization) were combined in a framework. Methods were derived for the design, analysis and presentation phases of an economic evaluation. Concerns related mainly to the danger of false-positive results and equity issues. By systematically reviewing current knowledge regarding patient heterogeneity within economic evaluations of healthcare programmes, we provide guidance for future economic evaluations. Guidance is provided on which sources of patient heterogeneity to consider, how to acknowledge them in economic evaluation and potential concerns. The improved acknowledgement of patient heterogeneity in future economic evaluations may well improve the

  14. 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.

    Directory of Open Access Journals (Sweden)

    Pablo Romero-Sanchiz

    Full Text Available 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.clinicaltrials.gov NCT01611818.

  15. Assessing sufficient capability: A new approach to economic evaluation.

    Science.gov (United States)

    Mitchell, Paul Mark; Roberts, Tracy E; Barton, Pelham M; Coast, Joanna

    2015-08-01

    Amartya Sen's capability approach has been discussed widely in the health economics discipline. Although measures have been developed to assess capability in economic evaluation, there has been much less attention paid to the decision rules that might be applied alongside. Here, new methods, drawing on the multidimensional poverty and health economics literature, are developed for conducting economic evaluation within the capability approach and focusing on an objective of achieving "sufficient capability". This objective more closely reflects the concern with equity that pervades the capability approach and the method has the advantage of retaining the longitudinal aspect of estimating outcome that is associated with quality-adjusted life years (QALYs), whilst also drawing on notions of shortfall associated with assessments of poverty. Economic evaluation from this perspective is illustrated in an osteoarthritis patient group undergoing joint replacement, with capability wellbeing assessed using ICECAP-O. Recommendations for taking the sufficient capability approach forward are provided. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. A new method for evaluating worst- and best-case (WBC) economic consequences of technological development

    DEFF Research Database (Denmark)

    Schjær-Jacobsen, Hans

    1996-01-01

    This paper is addressing the problem of evaluating economic worst- and best-care (WBC) consequences of technological development in industrial companies faking into account uncertainties and lack of exact cost and market information. In the theoretical part of the paper, the mathematical concepts...

  17. Optimal approaches to the health economics of palliative care: report of an international think tank.

    Science.gov (United States)

    Gomes, Barbara; Harding, Richard; Foley, Kathleen M; Higginson, Irene J

    2009-07-01

    More people will need palliative care in aging societies with stretched health budgets and less ability to provide informal care. The future will bring new and tougher challenges to sustain, optimize, and expand the 8000 dedicated palliative care services that currently exist in the world. The full breakdown of the costs of palliative care is yet to be unveiled, and this has left huge unresolved questions for funding, costing, evaluating, and modeling palliative care. At an international meeting in London in November 2007, a group of 40 researchers, health economists, policy makers, and advocates exchanged their experiences, concerns, and recommendations in five main areas: shared definitions, strengths and weaknesses of different payment systems, international and country-specific research challenges, appropriate economic evaluation methods, and the varied perspectives to the costs of palliative care. This article reports the discussions that took place and the views of this international group of experts on the best research approaches to capture, analyze, and interpret data on both costs and outcomes for families and patients toward the end of life.

  18. Economical evaluation of electricity generation considering externalities

    International Nuclear Information System (INIS)

    El-Kordy, M.N.; Badr, M.A.; Abed, K.A.; Ibrahim, Said M.A.

    2002-01-01

    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)

  19. Economic Evaluations of Strategies to Prevent Hospital-Acquired Pressure Injuries.

    Science.gov (United States)

    Ocampo, Wrechelle; Cheung, Amanda; Baylis, Barry; Clayden, Nancy; Conly, John M; Ghali, William A; Ho, Chester H; Kaufman, Jaime; Stelfox, Henry T; Hogan, David B

    2017-07-01

    To provide information from a review of literature about economic evaluations of preventive strategies for pressure injuries (PIs). This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Identify the purpose and methods used for this study.2. Compare costs and effectiveness related to preventative strategies for PIs. BACKGROUND: Pressure injuries (PIs) are a common and resource-intensive challenge for acute care hospitals worldwide. While a number of preventive strategies have the potential to reduce the cost of hospital-acquired PIs, it is unclear what approach is the most effective. The authors performed a narrative review of the literature on economic evaluations of preventive strategies to survey current findings and identify important factors in economic assessments. Ovid, MEDLINE, NHS Economic Evaluation Databases, and the Cochrane Database of Systematic ReviewsSELECTION CRITERIA: Potentially relevant original research articles and systematic reviews were considered. Selection criteria included articles that were written in English, provided data on cost or economic evaluations of preventive strategies of PIs in acute care, and published between January 2004 and September 2015. Data were abstracted from the articles using a standardized approach to evaluate how the items on the Consolidated Health Economic Evaluation Reporting Standards checklist were addressed. The searches identified 192 references. Thirty-three original articles were chosen for full-text reviews. Nineteen of these articles provided clear descriptions of interventions, study methods, and outcomes considered. Limitations in the available literature prevent firm conclusions from being reached about the relative economic merits of the various approaches to the prevention of PIs. The authors' review

  20. Economics and ethics in mental health care: traditions and trade-offs.

    Science.gov (United States)

    Chisholm, Daniel; Stewart, Alan

    1998-07-01

    BACKGROUND: Both economic and ethical perspectives are exerting increasing influence at all levels of mental health policy and practice; yet there is little consensus on how these two different perspectives are to be reconciled or explicitly incorporated into decision-making. AIM: This review article is directed towards a fuller understanding of the complex trade-offs and compromises that are or may be made by clinicians, managers and policy-makers alike in the context of mental health care planning and delivery. METHOD: We briefly outline a number of key principles of health care economics and ethics, and then focus on the particular incentives and trade-offs that are raised by these principles at three levels of the mental health system: government and society; purchasers and providers; and users and carers. RESULTS: At the level of government and society, we find (economically influenced) attempts to reform mental health care offset by concerns revolving around access to care: whether society is prepared to forgo economic benefits in exchange for improved equity depends to a considerable extent on the prevailing ethical paradigm. The implementation of these reforms at the level of purchasers and providers has helped to focus attention on evaluation and prioritization, but has also introduced "perverse incentives" such as cost-shifting and cream-skimming, which can impede access to or continuity of appropriate care for mentally ill people. Finally, we detect opportunities for moral hazard and other forms of strategic behaviour that are thrown up by the nature of the carer:user relationship in mental health care. CONCLUSION: We conclude by highlighting the need to move towards a more open, accountable and evidence-based mental health care system. Acknowledgement of and progress towards these three requirements will not deliver ideal levels of efficiency or equity, but will foster a greater understanding of the relevance of ethical considerations to mental health

  1. Economic evaluation of laser enrichment plant

    International Nuclear Information System (INIS)

    Arisawa, Takashi; Shiba, Koreyuki

    1983-08-01

    Operational characteristics of Laser Enrichment Plant are described based on the data available at present. And its economy is also discussed from the view point of investment and energy consumption. In the procedure of this estimation, the composition of the plant is firstly considered, secondly each component is designed, and thirdly the production cost of each component is estimated. Then the sensitivity of the component cost on the plant cost is analysed, which leads to the optimization of the product cost and the determination of the economic plant size, etc. The results shows that the power cost of the electric gun occupies the large majority of the total power cost, and that the capital cost of laser devices occupies most of the total capital cost. (author)

  2. Economic evaluation of fast reactor fuel cycling

    International Nuclear Information System (INIS)

    Hu Ping; Zhao Fuyu; Yan Zhou; Li Chong

    2012-01-01

    Economic calculation and analysis of two kinds of nuclear fuel cycle are conducted by check off method, based on the nuclear fuel cycling process and model for fast reactor power plant, and comparison is carried out for the economy of fast reactor fuel cycle and PWR once-through fuel cycle. Calculated based on the current price level, the economy of PWR one-through fuel cycle is better than that of the fast reactor fuel cycle. However, in the long term considering the rising of the natural uranium's price and the development of the post treatment technology for nuclear fuels, the cost of the fast reactor fuel cycle is expected to match or lower than that of the PWR once-through fuel cycle. (authors)

  3. Evaluating the economics of biodiesel in Africa

    International Nuclear Information System (INIS)

    Mulugetta, Yacob

    2009-01-01

    Road transport in Sub-Saharan Africa is expected to rise in the coming years. Paradoxically, this expansion is occurring at a time when oil prices have reached new heights. Unstable oil prices do indeed increase the vulnerability of importers. However, it also presents them with a unique opportunity to explore promising technical options to help reduce their over-reliance on imported petroleum fuels. This paper takes a closer look at the potential for biodiesel, with an emphasis on fuels produced from oil palm, castor oil and jatropha in Ghana, Kenya and Tanzania, respectively. The paper provides an economic appraisal of biodiesels from these feedstocks, and sets the context for further discussions on biofuels in Africa. (author)

  4. Measuring value for money: a scoping review on economic evaluation of health information systems.

    Science.gov (United States)

    Bassi, Jesdeep; Lau, Francis

    2013-01-01

    To explore how key components of economic evaluations have been included in evaluations of health information systems (HIS), to determine the state of knowledge on value for money for HIS, and provide guidance for future evaluations. We searched databases, previously collected papers, and references for relevant papers published from January 2000 to June 2012. For selection, papers had to: be a primary study; involve a computerized system for health information processing, decision support, or management reporting; and include an economic evaluation. Data on study design and economic evaluation methods were extracted and analyzed. Forty-two papers were selected and 33 were deemed high quality (scores ≥ 8/10) for further analysis. These included 12 economic analyses, five input cost analyses, and 16 cost-related outcome analyses. For HIS types, there were seven primary care electronic medical records, six computerized provider order entry systems, five medication management systems, five immunization information systems, four institutional information systems, three disease management systems, two clinical documentation systems, and one health information exchange network. In terms of value for money, 23 papers reported positive findings, eight were inconclusive, and two were negative. We found a wide range of economic evaluation papers that were based on different assumptions, methods, and metrics. There is some evidence of value for money in selected healthcare organizations and HIS types. However, caution is needed when generalizing these findings. Better reporting of economic evaluation studies is needed to compare findings and build on the existing evidence base we identified.

  5. An economic analysis methodology for project evaluation and programming.

    Science.gov (United States)

    2013-08-01

    Economic analysis is a critical component of a comprehensive project or program evaluation methodology that considers all key : quantitative and qualitative impacts of highway investments. It allows highway agencies to identify, quantify, and value t...

  6. Economic evaluation of coal deposits. Ekonomicheskaya otsenka ugolinykh mestorozhdenii

    Energy Technology Data Exchange (ETDEWEB)

    Raikhel' , B L

    1979-01-01

    A presentation is made of theoretical problems, methods, and criteria for the economic evaluation of coal deposits. An examination is made of factors which influence the formation of magnitudes that are utilized in economic evaluations as well as problems whose solution requires the consideration of the economic evaluation of coal deposits (evaluation of useful mineral losses, substantiation for the extraction of reserves under various conditions, sectioning off reserves to an operating mine, the completeness of reserve extraction, and technico-economic substantiation for quality). Extensive experience in planning is summarized and data are illustrated by examples. The book is intended for engineering-technical personnel of enterprises, organizations, planning, and scientific-research institutes of the coal industry as well as geological organizations. 29 references, 27 tables.

  7. [Decision modeling for economic evaluation of health technologies].

    Science.gov (United States)

    de Soárez, Patrícia Coelho; Soares, Marta Oliveira; Novaes, Hillegonda Maria Dutilh

    2014-10-01

    Most economic evaluations that participate in decision-making processes for incorporation and financing of technologies of health systems use decision models to assess the costs and benefits of the compared strategies. Despite the large number of economic evaluations conducted in Brazil, there is a pressing need to conduct an in-depth methodological study of the types of decision models and their applicability in our setting. The objective of this literature review is to contribute to the knowledge and use of decision models in the national context of economic evaluations of health technologies. This article presents general definitions about models and concerns with their use; it describes the main models: decision trees, Markov chains, micro-simulation, simulation of discrete and dynamic events; it discusses the elements involved in the choice of model; and exemplifies the models addressed in national economic evaluation studies of diagnostic and therapeutic preventive technologies and health programs.

  8. [The reform of primary health care: the economic, care and satisfaction results].

    Science.gov (United States)

    Durán, J; Jodar, G; Pociello, V; Parellada, N; Martín, A; Pradas, J

    1999-05-15

    To compare the overall effect on the general public before and after the primary care reform, its economic outcome and professional satisfaction, following the model of the European Foundation for Quality Management. A descriptive analysis of results at reformed primary care centres compared with results at non-reformed centres in the same city. The study was conducted at Sant Boi de Llobregat, a town of 77,591 inhabitants in Baix Llobregat county (Barcelona). 32.7% of the population was covered by two reformed centres. The rest was covered by one single non-reformed primary care centre. Clinical audits and data on pharmaceutical prescription quality were used to find attendance. For economic results, the formula of attribution of cost/inhabitant and cost/inhabitant seen, including the costs of labour, structure, referral, further tests and pharmacy, were used. The satisfaction of the outside customer (user) was measured by a population survey. Internal customer satisfaction was measured by a survey of the professionals. Results were compared with those for 1997. The study showed that the reformed primary care sector's results, measured in terms of professional satisfaction, user-outside customer, attendance, economic results and social impact, were better than the non-reformed sector's. Inside and outside customers' satisfaction was higher in the reformed network. The cost per inhabitant in the reformed network was 31,874 pesetas, against 25,177 in the non-reformed network. The cost per inhabitant seen was 34,482 and 44,603, respectively. The reform creates efficient resource management and greater satisfaction of the general public and professionals, when an indicator sensitive to the real use of services is used.

  9. Realization of economic evaluation expert system for uranium mine project

    International Nuclear Information System (INIS)

    Wang Haifeng

    1993-01-01

    By studying the EVALUATOR, economic evaluation expert system of uranium mine project, the theoretical fundamentals of expert system, principle of inference mechanism, implementation of knowledge base, realization of explanation mechanism, acquisition of domain knowledge and representation of knowledge were described, especially the subjective Bayes approach for inexact reasoning problem used in EVALUATOR was discussed in detail

  10. Home Economics/Health Grades 6-12. Program Evaluation.

    Science.gov (United States)

    Des Moines Public Schools, IA. Teaching and Learning Div.

    Home economics programs are offered to students in grades 6-12 in the Des Moines INdependent Community School District (Iowa). Programs at the middle school level are exploratory, leading to occupational training in family and consumer science, child care, food service, and textile and fashion arts at the high school level. Health education…

  11. 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.

  12. 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.

  13. [Health care economics, uncertainty and physician-induced demand].

    Science.gov (United States)

    Domenighetti, G; Casabianca, A

    1995-10-21

    The health care market is a very particular one that is mainly characterized by the absence of information and transparency at every level, particularly between the physician-supplier and the patient-consumer. On this market it is up to the physician to evaluate and define the patient's needs and to decide which are the most effective goods for the patient. The determinants of medical prescription are not only related to the health status of the patient, but also to the payment system (fee for services, salary), to physician density, professional uncertainty, the role and status of the physician in his profession, the legal framework which rules the medical profession, and also the information level of the patient. Agency relationship and professional uncertainty are the most relevant determinants of supplier-induced demand. Professional uncertainty inherent in the practice of a stochastic art such as medicine will "always" give an ethical justification for supplier-induced demand or for the pursuit of "maximal" and/or "defensive" care when market competition is perceived by the physician as a threat to his/her income or employment. Time is ripe for consumers and physicians empowerment in the aim to promote better self-management of health and more thoughtful access to care (for consumers) and more evidences based medicine for physicians.

  14. [Evaluation of economic forest ecosystem services in China].

    Science.gov (United States)

    Wang, Bing; Lu, Shao-Wei

    2009-02-01

    This paper quantitatively evaluated the economic forest ecosystem services in the provinces of China in 2003, based on the long-term and continuous observations of economic forest ecosystems in this country, the sixth China national forest resources inventory data, and the price parameter data from the authorities in the world, and by applying the law of market value, the method of substitution of the expenses, and the law of the shadow project. The results showed that in 2003, the total value of economic forest ecosystem services in China was 11763.39 x 10(8) yuan, and the total value of the products from economic forests occupied 19.3% of the total ecosystem services value, which indicated that the economic forests not only provided society direct products, but also exhibited enormous eco-economic value. The service value of the functions of economic forests was in the order of water storage > C fixation and O2 release > biodiversity conservation > erosion control > air quality purification > nutrient cycle. The spatial pattern of economic forest ecosystem services in the provinces of China had the same trend with the spatial distribution of water and heat resources and biodiversity. To understand the differences of economic forest ecosystem services in the provinces of China was of significance in alternating the irrational arrangement of our present forestry production, diminishing the abuses of forest management, and establishing high grade, high efficient, and modernized economic forests.

  15. Health-economic evaluation in implant trials: design considerations.

    Science.gov (United States)

    Alt, Volker; Pavlidis, Theodoros; Szalay, Gabor; Heiss, Christian; Schnettler, Reinhard

    2009-01-01

    In today's world, demonstration of the safety, efficacy, and quality of a new treatment strategy is no longer sufficient in many countries for market entry and reimbursement in the public healthcare system. This implies that new implants in orthopedic and orthopedic trauma surgery not only must be shown to lead to better medical outcome compared with the standard of care implant, but also must be shown to exhibit "good value" for the money for the public health-care system based on sound economic data from health-economic studies. The purpose of this article is to elucidate a framework for health-economic aspects alongside implant trials, with the assumption that the new implant is more costly but potentially better than the control implant. Cost-effectiveness, cost-utility, and cost-benefit studies are suitable for the assessment of the health-economic value of a new implant. The following criteria should be considered for a health-economic study design in the context with an implant: i) it should state medical benefits of the new implant compared with the control implant; ii) it should precise the type of health economic study; iii) it should define the methodological approach, perspective of the study, and types of costs; iv) if necessary, it should state discount costs and/benefits; and v) a sound sensitivity analysis should be included. Furthermore, close cooperation between researchers, clinicians, and health economists is essential.

  16. Economic evaluation of the Blanket Comparison and Selection Study

    International Nuclear Information System (INIS)

    Waganer, L.M.

    1985-01-01

    The economic impact of employing the highly ranked blankets in the Blanket Comparison and Selection Study (BCSS) was evaluated in the context of both a tokamak and a tandem mirror power reactor (TMR). The economic evaluation criterion was determined to be the cost of electricity. The influencing factors that were considered are the direct cost of the blankets and related systems; the annual cost of blanket replacement; and the performance of the blanket, heat transfer, and energy conversion systems. The technical and cost bases for comparison were those of the STARFIRE and Mirror Advanced Reactor Study conceptual design power plants. The economic evaluation results indicated that the nitrate-salt-cooled blanket concept is an economically attractive concept for either reactor type. The water-cooled, solid breeder blanket is attractive for the tokamak and somewhat less attractive for the TMR. The helium-cooled, liquidlithium breeder blanket is the least economically desirable of higher ranked concepts. The remaining self-cooled liquid-metal and the helium-cooled blanket concepts represent moderately attractive concepts from an economic standpoint. These results are not in concert with those found in the other BCSS evaluation areas (engineering feasibility, safety, and research and development (R and D) requirements). The blankets faring well economically had generally lower cost components, lower pumping power requirements, and good power production capability. On the other hand, helium- and lithium-cooled systems were preferred from the standpoints of safety, engineering feasibility, and R and D requirements

  17. Economic evaluation of health promotion interventions for older people: do applied economic studies meet the methodological challenges?

    Science.gov (United States)

    Huter, Kai; Dubas-Jakóbczyk, Katarzyna; Kocot, Ewa; Kissimova-Skarbek, Katarzyna; Rothgang, Heinz

    2018-01-01

    In the light of demographic developments health promotion interventions for older people are gaining importance. In addition to methodological challenges arising from the economic evaluation of health promotion interventions in general, there are specific methodological problems for the particular target group of older people. There are especially four main methodological challenges that are discussed in the literature. They concern measurement and valuation of informal caregiving, accounting for productivity costs, effects of unrelated cost in added life years and the inclusion of 'beyond-health' benefits. This paper focuses on the question whether and to what extent specific methodological requirements are actually met in applied health economic evaluations. Following a systematic review of pertinent health economic evaluations, the included studies are analysed on the basis of four assessment criteria that are derived from methodological debates on the economic evaluation of health promotion interventions in general and economic evaluations targeting older people in particular. Of the 37 studies included in the systematic review, only very few include cost and outcome categories discussed as being of specific relevance to the assessment of health promotion interventions for older people. The few studies that consider these aspects use very heterogeneous methods, thus there is no common methodological standard. There is a strong need for the development of guidelines to achieve better comparability and to include cost categories and outcomes that are relevant for older people. Disregarding these methodological obstacles could implicitly lead to discrimination against the elderly in terms of health promotion and disease prevention and, hence, an age-based rationing of public health care.

  18. Challenges in economic evaluation of new drugs: experience with rituximab in Hungary.

    Science.gov (United States)

    Brodszky, Valentin; Orlewska, Ewa; Pentek, Martha; Karpati, Krisztian; Skoupa, Jana; Gulacsi, Laszlo

    2010-01-01

    Implementation of a new therapy into clinical practice is a complex process. Various countries have different requirements for information but most often focus on economic evaluation, which often plays a stronger role in healthcare decision making than does clinical evidence. To identify all potential challenges in economic evaluation, the case of a new biological drug, rituximab, used to treat rheumatoid arthritis, has been taken as an example. We present methods and results of economic assessment, highlighting the specific issues that should be considered in countries with economic and health care conditions similar to those of Hungary. In principle, economic evaluation requires data on characteristics of target population, disease progression, treatment impact, preferences, resource utilization and unit prices. Treatment effect/relative risk reduction and clinical practice patterns (resource use) may be more generalizable, whereas prices and baseline risk need to be jurisdiction specific. In order to address issues of transferability, investments need to be made in the collection of epidemiological and demographic data, plus data on clinical practice patterns, resource use, costs and health state valuation. In Hungary this problem has been solved through conducting a well designed 255 patient cross-sectional study. The Hungarian example shows that there should be more investment in data collection for those parameters that are thought to differ most from place to place. Owing to the similarities between Central and Eastern Europe countries in health care systems, clinical practice patterns and economic indicators, they may be able to develop partnerships to develop relevant regional databases and registries.

  19. 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 €.

  20. Psoriasis treatment and management - a systematic review of full economic evaluations.

    Science.gov (United States)

    Hamilton, M P; Ntais, D; Griffiths, C E M; Davies, L M

    2015-03-01

    Psoriasis frequently requires lifetime control and current therapies vary significantly in price. High-quality economic evaluations are necessary to determine if higher-cost treatments are value for money. This review aims to identify the cost-effectiveness of psoriasis care (whether more expensive interventions are associated with savings in health care and psoriasis management and/or improve patients' health); assess the level of uncertainty and transferability of this evidence to policy and practice; and, identify future research needs. Searches of electronic databases Embase, MEDLINE and NHS EED for full economic evaluations were conducted in January 2012 (updated April 2014). Included articles were screened, selected and critically appraised using predefined inclusion criteria and data extraction forms: 1355 articles were identified; 37 papers reporting 71 comparisons met the inclusion criteria. Treatments evaluated were systemic (n = 45), topical (n = 22), phototherapies (n = 14) and combination (n = 4). Despite a significant number of recent economic evaluations, the cost-effectiveness of all therapies remains unclear. This uncertainty arises from a diversity in settings, perspective and design. Economic evaluations were constrained by limited availability of high-quality short- and long-term head-to-head comparisons of the effectiveness, safety and adherence of different interventions. The economic evidence is dominated by comparisons of interventions to placebo, with implicit comparisons of different therapies. There is a lack of evaluations of service model innovations to deliver complex packages of care for psoriasis. Primary and secondary integrated clinical and economic research is needed to address the limitations and to identify patient preferences and barriers/facilitators to treatment. © 2014 British Association of Dermatologists.

  1. [Systematic economic assessment and quality evaluation for traditional Chinese medicines].

    Science.gov (United States)

    Sun, Xiao; Guo, Li-ping; Shang, Hong-cai; Ren, Ming; Lei, Xiang

    2015-05-01

    To learn about the economic studies on traditional Chinese medicines in domestic literatures, in order to analyze the current economic assessment of traditional Chinese medicines and explore the existing problems. Efforts were made to search CNKI, VIP, Wanfang database and CBM by computer and include all literatures about economic assessment of traditional Chinese medicines published on professional domestic journals in the systematic assessment and quality evaluation. Finally, 50 articles were included in the study, and the systematic assessment and quality evaluation were made for them in terms of titles, year, authors' identity, expense source, disease type, study perspective, study design type, study target, study target source, time limit, cost calculation, effect indicator, analytical technique and sensitivity analysis. The finally quality score was 0.74, which is very low. The results of the study showed insufficient studies on economics of traditional Chinese medicines, short study duration and simple evaluation methods, which will be solved through unremitting efforts in the future.

  2. Economic evaluation in patient safety: a literature review of methods.

    Science.gov (United States)

    de Rezende, Bruna Alves; Or, Zeynep; Com-Ruelle, Laure; Michel, Philippe

    2012-06-01

    Patient safety practices, targeting organisational changes for improving patient safety, are implemented worldwide but their costs are rarely evaluated. This paper provides a review of the methods used in economic evaluation of such practices. International medical and economics databases were searched for peer-reviewed publications on economic evaluations of patient safety between 2000 and 2010 in English and French. This was complemented by a manual search of the reference lists of relevant papers. Grey literature was excluded. Studies were described using a standardised template and assessed independently by two researchers according to six quality criteria. 33 articles were reviewed that were representative of different patient safety domains, data types and evaluation methods. 18 estimated the economic burden of adverse events, 3 measured the costs of patient safety practices and 12 provided complete economic evaluations. Healthcare-associated infections were the most common subject of evaluation, followed by medication-related errors and all types of adverse events. Of these, 10 were selected that had adequately fulfilled one or several key quality criteria for illustration. This review shows that full cost-benefit/utility evaluations are rarely completed as they are resource intensive and often require unavailable data; some overcome these difficulties by performing stochastic modelling and by using secondary sources. Low methodological transparency can be a problem for building evidence from available economic evaluations. Investing in the economic design and reporting of studies with more emphasis on defining study perspectives, data collection and methodological choices could be helpful for strengthening our knowledge base on practices for improving patient safety.

  3. Economic evaluation of the integrated SMART desalination plant

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Young Dong; Lee, Man Kye; Yeo, Ji Won; Kim, Hee Chul; Chang, Moon Hee

    2001-04-01

    In this study, an economic evaluation methodology of the integrated SMART desalination plant was established and the economic evaluation of SMART was performed. The plant economics was evaluated with electricity generation costs calculated using approximate estimates of SMART cost data and the result was compared with the result calculated using the SMART design data and estimated bulk materials. In addition, a series of sensitivity studies on the power generation cost was performed for the main economic parameters of SMART Power credit method was used for the economic analysis of the integrated SMART desalination plant. Power credit method is a widely used economic analysis method for the cogeneration plant when the major portion of the energy is used for the electricity generation. In the case of using SMART fot power generation only, the result shows that the electricity generation cost of SMART is higher than that of the alternative power options. However, it can be competitive with the other power options in the limited cases, especially with the gas fired combined plant. In addition, an economic analysis of the integrated SMART desalination plant coupled with MED was performed. The calculated water production cost is in the range of 0.56 approx. 0.88($/m{sup 3}) for the plant availability of 80% or higher, which is close to the study results presented by the various other countries. This indicates that SMART can be considered as a competitive choice for desalination among various alternative energy sources.

  4. Economic evaluation of the integrated SMART desalination plant

    International Nuclear Information System (INIS)

    Hwang, Young Dong; Lee, Man Kye; Yeo, Ji Won; Kim, Hee Chul; Chang, Moon Hee

    2001-04-01

    In this study, an economic evaluation methodology of the integrated SMART desalination plant was established and the economic evaluation of SMART was performed. The plant economics was evaluated with electricity generation costs calculated using approximate estimates of SMART cost data and the result was compared with the result calculated using the SMART design data and estimated bulk materials. In addition, a series of sensitivity studies on the power generation cost was performed for the main economic parameters of SMART Power credit method was used for the economic analysis of the integrated SMART desalination plant. Power credit method is a widely used economic analysis method for the cogeneration plant when the major portion of the energy is used for the electricity generation. In the case of using SMART fot power generation only, the result shows that the electricity generation cost of SMART is higher than that of the alternative power options. However, it can be competitive with the other power options in the limited cases, especially with the gas fired combined plant. In addition, an economic analysis of the integrated SMART desalination plant coupled with MED was performed. The calculated water production cost is in the range of 0.56 approx. 0.88($/m 3 ) for the plant availability of 80% or higher, which is close to the study results presented by the various other countries. This indicates that SMART can be considered as a competitive choice for desalination among various alternative energy sources

  5. Improving early cycle economic evaluation of diagnostic technologies.

    Science.gov (United States)

    Steuten, Lotte M G; Ramsey, Scott D

    2014-08-01

    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 increase the return on investment as well as patient and societal impact. This paper describes examples of 'early cycle economic evaluations' as applied to diagnostic technologies and highlights challenges in its real-time application. It shows that especially in the field of diagnostics, with rapid technological developments and a changing regulatory climate, early cycle economic evaluation can have a guiding role to improve the efficiency of the diagnostics innovation process. In the next five years the attention will move beyond the methodological and analytic challenges of early cycle economic evaluation towards the challenge of effectively applying it to improve diagnostic research and development and patient value. Future work in this area should therefore be 'strong on principles and soft on metrics', that is, the metrics that resonate most clearly with the various decision makers in this field.

  6. The Development Evaluation of Economic Zones in China

    Science.gov (United States)

    Shi, Hong-Bo; Zhang, Zhe; Zhai, Yuming; Chen, Quan; Wang, Jiangtao

    2018-01-01

    After the Chinese reform and opening up, the construction of economic zones, such as Special Economic Zones, Hi-tech Zones and Bonded Zones, has played an irreplaceable role in China’s economic development. Currently, against the background of Chinese economic transition, research on development evaluation of economic zones has become popular and necessary. Similar research usually focuses on one specific field, and the methods that are used to evaluate it are simple. This research aims to analyse the development evaluation of zones by synthesis. A new hybrid multiple criteria decision making (MCDM) model that combines the DEMATEL technique and the DANP method is proposed. After establishing the evaluation criterion system and acquiring data, the influential weights of dimensions and criteria can be calculated, which will be a guide for forming measures of development. Shandong Peninsula Blue Economic Zone is used in the empirical case analysis. The results show that Transportation Conditions, Industrial Structure and Business Climate are the main influencing criteria and measures based on these criteria are proposed. PMID:29301304

  7. Using the Delphi technique in economic evaluation: time to revisit the oracle?

    Science.gov (United States)

    Simoens, S

    2006-12-01

    Although the Delphi technique has been commonly used as a data source in medical and health services research, its application in economic evaluation of medicines has been more limited. The aim of this study was to describe the methodology of the Delphi technique, to present a case for using the technique in economic evaluation, and to provide recommendations to improve such use. The literature was accessed through MEDLINE focusing on studies discussing the methodology of the Delphi technique and economic evaluations of medicines using the Delphi technique. The Delphi technique can be used to provide estimates of health care resources required and to modify such estimates when making inter-country comparisons. The Delphi technique can also contribute to mapping the treatment process under investigation, to identifying the appropriate comparator to be used, and to ensuring that the economic evaluation estimates cost-effectiveness rather than cost-efficacy. Ideally, economic evaluations of medicines should be based on real-patient data. In the absence of such data, evaluations need to incorporate the best evidence available by employing approaches such as the Delphi technique. Evaluations based on this approach should state the limitations, and explore the impact of the associated uncertainty in the results.

  8. Primary care in an unstable security, humanitarian, economic and political context: the Kurdistan Region of Iraq

    NARCIS (Netherlands)

    Shukor, Ali R.; Klazinga, Niek S.; Kringos, Dionne S.

    2017-01-01

    Background: This study presents a descriptive synthesis of Kurdistan Region of Iraq's (KRI) primary care system, which is undergoing comprehensive primary care reforms within the context of a cross-cutting structural economic adjustment program and protracted security, humanitarian, economic and

  9. 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.

  10. 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.

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

    NARCIS (Netherlands)

    Mutschler, B.B.; Zarvic, 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

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

    Science.gov (United States)

    Walzer, Stefan; Droeschel, Daniel; Nuijten, Mark; Chevrou-Séverac, Hélène

    2014-01-01

    Health care decision-makers have begun to realize that medical nutrition plays an important role in the delivery of care, and it needs to be seen as a sole category within the overall health care reimbursement system to establish the value for money. Indeed, improving health through improving patients' nutrition may contribute to the cost-effectiveness and financial sustainability of health care systems. Medical nutrition is regulated by a specific bill either in Europe or in the United States, which offers specific legislations and guidelines (as provided to patients with special nutritional needs) and indications for nutritional support. Given that the efficacy of medical nutrition has been proven, one can wonder whether the heterogeneous nature of its coverage/reimbursement across countries might be due to the lack of health-related economic evidence or value-for-money of nutritional interventions. This paper aims to address this knowledge gap by performing a systematic literature review on health economics evidence regarding medical nutrition, and by summarizing the results of these publications related to the value for money of medical nutrition interventions. A systematic literature search was initiated and executed based on a predefined search protocol following the population, intervention, comparison, and outcomes (PICO) criteria. Following the systematic literature search of recently published literature on health economics evidence regarding medical nutrition, this study aims to summarize the results of those publications that are related to the 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. A total of 225 abstracts were identified for the detailed review, and the data were

  13. Conceptual Framework of Economic Evaluation on SMRs

    International Nuclear Information System (INIS)

    Cho, Jin Sam; Kim, Jee Young; Kim, Chang Hoon

    2010-01-01

    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

  14. Economic evaluations of pharmacist-managed services in people with diabetes mellitus: a systematic review.

    Science.gov (United States)

    Wang, Y; Yeo, Q Q; Ko, Y

    2016-04-01

    To review and evaluate the most recent literature on the economic outcomes of pharmacist-managed services in people with diabetes. The global prevalence of diabetes is increasing. Although pharmacist-managed services have been shown to improve people's health outcomes, the economic impact of these programmes remains unclear. A systematic review was conducted of six databases. Study inclusion criteria were: (1) original research; (2) evaluation of pharmacist-managed services in people with diabetes; (3) an economic evaluation; (4) English-language publication; and (5) full-text, published between January 2006 and December 2014. The quality of the full economic evaluations reviewed was evaluated using the Consolidated Health Economic Evaluation Reporting Standards checklist. A total of 2204 articles were screened and 25 studies were selected. These studies were conducted in a community pharmacy (n = 10), a clinic- /hospital-based outpatient facility (n = 8), or others. Pharmacist-managed services included targeted education (n = 24), general pharmacotherapeutic monitoring (n = 21), health screening or laboratory testing services (n = 9), immunization services (n = 2) and pharmacokinetic monitoring (n = 1). Compared with usual care, pharmacist-managed services resulted in cost savings that varied from $7 to $65,000 ($8 to $85,000 in 2014 US dollars) per person per year, and generated higher quality-adjusted life years with lower costs. Benefit-to-cost ratios ranged from 1:1 to 8.5:1. Among the 25 studies reviewed, 11 were full economic evaluations of moderate quality. Pharmacist-managed services had a positive return in terms of economic viability. With the expanding role of pharmacists in the healthcare sector, alongside increasing health expenditure, future economic studies of high quality are needed to investigate the cost-effectiveness of these services. © 2015 Diabetes UK.

  15. Health care evaluation, utilitarianism and distortionary taxes.

    Science.gov (United States)

    Calcott, P

    2000-09-01

    Cost Utility Analysis (CUA) and Cost Benefit Analysis (CBA) are methods to evaluate allocations of health care resources. Problems are raised for both methods when income taxes do not meet the first best optimum. This paper explores the implications of three ways that taxes may fall short of this ideal. First, taxes may be distortionary. Second, they may be designed and administered without reference to information that is used by providers of health care. Finally, the share of tax revenue that is devoted to health care may be suboptimal. The two methods are amended to account for these factors.

  16. Feasibility Study on Nuclear Propulsion Ship according to Economic Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Gil, Youngmi; Yoo, Seongjin; Oh, June; Byun, Yoonchul; Woo, Ilguk [Daewoo Shipbuilding and Marine Engineering Co., Ltd, Seoul (Korea, Republic of); Kim, Jiho; Choi, Suhn [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2013-05-15

    The use of nuclear ships has been extending to the icebreaker, the deep-water exploration ship, and the floating nuclear power plant. Prior to developing the new ship, the relevant regulations need to be considered. In this study, we reviewed the nuclear ship-related regulations. In addition, economic value is one of the most important factors which should be considered in the pre-design phase. To evaluate the economics of the nuclear ship, we calculated Capital Expenditure (abbreviated as CAPEX) and Operation Expenditure (abbreviated as OPEX) for various types of ships. We reviewed the nuclear ship-related regulations and evaluated the economics of the nuclear ship compared to the diesel ship. The calculation result shows that economic feasibility of the nuclear ship depends on the oil price as well as the cost of the nuclear reactor.

  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...... Policy were then evaluated. These two major factors - ecological and economic - were then integrated into decision support models for predicting the overall consequences of introducing GM crops into an agricultural system. Bt-maize line MON 810, resistant to a widespread insect pest called the European...... and economic results were integrated into a decision support model to facilitate the assessment of the impact of various cropping systems on soil quality and economics. In conclusion, the ECOGEN results indicate no difference of biological relevance in the impact on soil organisms between Bt-maize line MON 810...

  18. The economics of Language Policy: An Introduction to Evaluation Work

    OpenAIRE

    Grin, François; Vaillancourt, François

    2015-01-01

    This chapter presents some of the main empirical methods used by economists who since the 1970s have contributed to the elaboration of language policies. This specific focus is the result of the theme of this book; it is more restrictive than discussions on the economics of language of the economics of language policy evaluation. Furthermore, this leads us to emphasize practice-oriented research using quantitative data, in which economists have addressed questions such as: "How much does it c...

  19. Economic evaluation of municipal solid waste recycling in Yazd:

    OpenAIRE

    Eslami H; Mokhtari M; Eslami Dost Z; Barzegar Khanghah MR; Ranjbar Ezzatabadi M

    2017-01-01

    Background and aims: In every urban waste management plan, recycling and reuse is considered as an economic pattern. This study aimed to economic evaluation of municipal solid waste recycling in Yazd by cost-benefit analysis in 2015. Methods: This research is a descriptive–analytic study which in the data about quality and quantity of municipal solid waste in Yazd city were collected through the sampling and physical analysis and the data about total income and costs from the implementatio...

  20. Health economic evaluations in orthodontics: a systematic review.

    Science.gov (United States)

    Sollenius, Ola; Petrén, Sofia; Björnsson, Liselotte; Norlund, Anders; Bondemark, Lars

    2016-06-01

    Economic evaluation is assuming increasing importance as an integral component of health services research. To conduct a systematic review of the literature and assess the evidence from studies presenting orthodontic treatment outcomes and the related costs. The literature review was conducted in four steps, according to Goodman's model, in order to identify all studies evaluating economic aspects of orthodontic interventions. The search covered the databases Medline, Cinahl, Cochrane, Embase, Google Scholar, National Health Service Economic Evaluation Database, and SCOPUS, for the period from 1966 to September 2014. The inclusion criteria were as follows: randomized controlled trials or controlled clinical trials comparing at least two different orthodontic interventions, evaluation of both economic and orthodontic outcomes, and study populations of all ages. The quality of each included study was assessed as limited, moderate, or high. The overall evidence was assessed according to the GRADE system (The Grading of Recommendations Assessment, Development and Evaluation). The applied terms for searches yielded 1838 studies, of which 989 were excluded as duplicates. Application of the inclusion and exclusion criteria identified 26 eligible studies for which the full-text versions were retrieved and scrutinized. At the final analysis, eight studies remained. Three studies were based on cost-effectiveness analyses and the other five on cost-minimization analysis. Two of the cost-minimization studies included a societal perspective, i.e. the sum of direct and indirect costs. The aims of most of the studies varied widely and of studies comparing equivalent treatment methods, few were of sufficiently high study quality. Thus, the literature to date provides an inadequate evidence base for economic aspects of orthodontic treatment. This systematic review disclosed that few orthodontic studies have presented both economic and clinical outcomes. There is currently

  1. A systematic review of economic evaluations of treatments for patients with epilepsy.

    Science.gov (United States)

    Wijnen, Ben F M; van Mastrigt, Ghislaine A P G; Evers, Silvia M A A; Gershuni, Olga; Lambrechts, Danielle A J E; Majoie, Marian H J M; Postulart, Debby; Aldenkamp, Bert A P; de Kinderen, Reina J A

    2017-05-01

    define a reference case (e.g., how should an economic evaluation within epilepsy be performed) and to derive consensus on what constitutes "standard optimal care." Wiley Periodicals, Inc. © 2017 International League Against Epilepsy.

  2. A reference case for economic evaluations in osteoarthritis: an expert consensus article from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO).

    Science.gov (United States)

    Hiligsmann, Mickaël; Cooper, Cyrus; Guillemin, Francis; Hochberg, Marc C; Tugwell, Peter; Arden, Nigel; Berenbaum, Francis; Boers, Maarten; Boonen, Annelies; Branco, Jaime C; Maria-Luisa, Brandi; Bruyère, Olivier; Gasparik, Andrea; Kanis, John A; Kvien, Tore K; Martel-Pelletier, Johanne; Pelletier, Jean-Pierre; Pinedo-Villanueva, Rafael; Pinto, Daniel; Reiter-Niesert, Susanne; Rizzoli, René; Rovati, Lucio C; Severens, Johan L; Silverman, Stuart; Reginster, Jean-Yves

    2014-12-01

    General recommendations for a reference case for economic studies in rheumatic diseases were published in 2002 in an initiative to improve the comparability of cost-effectiveness studies in the field. Since then, economic evaluations in osteoarthritis (OA) continue to show considerable heterogeneity in methodological approach. To develop a reference case specific for economic studies in OA, including the standard optimal care, with which to judge new pharmacologic and non-pharmacologic interventions. Four subgroups of an ESCEO expert working group on economic assessments (13 experts representing diverse aspects of clinical research and/or economic evaluations) were charged with producing lists of recommendations that would potentially improve the comparability of economic analyses in OA: outcome measures, comparators, costs and methodology. These proposals were discussed and refined during a face-to-face meeting in 2013. They are presented here in the format of the recommendations of the recently published Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, so that an initiative on economic analysis methodology might be consolidated with an initiative on reporting standards. Overall, three distinct reference cases are proposed, one for each hand, knee and hip OA; with diagnostic variations in the first two, giving rise to different treatment options: interphalangeal or thumb-based disease for hand OA and the presence or absence of joint malalignment for knee OA. A set of management strategies is proposed, which should be further evaluated to help establish a consensus on the "standard optimal care" in each proposed reference case. The recommendations on outcome measures, cost itemisation and methodological approaches are also provided. The ESCEO group proposes a set of disease-specific recommendations on the conduct and reporting of economic evaluations in OA that could help the standardisation and comparability of studies that evaluate

  3. [Principles of health economic evaluation for use by caregivers].

    Science.gov (United States)

    Derumeaux-Burel, Hélène; Derancourt, Christian; Rambhojan, Christine; Branchard, Olivier; Hayes, Nathalie; Bénard, Antoine

    2017-01-01

    The aim of health economic evaluation is to maximize health gains from limited resources. By definition, health economic evaluation is comparative, based on average costs and outcomes of compared interventions. Incremental costs and outcomes are used to calculate the cost-effectiveness ratio, which represents the average incremental cost per gained unit of effectiveness (i.e.: a year of life) with the evaluated intervention compared to the reference. The health economic rationale applies to all health domains. We cannot spend collective resources (health insurance) without asking ourselves about their potential alternative uses. This reasoning is useful to caregivers for understanding resources allocation decisions and healthcare recommandations. Caregivers should grab this field of expertise because they are central in this strategic reflection for defining the future French healthcare landscape. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  4. Economic evaluation of private power production under uncertainties

    Energy Technology Data Exchange (ETDEWEB)

    Weiguo Xing; Wu, F.F. [University of Hong Kong (China). Centre for Electrical Energy Systems

    2003-02-01

    Private power production is becoming an increasingly important source of electricity generation. In developing countries, build-operate-transfer (BOT) arrangement has emerged as a dominant form of private investment. Pricing private power production at its avoided cost is the breakeven point for the utility in economic evaluation, and uncertainties must be taken into account. In this paper, an approach of calculating the breakeven cost to the utility of a BOT power plant whose contract lasts for 10-25 years is proposed. The proposed approach requires the computation of production costs from long-term generation expansion planning (GEP) under future uncertainties. To facilitate the inclusion of constraints introduced by BOT plants in GEP and uncertainties, a genetic algorithm method is utilized in GEP. The breakeven cost is a useful measure in the economic evaluation of BOT power plants. An example is presented to illustrate the economic evaluation of BOT plants using the concept of breakeven cost.(author)

  5. 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.

  6. Genetic testing in the European Union: does economic evaluation matter?

    Science.gov (United States)

    Antoñanzas, Fernando; Rodríguez-Ibeas, R; Hutter, M F; Lorente, R; Juárez, C; Pinillos, M

    2012-10-01

    We review the published economic evaluation studies applied to genetic technologies in the EU to know the main diseases addressed by these studies, the ways the studies were conducted and to assess the efficiency of these new technologies. The final aim of this review was to understand the possibilities of the economic evaluations performed up to date as a tool to contribute to decision making in this area. We have reviewed a set of articles found in several databases until March 2010. Literature searches were made in the following databases: PubMed; Euronheed; Centre for Reviews and Dissemination of the University of York-Health Technology Assessment, Database of Abstracts of Reviews of Effects, NHS Economic Evaluation Database; and Scopus. The algorithm was "(screening or diagnosis) and genetic and (cost or economic) and (country EU27)". We included studies if they met the following criteria: (1) a genetic technology was analysed; (2) human DNA must be tested for; (3) the analysis was a real economic evaluation or a cost study, and (4) the articles had to be related to any EU Member State. We initially found 3,559 papers on genetic testing but only 92 articles of economic analysis referred to a wide range of genetic diseases matched the inclusion criteria. The most studied diseases were as follows: cystic fibrosis (12), breast and ovarian cancer (8), hereditary hemochromatosis (6), Down's syndrome (7), colorectal cancer (5), familial hypercholesterolaemia (5), prostate cancer (4), and thrombophilia (4). Genetic tests were mostly used for screening purposes, and cost-effectiveness analysis is the most common type of economic study. The analysed gene technologies are deemed to be efficient for some specific population groups and screening algorithms according to the values of their cost-effectiveness ratios that were below the commonly accepted threshold of 30,000€. Economic evaluation of genetic technologies matters but the number of published studies is still

  7. 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.

  8. Study on Economic Evaluation of Nuclear Power Plant's SSC

    International Nuclear Information System (INIS)

    Yun, Eun-Sub; Park, Young-Sheop

    2007-01-01

    As the operating year of nuclear power plant increases, more improvement plans on degraded SSCs(Structure, System, and Component) are suggested. Because of safety concern, the maintenance and replacing cost of nuclear power plant's SSCs are usually high and it can be a burden to financial control. To satisfy both safety and economic problems, systematic and efficient plans are needed. For this reason, KHNP is now developing the LTAM (Long Term Asset Management) program to establish the long term improvement plans for SSCs, from safety and economic point of views. Actually LTAM program is one of the steps of INPO ER (Equipment Reliability) process. In USA, EPRI (Electric Power Research Institute) has developed the LCM (Life Cycle Management) program and it was applied to some nuclear power plants. In this program, several alternatives are candidated. Then, economic evaluation is applied to each alternative. The result of economic evaluation affects to the final alternative decision. In this study, EPRI's economic evaluation method is reviewed

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

    Science.gov (United States)

    Mihic, Marko M; Todorovic, Marija Lj; Obradovic, Vladimir Lj; Mitrovic, Zorica M

    2016-01-01

    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. 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. This paper combines statistical analysis methods such as correlation and regression analysis, methods of economic analysis, and scenario method. 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%. 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.

  10. "Holistic" care for stroke in the context of the current health care bureaucracy and economic reality.

    Science.gov (United States)

    Teasell, Robert

    2011-01-01

    The target paper by Sharon Kaufman argues that modern Western health care delivery is characterized by "the coexistence of two conflicting conceptual frameworks," namely a "holistic" approach that attempts to take into account the cultural and personal needs of the individual stroke patient and "medicalization" that attempts to reduce people and their illnesses to biological processes which can then be treated through "evidence-based" biomedical approaches. Although it is true that these 2 approaches often coexist and are sometimes in conflict, it would be misleading to see these as totally dichotomous. Patients want holistic approaches less than we give them credit for, and physicians are less mechanical than such a dichotomy would suggest. In fact, more often than not, patients and their health care providers combine to engender unrealistic expectations about what modern medicine is actually able to accomplish. When the system breaks down, as it often does in stroke (with a patient who is still left with a significant impairment an disability as well as unresolved concerns and issues related to his or her often catastrophic loss of function), there is a certain inevitable backlash. However, this tension between holistic expectations and the medical response is overshadowed by institutional constraints on clinical decision making that are designed to manage or balance expectations of both patients and health care professionals with economic realities and, in doing so, often run rough-shod over the "holistic" needs of patients and their families as well as health care providers' attempts to manage disease and disability within a medical framework.

  11. Economic evaluation of the practical approach to lung health and informal provider interventions for improving the detection of tuberculosis and chronic airways disease at primary care level in Malawi: study protocol for cost-effectiveness analysis.

    Science.gov (United States)

    Gama, Elvis; Madan, Jason; Banda, Hastings; Squire, Bertie; Thomson, Rachael; Namakhoma, Ireen

    2015-01-08

    Chronic airway diseases pose a big challenge to health systems in most developing countries, particularly in Sub-Saharan Africa. A diagnosis for people with chronic or persistent cough is usually delayed because of individual and health system barriers. However, delayed diagnosis and treatment facilitates further transmission, severity of disease with complications and mortality. The objective of this study is to assess the cost-effectiveness of the practical approach to lung health strategy, a patient-centred approach for diagnosis and treatment of common respiratory illnesses in primary healthcare settings, as a means of strengthening health systems to improve the quality of management of respiratory diseases. Economic evaluation nested in a cluster randomised controlled trial with three arms will be performed. Measures of effectiveness and costs for all arms of the study will be obtained from the cluster randomised controlled clinical trial. The main outcome measures are a combined rate of major respiratory diseases milestones and process indicators extracted from the practical approach to lung health strategy. For analysis, descriptive as well as regression techniques will be used. A cost-effectiveness analysis will be performed according to intention-to-treat principle and from a societal perspective. Cost-effectiveness ratios will be calculated using bootstrapping techniques. We hope to demonstrate the cost-effectiveness of the practical approach to lung health and informal healthcare providers, see an improvement in patients' quality of life, achieve a reduction in the duration and occurrence of episodes and the chronicity of respiratory diseases, and are able to report a decrease in the social cost. If the practical approach to lung health and informal healthcare provider's interventions are cost-effective, they could be scaled up to all primary healthcare centres. PACTR: PACTR201411000910192.

  12. Business ethics as a novel issue in health care economics.

    Science.gov (United States)

    Vrbová, H; Holmerová, I; Hrubantová, L

    1997-01-01

    The problems of health care providing and solutions suggested to solve them should be discussed publicly at all appropriate levels in all developed countries. In this contribution, new approaches to understanding the problems of business ethics in health care are mentioned and recommended for discussion. An application of such principles of business ethics as trust, accountability, solidarity, transparency and social responsibility is considered in the four following areas. First, it is the allocation of limited resources in health care. This is the world-wide problem of the end of 20th century, as the development of medical technologies offers a wide range of new diagnostic and therapeutic procedures. In our country this coincides with the on-going, and still incompleted reform of health care. Second, the other area is that of connecting health-care and social problems, important namely for vulnerable groups such as children, the elderly and chronically ill. The third area is concerned with the privatization of health care, the newly emanating structure and function of the health care system and the role of health care provides in society. The last group contains issues concerning attempts to facilitate communication between health care specialists and general public, as well as attempts to support those institutions of the civic democratic society that are oriented toward health, sickness and health care providing.

  13. A systematic review and overview of health economic evaluations of emergency laparotomy

    Directory of Open Access Journals (Sweden)

    Sohail Bampoe

    2017-11-01

    Full Text Available Abstract Background Little is known about the economic impact of emergency laparotomy (EL surgery in healthcare systems around the world. The aim of this systematic review is to describe the primary resource utilisation, healthcare economic and societal costs of EL in adults in different countries. Methods MEDLINE, EMBASE, ISI Web of Knowledge, Cochrane Central Register Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL were searched for full and partial economic analyses of EL published between 1 January 1991 and 31 December 2015. Quality of studies was assessed using the Consensus on Health Economic Criteria (CHEC checklist. Results Sixteen studies were included from a range of countries. One study was a full economic analysis. Fifteen studies were partial economic evaluations. These studies revealed that emergency abdominal surgery is expensive compared to similar elective surgery when comparing primary resource utilisation costs, with an important societal impact. Most contemporaneous studies indicate that in-hospital costs for EL are in excess of US$10,000 per patient episode, rising substantially when societal costs are considered. Discussion EL is a high-risk and costly procedure with a disproportionate financial burden for healthcare providers, relative to national funding provisions and wider societal cost impact. There is substantial heterogeneity in the methodologies and quality of published economic evaluations of EL; therefore, the true economic costs of EL are yet to be fully defined. Future research should focus on developing strategies to embed health economic evaluations within national programmes aiming to improve EL care, including developing the required measures and infrastructure. Conclusions Emergency laparotomy is expensive, with a significant cost burden to healthcare and systems and society worldwide. Novel strategies for reducing this econmic burden should urgently be explored if greater access to

  14. A systematic review and overview of health economic evaluations of emergency laparotomy.

    Science.gov (United States)

    Bampoe, Sohail; Odor, Peter M; Ramani Moonesinghe, S; Dickinson, Matthew

    2017-01-01

    Little is known about the economic impact of emergency laparotomy (EL) surgery in healthcare systems around the world. The aim of this systematic review is to describe the primary resource utilisation, healthcare economic and societal costs of EL in adults in different countries. MEDLINE, EMBASE, ISI Web of Knowledge, Cochrane Central Register Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL were searched for full and partial economic analyses of EL published between 1 January 1991 and 31 December 2015. Quality of studies was assessed using the Consensus on Health Economic Criteria (CHEC) checklist. Sixteen studies were included from a range of countries. One study was a full economic analysis. Fifteen studies were partial economic evaluations. These studies revealed that emergency abdominal surgery is expensive compared to similar elective surgery when comparing primary resource utilisation costs, with an important societal impact. Most contemporaneous studies indicate that in-hospital costs for EL are in excess of US$10,000 per patient episode, rising substantially when societal costs are considered. EL is a high-risk and costly procedure with a disproportionate financial burden for healthcare providers, relative to national funding provisions and wider societal cost impact. There is substantial heterogeneity in the methodologies and quality of published economic evaluations of EL; therefore, the true economic costs of EL are yet to be fully defined. Future research should focus on developing strategies to embed health economic evaluations within national programmes aiming to improve EL care, including developing the required measures and infrastructure. Emergency laparotomy is expensive, with a significant cost burden to healthcare and systems and society worldwide. Novel strategies for reducing this econmic burden should urgently be explored if greater access to this type of surgery is to be pursued as a global health target. PROSPERO

  15. 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.

  16. The added value of thorough economic evaluation of telemedicine networks.

    Science.gov (United States)

    Le Goff-Pronost, Myriam; Sicotte, Claude

    2010-02-01

    This paper proposes a thorough framework for the economic evaluation of telemedicine networks. A standard cost analysis methodology was used as the initial base, similar to the evaluation method currently being applied to telemedicine, and to which we suggest adding subsequent stages that enhance the scope and sophistication of the analytical methodology. We completed the methodology with a longitudinal and stakeholder analysis, followed by the calculation of a break-even threshold, a calculation of the economic outcome based on net present value (NPV), an estimate of the social gain through external effects, and an assessment of the probability of social benefits. In order to illustrate the advantages, constraints and limitations of the proposed framework, we tested it in a paediatric cardiology tele-expertise network. The results demonstrate that the project threshold was not reached after the 4 years of the study. Also, the calculation of the project's NPV remained negative. However, the additional analytical steps of the proposed framework allowed us to highlight alternatives that can make this service economically viable. These included: use over an extended period of time, extending the network to other telemedicine specialties, or including it in the services offered by other community hospitals. In sum, the results presented here demonstrate the usefulness of an economic evaluation framework as a way of offering decision makers the tools they need to make comprehensive evaluations of telemedicine networks.

  17. 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

  18. 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

  19. Performance, Carcass Evaluation And Economics Of Production Of ...

    African Journals Online (AJOL)

    An eight-weeks feeding trial involving 162,8-week old goldline cockerel birds was carried out in a completely randomized design to evaluate the performance, carcass characteristics and economics of production of cockerels fed whole cassava plant meal (WCPM). Diet 1 was maize based and served as the control, diet 2 ...

  20. Economic evaluation of soil fertility management in groundnut fields ...

    African Journals Online (AJOL)

    This paper provides the economic evaluation of soil fertility replenishing technologies (use of inorganic fertilizers, organic manure, and rhizobium inoculant) that were tested and recommended. Data on groundnut technologies used, yields, resource availability and use, and farmers' characteristics were collected through ...

  1. Writing, Evaluating and Assessing Data Response Items in Economics.

    Science.gov (United States)

    Trotman-Dickenson, D. I.

    1989-01-01

    Describes some of the problems in writing data response items in economics for use by A Level and General Certificate of Secondary Education (GCSE) students. Examines the experience of two series of workshops on writing items, evaluating them and assessing responses from schools. Offers suggestions for producing packages of data response items as…

  2. Feasibility and economic evaluation of low-cost evaporative cooling ...

    African Journals Online (AJOL)

    Feasibility and economic evaluation of low-cost evaporative cooling system in fruit and vegetables storage. ... on fruit and vegetables quality during harvesting, transportation, storage and marketing. ... The coolers were found to be effective in maintaining micro-environmental conditions for ... AJOL African Journals Online.

  3. nutritional and economic evaluation of Moringa oleifera leaf meal as ...

    African Journals Online (AJOL)

    nutritional and economic evaluation of Moringa oleifera leaf meal as a dietary supplement in West African Dwarf goats. ... South African Journal of Animal Science ... Moringa oleifera leaves may have the potential to enhance nutritional status, growth performance, and health of ruminant animals when used as part of their ...

  4. Design and techno economic evaluation of biomass gasifier for ...

    African Journals Online (AJOL)

    This paper addresses the design, performance and economic evaluation of biomass based open core downdraft gasifier for industrial process heat application. The gasifier is having feed rate as 90 kg h-1 and producing about 850 MJ h-1 of heat. The gasifier has been installed in M/S Phosphate India Pvt. Limited, Udaipur ...

  5. Disease specific methods for economic evaluations of breast cancer therapies

    NARCIS (Netherlands)

    Frederix, G.W.J.

    2013-01-01

    Cost-effectiveness analyses (CEAs) are widely considered to be helpful tools for making informative decisions in a resource constrained environment. Since the introduction of economic evaluations in reimbursement submissions in Australia as a formal requirement in 1993, CEAs have become widespread

  6. 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.

  7. Evaluation of Demographic Variables and Socio-economic Status ...

    African Journals Online (AJOL)

    This study evaluated the demographic variables and socio-economic status on the prevalence of health hazards amongst residents of Akure North Local Government, Ondo State, Nigeria. The study was a descriptive research design of the survey type. The population for this study was estimated to be 131,587 residents.

  8. The impact of economic evaluation on quality management in spine surgery.

    Science.gov (United States)

    Boos, Norbert

    2009-08-01

    Health care expenditures are substantially increasing within the last two decades prompting the imperative need for economic evaluations in health care. Historically, economic evaluations in health care have been carried out by four approaches: (1) the human-capital approach (HCA), (2) cost-effectiveness analysis (CEA), (3) cost-utility analysis (CUA) and (4) cost-benefit analysis (CBA). While the HCA cannot be recommended because of methodological shortcomings, CEA and CUA have been used frequently in healthcare. In CEA, costs are measured in monetary terms and health effects are measured in a non-monetary unit, e.g. number of successfully treated patients. In an attempt to develop an effectiveness measure that incorporates effects on both quantity and quality of life, so-called Quality Adjusted Life Years (QUALYs) were introduced. Contingent valuation surveys are used in cost-benefit analyses (CBA) to elicit the consumer's monetary valuations for program benefits by applying the willingness-to-pay approach. A distinguished feature of CBA is that costs and benefits are expressed in the same units of value, i.e. money. Only recently, economic evaluations have started to explore various spinal interventions particularly the very expensive fusion operations. While most of the studies used CEA or CUA approaches, CBAs are still rare. Most studies fail to show that sophisticated spinal interventions are more cost-effective than conventional treatments. In spite of the lack of therapeutic or cost-effectiveness for most spinal surgeries, there is rapidly growing spinal implant market demonstrating market imperfection and information asymmetry. A change can only be anticipated when physicians start to focus on the improvement of health care quality as documented by outcome research and economic evaluations of cost-effectiveness and net benefits.

  9. Economic evaluation of information technology applications on dairy farms

    OpenAIRE

    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 predicted potential benefits from a theoretical model of the investment, and investigated how farmers should deal with the applications. The empirical approach observed the actual effects of the i...

  10. Evaluation of fusion study from socio-economic aspects

    International Nuclear Information System (INIS)

    Konishi, S.; Okano, K.; Ogawa, Y.; Nagumo, S.; Tokimatsu, K.; Tobita, K.

    2005-01-01

    A fusion research project was evaluated from the aspects of socio-economics and its possible economic benefit. Research project itself has large economic impacts and it appears in a different way in different time. Four categories were identified as such mechanisms; direct economic effect by purchase and employment, the growth of local community and its economy, an improvement of technical capability of the industry stimulated by the development, and fusion energy supply under environmental constraints. Industrial effects were analysed from actual R and D program and found to yield considerable economic outcome, although contribution by the research itself is far smaller than that required for industry before actual commercial products can be produced. Economic value of fusion energy could be huge, but appears several decades future, and should be reduced by discount rate and success probability. Its value is more important as a part of environmental policy. Value of the fusion research at present age cannot be estimated as actual benefit, but as the effectiveness in the policy, or benefit for public that is now regarded as a kind of Externality

  11. Caring Cooperators and Powerful Punishers: Differential Effects of Induced Care and Power Motivation on Different Types of Economic Decision Making.

    Science.gov (United States)

    Chierchia, G; Lesemann, F H Parianen; Snower, D; Vogel, M; Singer, T

    2017-09-11

    Standard economic theory postulates that decisions are driven by stable context-insensitive preferences, while motivation psychology suggests they are driven by distinct context-sensitive motives with distinct evolutionary goals and characteristic psycho-physiological and behavioral patterns. To link these fields and test how distinct motives could differentially predict different types of economic decisions, we experimentally induced participants with either a Care or a Power motive, before having them take part in a suite of classic game theoretical paradigms involving monetary exchange. We show that the Care induction alone raised scores on a latent factor of cooperation-related behaviors, relative to a control condition, while, relative to Care, Power raised scores on a punishment-related factor. These findings argue against context-insensitive stable preferences and theories of strong reciprocity and in favor of a motive-based approach to economic decision making: Care and Power motivation have a dissociable fingerprint in shaping either cooperative or punishment behaviors.

  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. The impact of economic growth on health care utilization: a longitudinal study in rural Vietnam.

    Science.gov (United States)

    Thoa, Nguyen Thi Minh; Thanh, Nguyen Xuan; Chuc, Nguyen Thi Kim; Lindholm, Lars

    2013-03-16

    In many developing countries, including Vietnam, out-of-pocket payment is the principal source of health financing. The economic growth is widening the gap between rich and poor people in many aspects, including health care utilization. While inequities in health between high- and low-income groups have been well investigated, this study aims to investigate how the health care utilization changes when the economic condition is changing at a household level. We analysed a panel data of 11,260 households in a rural district of Vietnam. Of the sample, 74.4% having an income increase between 2003 and 2007 were defined as households with economic growth. We used a double-differences propensity score matching technique to compare the changes in health care expenditure as percentage of total expenditure and health care utilization from 2003 to 2005, from 2003 to 2007, and from 2005 to 2007, between households with and without economic growth. Households with economic growth spent less percentage of their expenditure for health care, but used more provincial/central hospitals (higher quality health care services) than households without economic growth. The differences were statistically significant. The results suggest that households with economic growth are better off also in terms of health services utilization. Efforts for reducing inequalities in health should therefore consider the inequality in income growth over time.

  14. 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.

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

    NARCIS (Netherlands)

    Kringos, D.S.; Boerma, W.G.W.; Zee, J. van der; Groenewegen, P.P.

    2013-01-01

    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,

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

    NARCIS (Netherlands)

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

    2013-01-01

    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,

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

    NARCIS (Netherlands)

    Kringos, D.S.; Boerma, W.G.W.; Zee, J. van der; Groenewegen, P.P.

    2013-01-01

    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

  18. Vacuum boilers developed heating surfaces technic and economic efficiency evaluation

    Science.gov (United States)

    Slobodina, E. N.; Mikhailov, A. G.; Semenov, B. A.

    2018-01-01

    The vacuum boilers as manufacturing proto types application analysis was carried out, the possible directions for the heating surfaces development are identified with a view to improving the energy efficiency. Economic characteristics to evaluate the vacuum boilers application efficiency (Net Discounted Income (NDI), Internal Rate of Return (IRR), Profitability Index (PI) and Payback Period) are represented. The given type boilers application technic and economic efficiency criteria were established. NDI changing curves depending on the finning coefficient and operating pressure were obtained as a result of the conducted calculation studies.

  19. Integrated Emergy and Economic Evaluation of Lotus-Root ...

    Science.gov (United States)

    Lotus (Neumbo nucifera, Gaertn) is the most important aquatic vegetable in China, with a cultivation history of over 3000 years. The emergy, energy, material, and money flows of three lotus root cultivation modes in Wanqingsha, Nansha District, Guangzhou, China were examined using Energy Systems Language models and emergy evaluation to better understand their ecological and economic characteristics on multiple spatial and temporal scales. The natural resource foundations, economic characteristics and sustainability of these modes were evaluated and compared. The results showed that although all three modes were highly dependent on purchased emergy inputs, their potential impacts as measured by the local (ELRL) and global (ELRW) environmental loading ratios were less than 1.2 and 0.7, respectively. The lotus-fish mode was the most sustainable with its emergy index of sustainable development (EISD) 2.09 and 2.13 times that of the pure lotus and lotus-shrimp modes, respectively. All three lotus-root production modes had superior economic viability, since their Output/Input ratio ranged from 2.56 to 4.95. The results indicated that agricultural systems may have different environmental impacts and sustainability characteristics at different spatial and temporal scales, and that these impacts and characteristics can be simultaneously explored using integrated emergy and economic evaluations. This study provides some major new insights about agriculture and its potenti

  20. Angra 3 - economic and financial evaluation of the enterprise

    International Nuclear Information System (INIS)

    Andrade, Ronaldo Barata de

    2006-01-01

    This paper presents an updated economic-financial evaluation of Angra 3 Nuclear Power Plant project and estimates the lowest power tariff value at which power potentially made available may be commercialized and yet ensures the project a profitability level agreeable to the interests of economic agents and shareholders. According to the project evaluation practice, Angra 3 power generation was considered separately from ELETRONUCLEAR operating plants (Angra 1 and Angra 2), thus preventing result distortions bound to occur if the economic-financial variables of the new project were analyzed associated with financial commitments and commercialization conditions resulting from the project implementation process and the generated power commercialization conditions, respectively. For this evaluation different technical and economic scenarios were devised, and the theory of Capital Asset Pricing Model (CAPM) for Own Capital cost and that of Weighted Average Cost of Capital (WACC) were used in addition to the forecast of the Statement of Results and Free Cash flow of Shareholders throughout the power plant life, which is the estimate basis for the lowest power tariff value and the Internal Return Rate (IRR) of the project. (author)

  1. An example of economical evaluation of stratiform uranium ore deposit

    International Nuclear Information System (INIS)

    Miyata, Hatsuho; Tabuchi, Akihiro; Ushijima, Kenichi.

    1992-01-01

    The Power Reactor and Nuclear Fuel Development corp. has carried out the business of uranium resource investigation and exploration in foreign countries aiming at securing uranium resources. If there is the possibility of economically developing the discovered uranium deposit, it is transferred to a Japanese private enterprise. In this paper, among the economical evaluation works that were carried out for the uranium deposits discovered by the Corp., the example of the initial economical evaluation for a stratiform uranium deposit carried out recently is reported. The deposit is located at the depth of 50 m - 70 m, and is a stratiform deposit having the extension of 4000 m x 1000 m. The boring investigation of about 350 holes was carried out for it. The estimation of the amount of uranium was done, and the production plan was made considering the scale of production, the characteristics of the ore, the circumstances of the site and so on. Based on the production plan, the initial expenses and the operation expenses were calculated. The design of the optimal pit which affects most the profitability and the economical evaluation were carried out. (K.I.)

  2. Systematic overview of economic evaluations of health-related rehabilitation.

    Science.gov (United States)

    Howard-Wilsher, Stephanie; Irvine, Lisa; Fan, Hong; Shakespeare, Tom; Suhrcke, Marc; Horton, Simon; Poland, Fiona; Hooper, Lee; Song, Fujian

    2016-01-01

    Health related rehabilitation is instrumental in improving functioning and promoting participation by people with disabilities. To make clinical and policy decisions about health-related rehabilitation, resource allocation and cost issues need to be considered. To provide an overview of systematic reviews (SRs) on economic evaluations of health-related rehabilitation. We searched multiple databases to identify relevant SRs of economic evaluations of health-related rehabilitation. Review quality was assessed by AMSTAR checklist. We included 64 SRs, most of which included economic evaluations alongside randomized controlled trials (RCTs). The review quality was low to moderate (AMSTAR score 5-8) in 35, and high (score 9-11) in 29 of the included SRs. The included SRs addressed various health conditions, including spinal or other pain conditions (n = 14), age-related problems (11), stroke (7), musculoskeletal disorders (6), heart diseases (4), pulmonary (3), mental health problems (3), and injury (3). Physiotherapy was the most commonly evaluated rehabilitation intervention in the included SRs (n = 24). Other commonly evaluated interventions included multidisciplinary programmes (14); behavioral, educational or psychological interventions (11); home-based interventions (11); complementary therapy (6); self-management (6); and occupational therapy (4). Although the available evidence is often described as limited, inconsistent or inconclusive, some rehabilitation interventions were cost-effective or showed cost-saving in a variety of disability conditions. Available evidence comes predominantly from high income countries, therefore economic evaluations of health-related rehabilitation are urgently required in less resourced settings. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  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. Workshop on Realist Evaluation for Integrated Care

    OpenAIRE

    Busetto, Loraine; Vrijhoef, Bert

    2018-01-01

    Background: The medical and health sciences were described by Joan Eakin as “a land in which the randomized controlled trial (RCT) is considered the apex of the methodological food chain”. However, integrated care (IC) interventions may in themselves call for the prioritisation of comprehensive, qualitative and multimethod research instead of traditional quantitative, single-method evaluations of program effectiveness. Therefore, rather than focusing only on whether certain IC interventions c...

  5. 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.

  6. 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.

  7. Clinical and economic outcomes of nurse-led services in the ambulatory care setting: A systematic review.

    Science.gov (United States)

    Chan, Raymond J; Marx, Wolfgang; Bradford, Natalie; Gordon, Louisa; Bonner, Ann; Douglas, Clint; Schmalkuche, Diana; Yates, Patsy

    2018-02-21

    -led care is a safe and feasible model of care for consideration across a number of ambulatory care settings. With appropriate training and support provided, nurse-led care is able to produce at least equivocal outcomes or at times better outcomes in terms of health-related quality of life compared to physician-led care or standard care for managing chronic conditions. There is a lack of high quality economic evaluations for nurse-led services, which is essential for guiding the decision making of health policy makers. Key factors such as education and qualification of the nurse; self-management support; resources available for the nurse; prescribing capabilities; and evaluation using appropriate outcome should be carefully considered for future planning of nurse-led services. Copyright © 2018 Elsevier Ltd. All rights reserved.

  8. Analisis Kritis dan Pragmatis Caring Economics sebagai Paradigma baru Kajian Ekonomi

    Directory of Open Access Journals (Sweden)

    Mit Witjaksono

    2016-11-01

    Full Text Available This article critically and pragmatically analyze and expose the concept and basic principles of caring economics as a new paradigm of economics as opposed to neo-liberal economics and its implications to economic education in Indonesia. The analysis and exposition based on unobtrusive research techniques, i.e. comparative content analysis and historical notes among references used here and in the context of Pancasila and UUD 1945. The implications of the study in this article are formulated into three key recommendations: (a the need to review and operational translation of Articles 33 and 34 of the UUD 1945 (Amendment IV, 2002; (b the need to review the curriculum, learning approaches and tools, and practices of learning economics in schools in order that caring economic becoming educational character of the national economy; and (c the need to campaign of introduction to paradigm and practice of caring economics in the universities, both as an academic study or studies the development of teaching-learning models based on caring economics, through collaboration of higher education, school, community and local government.

  9. Economic and environmental evaluation of investment projects of biogas plants

    International Nuclear Information System (INIS)

    Guzmán Marrero, Elizabeth; Guzmán Chinea, Jesús Manuel; Mata Varela, Milagros C.; Pérez González, Yanet

    2015-01-01

    The economic evaluation of the implementation and use of renewable energy is an issue of paramount importance and has been approached from different perspectives by different authors in different countries. Biogas technology has its own characteristics that make it more complex analysis involved not only in this case the energy aspect but there is also a significant impact on health assessment difficult, fertilization, soil improvement, animal feed and improved conditions of life. The capital budgeting, in conjunction with the planning process, is a key economic tool for decision making and in turn represents an ongoing challenge for the agricultural sector. It is a necessity of our country, together with the entire world, potentiate the action to correct management of organic waste generated in intensive pig farming, to contribute to the reduction of environmental impacts that this work causes. Studies in this area show the shortcomings that exist in Cuban law established for the evaluation of investment projects, both in its structure and in its cycle, without taking into account important elements such as risk analysis. This research evaluates the economic and financial feasibility of an investment project, including a social and environmental assessment of the same financial justification for the inclusion of risk analysis in the evaluation process (full text)

  10. Economic evaluation, human immunodeficiency virus infection and screening: a review and critical appraisal of economic studies.

    Science.gov (United States)

    Dibosa-Osadolor, Onome; Roberts, Tracy

    2010-07-01

    The aim of this study was to review, systematically and critically, evidence used to derive estimates of cost-effectiveness of human immunodeficiency virus (HIV) screening. A systematic review was conducted. Searched were three main electronic bibliographic databases from 1993 to 2008 using key words including HIV, mass screening, HAART, economic evaluation, cost-effectiveness analysis, modeling. We included studies of sexually transmitted HIV infection in both sexes, including studies comparing diagnostic testing protocols and partner notification. Outcomes included were cases of HIV infection detected, deterioration to the AIDS state, secondary transmission of HIV, the quality-adjusted life-years/survival, costs, and cost-effectiveness of HIV screening. Eighty-four papers were identified; ten of which were formal economic evaluations, one cost study, three effectiveness studies, and three systematic reviews of HIV prevention programs. The predominant assertion was that HIV screening is cost-effective; methodological problems, such as the preponderance of static models which are inappropriate for infectious diseases, varying perspectives from which the studies were analyzed, and arbitrary threshold incremental cost-effectiveness ratio levels, limited the validity of these findings, and their usefulness in informing health policy decisions. The majority of published economic evaluations are based on inappropriate static models. This flaw renders the results of these studies as inconclusive and the purported cost-effectiveness of HIV screening debatable. The results of this review could form a basis for consideration of further research and analysis by health economists into the cost-effectiveness of HIV screening.

  11. Teachers' Stories of Change: Stress, Care and Economic Rationality

    Science.gov (United States)

    Easthope, Chris; Easthope, Gary

    2007-01-01

    The impact of economic rationalism on teachers' working lives has been documented extensively, particularly in the UK. This article provides a case study of its impact in the early 1990s in a small Australian state, Tasmania, to illustrate that although the particular institutional forms through which it is expressed may differ its impact is…

  12. Paediatric tracheostomy and ventilation home care with challenging socio-economic circumstances in South Africa.

    Science.gov (United States)

    Groenendijk, Ilse; Booth, Jane; van Dijk, Monique; Argent, Andrew; Zampoli, Marco

    2016-05-01

    Children discharged home with a tracheostomy need a safe home environment and access to health care. We described the indications, clinical characteristics, socio-economic circumstances and outcomes of children enroled in a tracheostomy home care programme in South Africa. We performed a retrospective chart review of children receiving a tracheostomy and enroled in the Breatheasy programme at the Red Cross War Memorial Children's Hospital, Cape Town. Medical and background characteristics were recorded. Influences of socio-economic variables and underlying medical conditions on length of hospital stay, unplanned readmissions and mortality in the first year after discharge were evaluated. In the period 2008-2012, 157 patients were discharged home with a tracheostomy. Median hospital stay after tracheostomy insertion was significantly longer when parents had incomplete schooling compared to completed secondary school or higher education; 30 days (IQR 21-53) versus 23 days (IQR 16-33), respectively. Unplanned readmissions in the first year were documented for 72 patients (45.9%). The risk for unplanned readmission was 2.6 times higher in families with substance abuse the risk of respiratory infections was two-fold in case of household cigarette smoke exposure (OR 2.3.) Tracheostomy-related mortality was low (1.2%). An underlying medical condition was the only independent significant risk factor for mortality (OR 5.1, 95% CI 1.8-14.3). This study demonstrates that despite difficult socio-economic circumstances, home ventilation of children with a tracheostomy is safe, provided caregivers are adequately trained and supported. Copyright © 2016. Published by Elsevier Ireland Ltd.

  13. Exploring integration of care for children living with complex care needs across the European union and European economic area

    DEFF Research Database (Denmark)

    Brenner, Maria; O’Shea, Miriam; Larkin, Philip J.

    2017-01-01

    Introduction: The aim of this paper is to report on the development of surveys to explore integration of care for children living with complex care needs across the European Union (EU) and European Economic Area (EEA). Theory and methods: Each survey consists of a vignette and questions adapted...... from the Standards for Systems of Care for Children and Youth with Special Health Care Needs and the Eurobarometer Survey. A Country Agent in each country, a local expert in child health services, will obtain data from indigenous sources. Results: We identified ‘in-principle’ complex problems...

  14. An evaluation of rural health care research.

    Science.gov (United States)

    Kane, R; Dean, M; Solomon, M

    1979-05-01

    Reviews the state of the art of rural health research and evaluation in the U.S. with particular emphasis on the questions of access, health personnel, and financing. The current state of knowledge both in the published and unpublished literature in each area is summarized and a series of unresolved issues is proposed. A strategy for further research to include the various types of rural health care programs is described. Major findings suggest that, although rural populations do have somewhat less access to care than do urban populations, our ability to quantify precisely the extent and importance of this discrepancy is underdeveloped. Despite a substantial investment in a variety of rural health care programs there is inadequate information as to their effectiveness. Programs designed to increase the supply of health personnel to rural areas have met with mixed success. Sites staffed by National Health Service Corps personnel show consistently lower productivity than do sites under other sponsorship. Nonphysician personnel (physician assistants and nurse practitioners) offer a promising source of primary care for rural areas: recent legislation that reimburses such care should increase their utilization. A persistent problem is the expectation (often a mandate) incorporated into many rural health care demonstration efforts that the programs become financially self-sufficient in a finite period of time. Self-sufficiency is a function of utilization, productivity, and the ability to recover charges for services. In many instances stringent enforcement of the self-sufficiency requirement may mean those who need services most will be least likely to receive them.

  15. Stakeholders' Perspectives About and Priorities for Economic Evaluation of Health and Safety Programs in Healthcare.

    Science.gov (United States)

    Tompa, Emile; de Boer, Henriette; Macdonald, Sara; Alamgir, Hasanat; Koehoorn, Mieke; Guzman, Jaime

    2016-04-01

    This study identified and prioritized resources and outcomes that should be considered in more comprehensive and scientifically rigorous health and safety economic evaluations according to healthcare sector stakeholders. A literature review and stakeholder interviews identified candidate resources and outcomes and then a Delphi panel ranked them. According to the panel, the top five resources were (a) health and safety staff time; (b) training workers; (c) program planning, promotion, and evaluation costs; (d) equipment purchases and upgrades; and (e) administration costs. The top five outcomes were (a) number of injuries, illnesses, and general sickness absences; (b) safety climate; (c) days lost due to injuries, illnesses, and general sickness absences; (d) job satisfaction and engagement; and (e) quality of care and patient safety. These findings emphasize stakeholders' stated priorities and are useful as a benchmark for assessing the quality of health and safety economic evaluations and the comprehensiveness of these findings. © 2016 The Author(s).

  16. Methods of international health technology assessment agencies for economic evaluations--a comparative analysis.

    Science.gov (United States)

    Mathes, Tim; Jacobs, Esther; Morfeld, Jana-Carina; Pieper, Dawid

    2013-09-30

    The number of Health Technology Assessment (HTA) agencies increases. One component of HTAs are economic aspects. To incorporate economic aspects commonly economic evaluations are performed. A convergence of recommendations for methods of health economic evaluations between international HTA agencies would facilitate the adaption of results to different settings and avoid unnecessary expense. A first step in this direction is a detailed analysis of existing similarities and differences in recommendations to identify potential for harmonization. The objective is to provide an overview and comparison of the methodological recommendations of international HTA agencies for economic evaluations. The webpages of 127 international HTA agencies were searched for guidelines containing recommendations on methods for the preparation of economic evaluations. Additionally, the HTA agencies were requested information on methods for economic evaluations. Recommendations of the included guidelines were extracted in standardized tables according to 13 methodological aspects. All process steps were performed independently by two reviewers. Finally 25 publications of 14 HTA agencies were included in the analysis. Methods for economic evaluations vary widely. The greatest accordance could be found for the type of analysis and comparator. Cost-utility-analyses or cost-effectiveness-analyses are recommended. The comparator should continuously be usual care. Again the greatest differences were shown in the recommendations on the measurement/sources of effects, discounting and in the analysis of sensitivity. The main difference regarding effects is the focus either on efficacy or effectiveness. Recommended discounting rates range from 1.5%-5% for effects and 3%-5% for costs whereby it is mostly recommended to use the same rate for costs and effects. With respect to the analysis of sensitivity the main difference is that oftentimes the probabilistic or deterministic approach is recommended

  17. 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.

  18. New approaches to the economic evaluation of fusion research

    International Nuclear Information System (INIS)

    Hazelrigg, G.A.; Lietzke, K.R.

    1978-01-01

    The economic evaluation of fusion research to date has focussed on the benefits of essentially unlimited energy for future generations. In this paper it is shown that energy research in general, and fusion research in particular, also provides benefits in the short term, benefitting us today as well as future generations. Short-term benefits are the result of two distinct aspects of fusion research. First, fusion research provides information for decision making on both the continuing fusion research efforts and on other energy research programs. Second, fusion research provides an expectation of a future energy source thereby promoting accelerated consumption of existing fossil fuels today. Both short-term benefits can be quantitatively evaluated and both are quite substantial. Together, these short-term benefits form the primary economic rationale for fusion research

  19. Economic evaluation of closure cap barrier materials study

    International Nuclear Information System (INIS)

    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

  20. 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.

  1. Monetary conversion factors for economic evaluations of substance use disorders.

    Science.gov (United States)

    McCollister, Kathryn; Yang, Xuan; Sayed, Bisma; French, Michael T; Leff, Jared A; Schackman, Bruce R

    2017-10-01

    Estimating the economic consequences of substance use disorders (SUDs) is important for evaluating existing programs and new interventions. Policy makers in particular must weigh program effectiveness with scalability and sustainability considerations in deciding which programs to fund with limited resources. This study provides a comprehensive list of monetary conversion factors for a broad range of consequences, services, and outcomes, which can be used in economic evaluations of SUD interventions (primarily in the United States), including common co-occurring conditions such as HCV and HIV. Economic measures were selected from standardized clinical assessment instruments that are used in randomized clinical trials and other research studies (e.g., quasi-experimental community-based projects) to evaluate the impact of SUD interventions. National datasets were also reviewed for additional SUD-related consequences, services, and outcomes. Monetary conversion factors were identified through a comprehensive literature review of published articles as well as targeted searches of other sources such as government reports. Eight service/consequence/outcome domains were identified containing more than sixty monetizable measures of medical and behavioral health services, laboratory services, SUD treatment, social services, productivity outcomes, disability outcomes, criminal activity and criminal justice services, and infectious diseases consequences. Unit-specific monetary conversion factors are reported, along with upper and lower bound estimates, whenever possible. Having an updated and standardized source of monetary conversion factors will facilitate and improve future economic evaluations of interventions targeting SUDs and other risky behaviors. This exercise should be repeated periodically as new sources of data become available to maintain the timeliness, comprehensiveness, and quality of these estimates. Copyright © 2017 The Authors. Published by Elsevier Inc

  2. The conceptual design and economic evaluation of utility scale SMES

    International Nuclear Information System (INIS)

    Masuda, M.

    1986-01-01

    The paper reports the result of current Japanese activities in designing and evaluating the economic feasibility of utility Superconducting Magnetic Energy Storage (SMES). The 5 GWh/1 GW is proposed as a relevant unit of SMES in the year 2000. More than 20 companies, several universities and two national laboratories joined in a task force to study this technology. After three year's assessment, the conclusion on utility scale SMES is that no unresolvable technologies have been found and commercialization potential exists

  3. Economic evaluation method of new facilities for uranium ore processing

    International Nuclear Information System (INIS)

    Hebert, J.P.

    1986-01-01

    The importance of economic evaluation in feasibility studies is underlined. Notions of discounting are recalled. Profits of a project are analyzed. Studies can be relatively simple for a first estimation if investment cost and production cost are available because profits of a new production unit or savings obtained by a new investment are determined. But for integrated projects mine-plant the studies are complex especially for complete exploitation account [fr

  4. 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

  5. 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...... Statistics Denmark. The outcome measure was BP control defined as BP...

  6. Use of economic evaluation guidelines: 2 years' experience in Canada.

    Science.gov (United States)

    Baladi, J F; Menon, D; Otten, N

    1998-05-01

    Considerable effort has been expended in recent years in the development of methodology guidelines for economic evaluation of pharmaceutical products, driven in part by the desire to improve the rigour and quality of economic evaluations and to help decision making. Canada was one of the first countries to develop such guidelines and to encourage their use. This paper examines the extent to which the economic evaluations that were submitted to the Canadian Coordinating Office for Health Technology Assessment in the last two years adhered to Canadian guidelines. The analytic technique employed by twelve studies as well as the comparator used, the perspective taken, the outcome measure selected, the cost items that were taken into consideration and the extent of sensitivity analyses that were performed are reviewed in this paper. It can be concluded that although studies have been of variable quality, the majority of them were well presented, complete and transparent, due in part to the guidelines. Except for the perspective of the analysis, guidelines were, in many respects, adhered to and did not restrict investigators to specific methodologies or specific techniques. They were also instrumental in ensuring a minimum set of standards.

  7. Precarious work and care responsibilities in the economic crisis

    Czech Academy of Sciences Publication Activity Database

    Hašková, Hana; Dudová, Radka

    2017-01-01

    Roč. 27, č. 1 (2017), s. 47-63 ISSN 0959-6801 R&D Projects: GA ČR GA15-07898S; GA ČR GA15-13766S Institutional support: RVO:68378025 Keywords : Czech Republic * economic crisis * precarious work Subject RIV: AO - Sociology, Demography OBOR OECD: Sociology Impact factor: 1.159, year: 2016 http://ejd.sagepub.com/content/early/2016/10/13/0959680116672279.full.pdf+html

  8. 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.

  9. Socio-Economic Inequalities in the Use of Postnatal Care in India

    Science.gov (United States)

    Singh, Abhishek; Padmadas, Sabu S.; Mishra, Udaya S.; Pallikadavath, Saseendran; Johnson, Fiifi A.; Matthews, Zoe

    2012-01-01

    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 interventions. PMID

  10. 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

  11. [Economic impact of an automated dispensing system in an intensive care unit].

    Science.gov (United States)

    Kheniene, F; Bedouch, P; Durand, M; Marie, F; Brudieu, E; Tourlonnias, M-M; Bongi, P; Allenet, B; Calop, J

    2008-03-01

    Automated dispensing systems (ADS) allow a reduction of medication errors and an improvement of drug distribution in clinical ward. The objective of this study was to evaluate the economic impact of ADS in an intensive care unit. A cost-benefit model was constructed based on the hospital perspective. The system was evaluated before-after implementation of an ADS in a 12-bed cardiovascular intensive care unit of a French teaching hospital: (a) by a measuring nurse and pharmacy technician working time required for various tasks; (b) by measuring the cost of drug storage and the cost of expired drug; (c) by measuring the nurses' acceptability. After ADS was installed, nursing personnel spent less time on medication-related activities (mean of 1.9 hour/day of nursing time). Pharmacy technicians spent more time on floor-stock activities (mean of 0.7 hour/day of technician time). Implementation reduced the cost of drug storage by 56% (14,742 euros) and cost of expired drug by 9,086 euros per year. Finally, cost-benefit analysis including potential savings in terms of working time showed a net benefit of 71,586 euros (14,317 euros/year). The ADS was given high marks by the nurses; 77% wanted to keep it on their unit. Implementation of ADS is expected to generate direct savings for the hospital and working time reallocation, for nurses to interact with patients and for pharmacy technicians to get involved on the ward.

  12. Evaluation of economical at a uranium enrichment demonstration plant

    International Nuclear Information System (INIS)

    Sugitsue, Noritake

    2001-01-01

    In this report, the economy of technical achievement apply in the uranium enrichment demonstration plant is evaluated. From the evaluation, it can be concluded that the expected purpose was achieved because there was a definite economic prospect to commercial plant. The benefit analysis of thirteen years operation of the uranium enrichment demonstration plant also provides a financial aspect of the uranium enrichment business. Therefore, the performance, price and reliability of the centrifuge is an important factor in the uranium enrichment business. And the continuous development of a centrifuge while considering balance with the development cost is necessary for the business in the future. (author)

  13. 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

    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

  14. Literature review of women's economic empowerment and the care ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    10 juil. 2013 ... While much literature exists on the care economy across the globe, our review indicates that Africa is relatively underserved. It also reveals that ... Le documentaire A Walnut Tree, produit grâce à l'appui du CRDI, récompensé aux festivals cinématographiques de Moscou et d'Istanbul. Le documentaire A ...

  15. Transferability of economic evaluations of medical technologies: a new technology for orthopedic surgery

    NARCIS (Netherlands)

    Steuten, Lotte Maria Gertruda; Vallejo-Torres, Laura; Young, Terry; Buxton, Martin

    2008-01-01

    Transferring results of economic evaluations across countries or jurisdictions can potentially save scarce evaluation resources while helping to make market access and reimbursement decisions in a timely fashion. This article points out why transferring results of economic evaluations is

  16. Economic analysis of the intangible impacts of informal care for people with Alzheimer's disease and other mental disorders.

    Science.gov (United States)

    Gervès, Chloé; Bellanger, Martine Marie; Ankri, Joël

    2013-01-01

    Valuation of the intangible impacts of informal care remains a great challenge for economic evaluation, especially in the framework of care recipients with cognitive impairment. Our main objective was to explore the influence of intangible impacts of caring on both informal caregivers' ability to estimate their willingness to pay (WTP) to be replaced and their WTP value. We mapped characteristics that influence ability or inability to estimate WTP by using a multiple correspondence analysis. We ran a bivariate probit model with sample selection to further analyze the caregivers' WTP value conditional on their ability to estimate their WTP. A distinction exists between the opportunity costs of the caring dimension and those of the intangible costs and benefits of caring. Informal caregivers' ability to estimate WTP is negatively influenced by both intangible benefits from caring (P WTP value is negatively associated with positive intangible impacts of informal care (P WTP and their ability to estimate WTP are both influenced by intangible burden and benefit of caring. These results call into question the relevance of a hypothetical generalized financial compensation system as the optimal way to motivate caregivers to continue providing care. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  17. 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

  18. Intensive Care Nurses' Belief Systems Regarding the Health Economics: A Focused Ethnography.

    Science.gov (United States)

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

    2016-09-01

    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. 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). 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. 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 reforms in various aspects, such as the hospital

  19. Evaluation of undrilled prospects. Sensitivity to economic and geological factors

    International Nuclear Information System (INIS)

    Hermanrud, C.; Abrahamsen, K.; Vollset, J.; Nordahl, S.; Jourdan, C.

    1996-01-01

    Economic prospect evaluation at an early stage involves personnel with different skills, such as geoscientists, reservoir engineers, construction engineers and economists. Data are transferred between these groups of people who often have only a vague understanding of the accuracy of the data they receive. This lack of communication naturally limits the correctness of the results. To improve this communication, the complete process of prospect evaluation (including both geological and economical aspects) has been followed here in order to show the different data sets that are transferred and to comment upon their accuracy. Although this paper is based entirely on Statoil's methodology, it is nevertheless believed to be of general relevance. In Statoil's methodology, prospect volumes calculated by geoscientists are given as likelihood distributions. Post-drilling examination of such volume distributions show that historically they have been too optimistic. However, historical prospect risking has correctly identified the most important risk factors and has been able to separate low-risk from high-risk prospects in a satisfactory manner. The number of appraisal wells that are needed before the development of a field can be decided upon is often crucial to the economic evaluations. This number, however, is usually underestimated during the early stages of exploration, probably because data limitations mask reservoir heterogeneities. Reservoir performance is of utmost importance to early economic calculations as it influences both the drilling costs and the production of hydrocarbons vs. time. Of course, reservoir productivity is highly uncertain when judged prior to drilling the first well. Historical data show that reserve estimates of producing fields tend to be upgraded as reservoir depletion proceeds, although several fields have had their reserve estimates downgraded shortly after production start-up. The operational and investment costs are not generally

  20. The economics of bladder cancer: costs and considerations of caring for this disease.

    Science.gov (United States)

    Svatek, Robert S; Hollenbeck, Brent K; Holmäng, Sten; Lee, Richard; Kim, Simon P; Stenzl, Arnulf; Lotan, Yair

    2014-08-01

    Due to high recurrence rates, intensive surveillance strategies, and expensive treatment costs, the management of bladder cancer contributes significantly to medical costs. To provide a concise evaluation of contemporary cost-related challenges in the care of patients with bladder cancer. An emphasis is placed on the initial diagnosis of bladder cancer and therapy considerations for both non-muscle-invasive bladder cancer (NMIBC) and more advanced disease. A systematic review of the literature was performed using Medline (1966 to February 2011). Medical Subject Headings (MeSH) terms for search criteria included "bladder cancer, neoplasms" OR "carcinoma, transitional cell" AND all cost-related MeSH search terms. Studies evaluating the costs associated with of various diagnostic or treatment approaches were reviewed. Routine use of perioperative chemotherapy following complete transurethral resection of bladder tumor has been estimated to provide a cost savings. Routine office-based fulguration of small low-grade recurrences could decrease costs. Another potential important target for decreasing variation and cost lies in risk-modified surveillance strategies after initial bladder tumor removal to reduce the cost associated with frequent cystoscopic and radiographic procedures. Optimizing postoperative care after radical cystectomy has the potential to decrease length of stay and perioperative morbidity with substantial decreases in perioperative care expenses. The gemcitabine-cisplatin regimen has been estimated to result in a modest increase in cost effectiveness over methotrexate, vinblastine, doxorubicin, and cisplatin. Additional costs of therapies need to be balanced with effectiveness, and there are significant gaps in knowledge regarding optimal surveillance and treatment of both early and advanced bladder cancer. Regardless of disease severity, improvements in the efficiency of bladder cancer care to limit unnecessary interventions and optimize effective

  1. Economic evaluation of multilateral nuclear fuel cycle approach

    International Nuclear Information System (INIS)

    Takashima, Ryuta; Kuno, Yusuke; Omoto, Akira; Tanaka, Satoru

    2011-01-01

    Recently previous works have shown that multilateral nuclear fuel cycle approach has benefits not only of non-proliferation but also of cost effectiveness. This is because for most facilities in nuclear fuel cycle, there exist economies of scale, which has a significant impact on the costs of nuclear fuel cycle. Therefore, the evaluation of economic rationality is required as one of the evaluation factors for the multilateral nuclear fuel cycle approach. In this study, we consider some options with respect to multilateral approaches to nuclear fuel cycle in Asian-Pacific region countries that are proposed by the University of Tokyo. In particular, the following factors are embedded into each type: A) no involvement of assurance of services, B) provision of assurance of services including construction of new facility, without transfer of ownership, and C) provision of assurance of service including construction of new joint facilities with ownership transfer of facilities to multilateral nuclear fuel cycle approach. We show the overnight costs taking into account install and operation of nuclear fuel cycle facilities for each option. The economic parameter values such as uranium price, scale factor, and market output expansion influences the total cost for each option. Thus, we show how these parameter values and economic risks affect the total overnight costs for each option. Additionally, the international facilities could increase the risk of transportation for nuclear material compared to national facilities. We discuss the potential effects of this transportation risk on the costs for each option. (author)

  2. Economic evaluation of interventions designed to reduce Clostridium difficile infection.

    Science.gov (United States)

    Brain, David; Yakob, Laith; Barnett, Adrian; Riley, Thomas; Clements, Archie; Halton, Kate; Graves, Nicholas

    2018-01-01

    Healthcare decision-makers are increasingly expected to balance increasing demand for health services with a finite budget. The role of economic evaluation in healthcare is increasing and this research provides decision-makers with new information about the management of Clostridium difficile infection, from an economic perspective. A model-based economic evaluation was undertaken to identify the most cost-effective healthcare intervention relating to the reduction of Clostridium difficile transmission. Efficacy evidence was synthesised from the literature and was used to inform the effectiveness of both bundled approaches and stand-alone interventions, where appropriate intervention combinations were coupled together. Changes in health outcomes were estimated by combining information about intervention effectiveness and its subsequent impact on quality of life. A bundled approach of improving hand hygiene and environmental cleaning produces the best combination of increased health benefits and cost-savings. It has the highest mean net monetary benefit when compared to all other interventions. This intervention remains the optimal decision under different clinical circumstances, such as when mortality rate and patient length of stay are increased. Bundled interventions offered the best opportunity for health improvements. These findings provide healthcare decision-makers with novel information about the allocation of scarce resources relating to Clostridium difficile. If investments are not made in interventions that clearly yield gains in health outcomes, the allocation and use of scarce healthcare resources is inappropriate and improvements in health outcomes will be forgone.

  3. Economic evaluation of interventions designed to reduce Clostridium difficile infection.

    Directory of Open Access Journals (Sweden)

    David Brain

    Full Text Available Healthcare decision-makers are increasingly expected to balance increasing demand for health services with a finite budget. The role of economic evaluation in healthcare is increasing and this research provides decision-makers with new information about the management of Clostridium difficile infection, from an economic perspective.A model-based economic evaluation was undertaken to identify the most cost-effective healthcare intervention relating to the reduction of Clostridium difficile transmission. Efficacy evidence was synthesised from the literature and was used to inform the effectiveness of both bundled approaches and stand-alone interventions, where appropriate intervention combinations were coupled together. Changes in health outcomes were estimated by combining information about intervention effectiveness and its subsequent impact on quality of life.A bundled approach of improving hand hygiene and environmental cleaning produces the best combination of increased health benefits and cost-savings. It has the highest mean net monetary benefit when compared to all other interventions. This intervention remains the optimal decision under different clinical circumstances, such as when mortality rate and patient length of stay are increased. Bundled interventions offered the best opportunity for health improvements.These findings provide healthcare decision-makers with novel information about the allocation of scarce resources relating to Clostridium difficile. If investments are not made in interventions that clearly yield gains in health outcomes, the allocation and use of scarce healthcare resources is inappropriate and improvements in health outcomes will be forgone.

  4. Evaluation of economics of spent fuel storage techniques

    International Nuclear Information System (INIS)

    Yamaji, Kenji; Nagano, Koji

    1988-01-01

    Various spent fuel storage techniques are evaluated in terms of required costs. The unit storage cost for each spent fuel storage scenario is calculated based on the total cost required for the scenario including capital expenditure, operation cost, maintenance cost and transport cost. Intermediate storage may be performed in relatively small facilities in the plant or in independent large-scale facilities installed away from the plant. Dry casks or water pools are assumed to be used in in-plant storage facilities while vaults may also be employed in independent facilities. Evaluation is made for these different cases. In in-plant facilities, dry cask storage is found to be more economical in all cases than water pool storage, especially when large-sized casks are employed. In independent facilities, on the other hand, the use of vaults is the most desirable because the required capital expenditure is the lowest due to the effect of scale economics. Dry cask storage is less expensive than water pool storage also in independent facilities. The annual discount rate has relatively small influence on the unit cost for storage. An estimated unit cost for storage in independent storage facilities is shown separately for facilities with a capacity of 1,000 tons, 3,000 tons or 5,000 tons. The report also outlines the economics of spent fuel storage in overseas facilities (Finland, Sweden and U.S.A.). (Nogami, K.)

  5. Economic evaluation of radiation processing in urban solid wastes treatment

    Science.gov (United States)

    Carassiti, F.; Lacquaniti, L.; Liuzzo, G.

    During the last few years, quite a number of studies have been done, or are still in course, on disinfection of urban liquid wastes by means of ionizing radiations. The experience gained by SANDIA pilot plant of irradiation on dried sewage sludge, together with the recently presented conceptual design of another plant handling granular solids, characterized by high efficiency and simple running, have shown the possibility of extending this process to the treatment of urban solid wastes. As a matter of fact, the problems connected to the pathogenic aspects of sludge handling are often similar to those met during the disposal of urban solid wastes. This is even more so in the case of their reuse in agriculture and zootechny. The present paper introduces the results of an analysis carried out in order to evaluate the economical advantage of inserting irradiation treatment in some process scheme for management of urban solid wastes. Taking as an example a comprehensive pattern of urban solid wastes management which has been analysed and estimated economically in previous works, we first evaluated the extra capital and operational costs due to the irradiation and then analysed economical justification, taking into account the increasing commercial value of the by-products.

  6. [Performance of self-help groups and their economic evaluation].

    Science.gov (United States)

    Engelhardt, H D; Trojan, A; Nickel, S

    2009-01-01

    Hoffmann von Fallersleben is quoted with the sentence "Self-help is worthwhile, because it does not demand anything from others". This sounds catchy; it is, however, wrong: Self-help groups ask for support, particularly for financial resources for the work of either individual, highly organized self-help associations or for general support of self-help groups via local contact and information centers ("contact points for self-help groups"). With this request for economic "investments" in self-help, the question arises whether this is profitable for the country, the local authority or the social health insurance. In principle, the initial answer to this is: yes, the work of self-help groups is worthwhile for a single person, but also for the larger community, as various kinds of services are provided by self-help groups and organizations. Despite many surveys of members or co-operation partners which show positive effects of self-help groups, the question remains whether services of self-help groups can be measured and economically evaluated. The socio- political question regarding funding is closely connected to the idea of an economic evaluation of self-help groups. The aim of this article is to summarize and discuss which empiric approaches and findings are available on this subject. The monetary value for the work done per member of self-help groups and year lies between approximately 700 and 900 EUR.

  7. Economic evaluation of I and C modernization approach in NPPs

    International Nuclear Information System (INIS)

    Kang, Hyeon Tae; Sung, Chan Ho; Lee, Jae Ki

    2009-01-01

    Utilities have recently been debating the respective pros and cons of implementation of a multi-phase modernization during several normal outages versus a single major modernization implementation during a prolonged outage. We have studied these approaches and have been developing the basic design of NPPs I and C modernization since early 2008. As part of this study, analyses of the NPPs I and C systems were conducted and the need for upgrading the systems was raised. One of the primary concerns regarding the system modernization is a cost-benefit implementation, which will influence the modernization approach. From this viewpoint, the I and C modernization must consider economic factors such as I and C vendor cost, architecture engineering cost, installation cost, utility cost, and other transition costs such as training and procedure development. This paper presents a comparison study of economical aspects including cost evaluation between the aforementioned modernization implementations and suggests a solution for the I and C modernization approach. (author)

  8. 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

  9. Energy-, environmental and economic evaluation of energy crops utilization

    International Nuclear Information System (INIS)

    1994-06-01

    This preliminary project is prepared in order to clarify the economic possibilities and rentability of energy crops. Examples of energy crop resource potential, environmental and economic consequences are calculated on the basis of existing data. Utilization of annual and perennial crops is evaluated with regard to the usual following of agricultural areas, and to the traditional power generation in a coal-fueled plant. Two technological options are discussed: one based on energy crop fuels supplementing the conventional coal fuel, and the other based on a separate biomass-fueled boiler, connected to the conventional coal-fueled unit. Implementation of the main project,following the preliminary one will permit to estimate the future prospects and strategies of energy crop utilization as a profitable energy resource. (EG)

  10. Economic evaluation for protein and energy supplementation in adults: opportunities to strengthen the evidence.

    Science.gov (United States)

    Milte, R K; Ratcliffe, J; Miller, M D; Crotty, M

    2013-12-01

    Malnutrition is a costly problem for health care systems internationally. Malnourished individuals require longer hospital stays and more intensive nursing care than adequately nourished individuals and have been estimated to cost an additional £7.3 billion in health care expenditures in the United Kingdom alone. However, treatments for malnutrition have rarely been considered from an economic perspective. The aim of this systematic review was to identify the cost effectiveness of using protein and energy supplementation as a widely used intervention to treat adults with and at risk of malnutrition. Papers were identified that included economic evaluations of protein or energy supplementation for the treatment or prevention of malnutrition in adults. While the variety of outcome measures reported for cost-effectiveness studies made synthesis of results challenging, cost-benefit studies indicated that the savings for the health system could be substantial due to reduced lengths of hospital stay and less intensive use of health services after discharge. In summary, the available economic evidence indicates that protein and energy supplementation in treatment or prevention of malnutrition provides an opportunity to improve patient wellbeing and lower health system costs.

  11. 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

  12. Optimizing chronic disease management mega-analysis: economic evaluation.

    Science.gov (United States)

    2013-01-01

    As Ontario's population ages, chronic diseases are becoming increasingly common. There is growing interest in services and care models designed to optimize the management of chronic disease. To evaluate the cost-effectiveness and expected budget impact of interventions in chronic disease cohorts evaluated as part of the Optimizing Chronic Disease Management mega-analysis. Sector-specific costs, disease incidence, and mortality were calculated for each condition using administrative databases from the Institute for Clinical Evaluative Sciences. Intervention outcomes were based on literature identified in the evidence-based analyses. Quality-of-life and disease prevalence data were obtained from the literature. Analyses were restricted to interventions that showed significant benefit for resource use or mortality from the evidence-based analyses. An Ontario cohort of patients with each chronic disease was constructed and followed over 5 years (2006-2011). A phase-based approach was used to estimate costs across all sectors of the health care system. Utility values identified in the literature and effect estimates for resource use and mortality obtained from the evidence-based analyses were applied to calculate incremental costs and quality-adjusted life-years (QALYs). Given uncertainty about how many patients would benefit from each intervention, a system-wide budget impact was not determined. Instead, the difference in lifetime cost between an individual-administered intervention and no intervention was presented. Of 70 potential cost-effectiveness analyses, 8 met our inclusion criteria. All were found to result in QALY gains and cost savings compared with usual care. The models were robust to the majority of sensitivity analyses undertaken, but due to structural limitations and time constraints, few sensitivity analyses were conducted. Incremental cost savings per patient who received intervention ranged between $15 per diabetic patient with specialized nursing to

  13. 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

    2017-07-01

    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.

  14. What is the quality of economic evaluations of non-drug therapies? A systematic review and critical appraisal of economic evaluations of radiotherapy for cancer.

    Science.gov (United States)

    Barbieri, M; Weatherly, H L A; Ara, R; Basarir, H; Sculpher, M; Adams, R; Ahmed, H; Coles, C; Guerrero-Urbano, T; Nutting, C; Powell, M

    2014-10-01

    Breast, cervical and colorectal cancers are the three most frequent cancers in women, while lung, prostate and colorectal cancers are the most frequent in men. Much attention has been given to the economic evaluation of pharmaceuticals for treatment of cancer by the National Institute for Health and Care Excellence (NICE) in the UK and similar authorities internationally, while economic analysis developed for other types of anti-cancer interventions, including radiotherapy and surgery, are less common. Our objective was to review methods used in published cost-effectiveness studies evaluating radiotherapy for breast, cervical, colorectal, head and neck and prostate cancer, and to compare the economic evaluation methods applied with those defined in the guidelines used by the NICE technology appraisal programme. A systematic search of seven databases (MEDLINE, EMBASE, CDSR, NHSEED, HTA, DARE, EconLit) as well as research registers, the NICE website and conference proceedings was conducted in July 2012. Only economic evaluations of radiotherapy interventions in individuals diagnosed with cancer that included quality-adjusted life-years (QALYs) or life-years (LYs) were included. Included studies were appraised on the basis of satisfying essential, preferred and UK-specific methods requirements, building on the NICE Reference Case for economic evaluations and on other methods guidelines. A total of 29 studies satisfied the inclusion criteria (breast 14, colorectal 2, prostate 10, cervical 0, head and neck 3). Only two studies were conducted in the UK (13 in the USA). Among essential methods criteria, the main issue was that only three (10%) of the studies used clinical-effectiveness estimates identified through systematic review of the literature. Similarly, only eight (28%) studies sourced health-related quality-of-life data directly from patients with the condition of interest. Other essential criteria (e.g. clear description of comparators, patient group indication

  15. EVALUATION OF BARTIN CITY ECONOMIC CONSTRUCT WITH DIGITALIZED SWOT ANALYSIS

    Directory of Open Access Journals (Sweden)

    NERMİN ÇELİK

    2013-06-01

    Full Text Available In this study, firstly besides weakness and strengths of Bartın economy, threats and opportunities were presented by means of SWOT analysis. Secondly obtained findings were evaluated in comparative way and priority weights of each one were calculated by means of Analytic Hierarchy Process (AHP which is an evaluation approach with multiple criteria. Finally, the weak aspects were taken attention on the basis of quantitative findings and the alternative strategies towards to economic development of the city were presented. The weakest side of the city is high unemployment ratio and immigration problem, the most strength side of the city is the using for trading of Bartın port. Besides preparing that study as a first for Bartın city which is within the Encouragement Law, offering the solutions by evaluating the current and potential situations can be described as original sides of this study.

  16. Continued care of uranium mill sites: some economic considerations

    International Nuclear Information System (INIS)

    Harrington, W.; Sawyer, J.W. Jr.

    1978-01-01

    A critique of recently enacted legislation authorizing the New Mexico Environmental Improvement Agency to regulate uranium mills in the state is presented. Under this new legislation, the Agency is authorized to require payment of up to 10 cents per pound of yellowcake from each licensed mill in the state until a total of $1 million has been deposited by that mill. The continued care fund thus created will provide for maintenance in perpetuity of mill sites after being decommissioned. Arguments are presented, based on calculations for a typical 5,000 ton per day mill, that even the maximum amount is not likely to generate sufficient income to support an adequate maintenance program. The matter is further aggravated by the rate of inflation which will increase costs beyond the coverage provided by a fixed funding system. To correct this situation, it is proposed that (1) the fund should generate an income stream sufficient to meet all maintenance costs based on currently available information on costs, interest, and inflation rates, and (2) the terms of the continued care contribution should be readily alterable as new information becomes available. The latter condition should be coupled with removal of the upper statutory limit now established for the fund

  17. 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. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. Exploring Integration of Care for Children Living with Complex Care Needs across the European Union and European Economic Area.

    Science.gov (United States)

    Brenner, Maria; O'Shea, Miriam; J Larkin, Philip; Kamionka, Stine Lundstroem; Berry, Jay; Hiscock, Harriet; Rigby, Michael; Blair, Mitch

    2017-04-24

    The aim of this paper is to report on the development of surveys to explore integration of care for children living with complex care needs across the European Union (EU) and European Economic Area (EEA). Each survey consists of a vignette and questions adapted from the Standards for Systems of Care for Children and Youth with Special Health Care Needs and the Eurobarometer Survey . A Country Agent in each country, a local expert in child health services, will obtain data from indigenous sources. We identified 'in-principle' complex problems and adapted surveys to capture care integration. We expect to get rich data to understand perceptions and to inform actions for a number of complex health issues. The study has the potential to make a wide contribution to individual countries of the EU/EEA to understand their own integration of services mapped against responses from other member states. Early results are expected in Spring 2017.

  19. Evaluation the potential economic impacts of Taiwanese biomass energy production

    International Nuclear Information System (INIS)

    Chen, Chi-Chung; McCarl, Bruce; Chang, Ching-Cheng; Tso, Chunto

    2011-01-01

    The Taiwanese rice paddy land set-aside program diverts a substantial land area. Given today's high energy prices and interests in energy security, that set-aside area could be converted to produce bioenergy feedstocks. This study evaluates the economic and environmental impacts of such a policy change using a Taiwanese agricultural sector model. The results show that such a strategy provides increased farm revenue, increased rural employment, increased energy sufficiency and reduced greenhouse gas emissions but also increased government expenditures. These outcomes indicate that the agricultural sector could play a positive role by producing renewable energy. -- Highlights: → This paper evaluates the economic and environmental impacts of converting set-aside area to produce bioenergy feedstocks. → Taiwanese agricultural sector model is built and applied to evaluate such impacts. → The empirical results show that producing bioenergy using set-aside area could provide increased farm revenue, increased rural employment, increased energy sufficiency and reduced greenhouse gas emissions but also increased government expenditures. → Agricultural sector in Taiwan could play a positive role by producing renewable energy.

  20. The impact of cancer drug wastage on economic evaluations.

    Science.gov (United States)

    Truong, Judy; Cheung, Matthew C; Mai, Helen; Letargo, Jessa; Chambers, Alexandra; Sabharwal, Mona; Trudeau, Maureen E; Chan, Kelvin K W

    2017-09-15

    The objective of this study was to determine the impact of modeling cancer drug wastage in economic evaluations because wastage can result from single-dose vials on account of body surface area- or weight-based dosing. Intravenous chemotherapy drugs were identified from the pan-Canadian Oncology Drug Review (pCODR) program as of January 2015. Economic evaluations performed by drug manufacturers and pCODR were reviewed. Cost-effectiveness analyses and budget impact analyses were conducted for no-wastage and maximum-wastage scenarios (ie, the entire unused portion of the vial was discarded at each infusion). Sensitivity analyses were performed for a range of body surface areas and weights. Twelve drugs used for 17 indications were analyzed. Wastage was reported (ie, assumptions were explicit) in 71% of the models and was incorporated into 53% by manufacturers; this resulted in a mean incremental cost-effectiveness ratio increase of 6.1% (range, 1.3%-14.6%). pCODR reported and incorporated wastage for 59% of the models, and this resulted in a mean incremental cost-effectiveness ratio increase of 15.0% (range, 2.6%-48.2%). In the maximum-wastage scenario, there was a mean increase in the incremental cost-effectiveness ratio of 24.0% (range, 0.0%-97.2%), a mean increase in the 3-year total incremental budget costs of 26.0% (range, 0.0%-83.1%), and an increase in the 3-year total incremental drug budget cost of approximately CaD $102 million nationally. Changing the mean body surface area or body weight caused 45% of the drugs to have a change in the vial size and/or quantity, and this resulted in increased drug costs. Cancer drug wastage can increase drug costs but is not uniformly modeled in economic evaluations. Cancer 2017;123:3583-90. © 2017 American Cancer Society. © 2017 American Cancer Society.

  1. Extending the liaison psychiatry service in a large hospital in the UK: a before and after evaluation of the economic impact and patient care following ED attendances for self-harm

    NARCIS (Netherlands)

    Opmeer, Brent C.; Hollingworth, William; Marques, Elsa M. R.; Margelyte, Ruta; Gunnell, David

    2017-01-01

    Objectives To evaluate the impact of an expansion of liaison psychiatry services (LPS) on patient management, outcomes and treatment costs for emergency department (ED) attendances for self-harm. Design Retrospective before and after cohort study using routinely collected Self-Harm Surveillance

  2. Technical and economic evaluation of nuclear seawater desalination systems

    International Nuclear Information System (INIS)

    Grechko, A.G.; Romenkov, A.A.; Shishkin, V.A.

    1998-01-01

    The IAEA Cogeneration/Desalination Cost Model spreadsheets were used for the economic evaluation of sea water desalination plants coupled with small and medium size nuclear reactors developed in RDIPE. The results of calculations have shown that the cost of potable water is equal to or even below 1$/m 3 . This is very close to similar indices of the best fossil driven desalination plants. For remote and difficult-to-access regions, where the transportation share contributes significantly to the product water cost at fossil plants, the nuclear power sources of these reactor types are cost-efficient and can successfully compete with fossil power sources. (author)

  3. Economics of Palliative Care for Hospitalized Adults With Serious Illness: A Meta-analysis.

    Science.gov (United States)

    May, Peter; Normand, Charles; Cassel, J Brian; Del Fabbro, Egidio; Fine, Robert L; Menz, Reagan; Morrison, Corey A; Penrod, Joan D; Robinson, Chessie; Morrison, R Sean

    2018-06-01

    Economics of care for adults with serious illness is a policy priority worldwide. Palliative care may lower costs for hospitalized adults, but the evidence has important limitations. To estimate the association of palliative care consultation (PCC) with direct hospital costs for adults with serious illness. Systematic searches of the Embase, PsycINFO, CENTRAL, PubMed, CINAHL, and EconLit databases were performed for English-language journal articles using keywords in the domains of palliative care (eg, palliative, terminal) and economics (eg, cost, utilization), with limiters for hospital and consultation. For Embase, PsycINFO, and CENTRAL, we searched without a time limitation. For PubMed, CINAHL, and EconLit, we searched for articles published after August 1, 2013. Data analysis was performed from April 8, 2017, to September 16, 2017. Economic evaluations of interdisciplinary PCC for hospitalized adults with at least 1 of 7 illnesses (cancer; heart, liver, or kidney failure; chronic obstructive pulmonary disease; AIDS/HIV; or selected neurodegenerative conditions) in the hospital inpatient setting vs usual care only, controlling for a minimum list of confounders. Eight eligible studies were identified, all cohort studies, of which 6 provided sufficient information for inclusion. The study estimated the association of PCC within 3 days of admission with direct hospital costs for each sample and for subsamples defined by primary diagnoses and number of comorbidities at admission, controlling for confounding with an instrumental variable when available and otherwise propensity score weighting. Treatment effect estimates were pooled in the meta-analysis. Total direct hospital costs. This study included 6 samples with a total 133 118 patients (range, 1020-82 273), of whom 93.2% were discharged alive (range, 89.0%-98.4%), 40.8% had a primary diagnosis of cancer (range, 15.7%-100.0%), and 3.6% received a PCC (range, 2.2%-22.3%). Mean Elixhauser index scores ranged

  4. AMCP Partnership Forum: FDAMA Section 114-Improving the Exchange of Health Care Economic Data.

    Science.gov (United States)

    2016-07-01

    The Food and Drug Administration Modernization Act (FDAMA) of 1997 included Section 114 as a regulatory safe harbor with the goal of increasing the dissemination of health care economic information (HCEI) to those responsible for formulary decision making. HCEI is typically not included within FDA-approved labeling. Although it has been nearly 20 years since passage and enactment of Section 114, proactive distribution of HCEI has been underutilized by biopharmaceutical companies partly because of (a) vague wording in the statute and (b) the absence of FDA-implementing regulations. Consequently, companies and health care decisions makers have had to speculate about the scope of the provisions. As a result, the biopharmaceutical industry has significant concerns about stepping over the line when using the safe harbor. Also, payers and other "payer-like" decision makers (e.g., self-funded corporate insurers) who are trying to make appropriate coverage and utilization decisions are demanding this information but are not receiving it because of the uncertainties in the statute. Considering this renewed interest by multiple stakeholders regarding the need for revisions and/or guidance pertaining to Section 114, the Academy of Managed Care Pharmacy held a partnership forum on March 1-2, 2016, with a diverse group of health care stakeholders to provide the FDA with considerations for disseminating a guidance document on current thinking for the sharing of HCEI with health care decision makers. Forum participants represented the managed care industry, biopharmaceutical industry, health care providers, pharmacoeconomic experts, policy experts, and patient advocacy groups with specific expertise in the development, use, and dissemination of HCEI. The multistakeholder group represented the key professionals and entities affected by the provisions of Section 114 and present the collective credibility necessary for Congress and the FDA to modernize and operationalize the safe

  5. Economic evaluation of algae biodiesel based on meta-analyses

    Science.gov (United States)

    Zhang, Yongli; Liu, Xiaowei; White, Mark A.; Colosi, Lisa M.

    2017-08-01

    The objective of this study is to elucidate the economic viability of algae-to-energy systems at a large scale, by developing a meta-analysis of five previously published economic evaluations of systems producing algae biodiesel. Data from original studies were harmonised into a standardised framework using financial and technical assumptions. Results suggest that the selling price of algae biodiesel under the base case would be 5.00-10.31/gal, higher than the selected benchmarks: 3.77/gal for petroleum diesel, and 4.21/gal for commercial biodiesel (B100) from conventional vegetable oil or animal fat. However, the projected selling price of algal biodiesel (2.76-4.92/gal), following anticipated improvements, would be competitive. A scenario-based sensitivity analysis reveals that the price of algae biodiesel is most sensitive to algae biomass productivity, algae oil content, and algae cultivation cost. This indicates that the improvements in the yield, quality, and cost of algae feedstock could be the key factors to make algae-derived biodiesel economically viable.

  6. Systematic Review of Health Economic Impact Evaluations of Risk Prediction Models : Stop Developing, Start Evaluating

    NARCIS (Netherlands)

    van Giessen, Anoukh; Peters, Jaime; Wilcher, Britni; Hyde, Chris; Moons, Carl; de Wit, Ardine; Koffijberg, Erik

    2017-01-01

    Background: Although health economic evaluations (HEEs) are increasingly common for therapeutic interventions, they appear to be rare for the use of risk prediction models (PMs). Objectives: To evaluate the current state of HEEs of PMs by performing a comprehensive systematic review. Methods: Four

  7. My Daddy Takes Care of Me! Fathers as Care Providers. Current Population Reports. Household Economic Studies.

    Science.gov (United States)

    Casper, Lynne M.

    1997-01-01

    This report examines statistical data on fathers caring for their children during mothers' working hours and which types of fathers are the most likely to take care of their children. Data are taken from the Survey of Income and Program Participation, a longitudinal survey conducted at four-month intervals by the Census Bureau. Care by fathers is…

  8. Evaluating Behavioral Economic Models of Heavy Drinking Among College Students.

    Science.gov (United States)

    Acuff, Samuel F; Soltis, Kathryn E; Dennhardt, Ashley A; Berlin, Kristoffer S; Murphy, James G

    2018-05-14

    Heavy drinking among college students is a significant public health concern that can lead to profound social and health consequences, including alcohol use disorder. Behavioral economics posits that low future orientation and high valuation of alcohol (alcohol demand) combined with deficits in alternative reinforcement increase the likelihood of alcohol misuse (Bickel et al., 2011). Despite this, no study has examined the incremental utility of all three variables simultaneously in a comprehensive model METHOD: The current study uses structural equation modeling to test the associations between behavioral economic variables - alcohol demand (latent), future orientation (measured with a delay discounting task and the Consideration of Future Consequences (CFC) scale), and proportionate substance-related reinforcement - and alcohol consumption and problems among 393 heavy drinking college students. Two models are tested: 1) an iteration of the reinforcer pathology model that includes an interaction between future orientation and alcohol demand; and 2) an alternative model evaluating the interconnectedness of behavioral economic variables in predicting problematic alcohol use RESULTS: The interaction effects in model 1 were nonsignificant. Model 2 suggests that greater alcohol demand and proportionate substance-related reinforcement is associated with greater alcohol consumption and problems. Further, CFC was associated with alcohol-related problems and lower proportionate substance-related reinforcement but was not significantly associated with alcohol consumption or alcohol demand. Finally, greater proportionate substance-related reinforcement was associated with greater alcohol demand CONCLUSIONS: Our results support the validity of the behavioral economic reinforcer pathology model as applied to young adult heavy drinking. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  9. Primary care in an unstable security, humanitarian, economic and political context: the Kurdistan Region of Iraq.

    Science.gov (United States)

    Shukor, Ali R; Klazinga, Niek S; Kringos, Dionne S

    2017-08-23

    This study presents a descriptive synthesis of Kurdistan Region of Iraq's (KRI) primary care system, which is undergoing comprehensive primary care reforms within the context of a cross-cutting structural economic adjustment program and protracted security, humanitarian, economic and political crises. The descriptive analysis used a framework operationalizing Starfield's classic primary care model for health services research. A scoping review was performed using relevant sources, and expert consultations were conducted for completing and validating data. The descriptive analysis presents a complex narrative of a primary care system undergoing classical developmental processes of transitioning middle-income countries. The system is simultaneously under tremendous pressure to adapt to the continuously changing, complex and resource-intensive needs of sub-populations exhibiting varying morbidity patterns, within the context of protracted security, humanitarian, economic, and political crises. Despite exhibiting significant resilience in the face of the ongoing crises, the continued influx of IDPs and Syrian refugees, coupled with extremely limited resources and weak governance at policy, organizational and clinical levels threaten the sustainability of KRI's public primary care system. Diverse trajectories to the strengthening and development of primary care are underway by local and international actors, notably the World Bank, RAND Corporation, UN organizations and USAID, focusing on varying imperatives related to the protracted humanitarian and economic crises. The convergence, interaction and outcomes of the diverse initiatives and policy approaches in relation to the development of KRI's primary care system are complex and highly uncertain. A common vision of primary care is required to align resources, initiatives and policies, and to enable synergy between all local and international actors involved in the developmental and humanitarian response. Further

  10. [Evaluation of a self-care leaflet].

    Science.gov (United States)

    Lystad, N; Heian, F

    1989-01-20

    A self care leaflet of 50 pages was distributed in Tingvoll, a municipality with 3,500 inhabitants. The leaflet gives advice about self treatment and prevention of common health problems, and guidelines for contacting the health services. In surveys conducted just before and 10 months after the distribution, we documented -- how the leaflet was accepted and used --changes in knowledge about the health problems mentioned in the leaflet. The leaflet was well accepted. It was characterized as easy to read and to use. 10 months after distribution to read and to use. 10 months after distribution 90% found it within five minutes. 63% used the leaflet when they had a health problem. 90% of those using the leaflet felt more sure that they acted correctly after consulting it, and 60% changed their mind about consulting a general practitioner. We consider the level of knowledge about health problems to be low. The evaluation showed increased knowledge in all groups, except for persons "responsible for caring for elderly relatives". The increase was most marked for "men" and for "persons with health education".

  11. Overview, methods and results of multi-country community-based maternal and newborn care economic analysis.

    Science.gov (United States)

    Daviaud, Emmanuelle; Owen, Helen; Pitt, Catherine; Kerber, Kate; Bianchi Jassir, Fiorella; Barger, Diana; Manzi, Fatuma; Ekipara-Kiracho, Elizabeth; Greco, Giulia; Waiswa, Peter; Lawn, Joy E

    2017-10-01

    Home visits for pregnancy and postnatal care were endorsed by the WHO and partners as a complementary strategy to facility-based care to reduce newborn and maternal mortality. This article aims to synthesise findings and implications from the economic analyses of community-based maternal and newborn care (CBMNC) evaluations in seven countries. The evaluations included five cluster randomized trials (Ethiopia, Ghana, South Africa, Tanzania, Uganda) and programmatic before/after assessments (Bolivia, Malawi). The economic analyses were undertaken using a standardized, comparable methodology the 'Cost of Integrated Newborn Care' Tool, developed by the South African Medical Research Council, with Saving Newborn Lives and a network of African economists. The main driver of costs is the number of community health workers (CHWs), determined by their time availability, as fixed costs per CHW (equipment, training, salary/stipend, supervision and management), independent from the level of activity (number of mothers visited) represented over 96% of economic and financial costs in five of the countries. Unpaid volunteers are not necessarily a cheap option. An integrated programme with multi-purpose paid workers usually has lower costs per visit but requires innovative management, including supervision to ensure that coverage, or quality of care are not compromised since these workers have many other responsibilities apart from maternal and newborn health. If CHWs reach 95% of pregnant women in a standardized 100 000 population, the additional financial cost in all cases would be under USD1 per capita. In five of the six countries, the programme would be highly cost-effective (cost per DALY averted < GDP/capita) by WHO threshold even if they only achieved a reduction of 1 neonatal death per 1000 live births. These results contribute useful information for implementation planning and sustainability of CBMNC programmes. © The Author 2017. Published by Oxford University

  12. The revised Canadian Guidelines for the Economic Evaluation of Pharmaceuticals.

    Science.gov (United States)

    Glennie, J L; Torrance, G W; Baladi, J F; Berka, C; Hubbard, E; Menon, D; Otten, N; Rivière, M

    1999-05-01

    The first edition of the Guidelines for Economic Evaluation of Pharmaceuticals: Canada was published in November 1994. At that time, the Canadian Coordinating Office for Health Technology Assessment (CCOHTA) was assigned the task of maintaining and regularly updating the Canadian Guidelines. Since their introduction, a great deal of experience has been gained with the practical application of the guidelines. Their role has also evolved over time, from being a framework for pharmacoeconomic research to the point where a wide variety of decision-makers use economic evaluations based on the principles set out in the guidelines as a means of facilitating their formulary decisions. In addition, methodologies in certain areas (and the body of related research literature in general) have developed considerably over time. Given these changes in the science and the experience gained, CCOHTA convened a multi-disciplinary committee to address the need for revisions to the guidelines. The underlying principles of the review process were to keep the guidance nature of the document, to focus on the needs of 'doers' (so as to meet the information needs of 'users') and to provide information and advice in areas of controversy, with sound direction in areas of general agreement. The purpose of this review is three-fold: (i) to outline the process which lead to the revision of the Canadian Guidelines; (ii) to describe the major changes made to the second edition of this document; and (iii) to consider the 'next steps' as they relate to the impact of such guidelines and the measurement of outcomes related to economic assessments of pharmaceuticals in general.

  13. Improved fuel design economics - a new evaluation tool

    International Nuclear Information System (INIS)

    Aboudara, J.L.

    1987-01-01

    Advanced fuel design technology is now beginning to be implemented with new reload regions for large pressurized water reactors. Until recently there has not been an integrated computer modeling product that would allow easy assessment of the economics of various advanced fuel design alternatives now available to utilities. The Fuel Cycle Scoping System (FCSS) was designed to fill this need. The FCSS is a personnel computer (PC) software package that is used to evaluate alternative strategies for supplying and using nuclear fuel in nuclear power reactors. The FCSS is an extremely flexible package that permits evaluation of in-core and out-of-core fuel management strategy options. For each strategy option, unit and reactor operating assumptions and assumptions for uranium supply, conversion, enrichment, fabrication, and spent fuel disposal can be made

  14. Estimating costs in the economic evaluation of medical technologies.

    Science.gov (United States)

    Luce, B R; Elixhauser, A

    1990-01-01

    The complexities and nuances of evaluating the costs associated with providing medical technologies are often underestimated by analysts engaged in economic evaluations. This article describes the theoretical underpinnings of cost estimation, emphasizing the importance of accounting for opportunity costs and marginal costs. The various types of costs that should be considered in an analysis are described; a listing of specific cost elements may provide a helpful guide to analysis. The process of identifying and estimating costs is detailed, and practical recommendations for handling the challenges of cost estimation are provided. The roles of sensitivity analysis and discounting are characterized, as are determinants of the types of costs to include in an analysis. Finally, common problems facing the analyst are enumerated with suggestions for managing these problems.

  15. Computational health economics for identification of unprofitable health care enrollees.

    Science.gov (United States)

    Rose, Sherri; Bergquist, Savannah L; Layton, Timothy J

    2017-10-01

    Health insurers may attempt to design their health plans to attract profitable enrollees while deterring unprofitable ones. Such insurers would not be delivering socially efficient levels of care by providing health plans that maximize societal benefit, but rather intentionally distorting plan benefits to avoid high-cost enrollees, potentially to the detriment of health and efficiency. In this work, we focus on a specific component of health plan design at risk for health insurer distortion in the Health Insurance Marketplaces: the prescription drug formulary. We introduce an ensembled machine learning function to determine whether drug utilization variables are predictive of a new measure of enrollee unprofitability we derive, and thus vulnerable to distortions by insurers. Our implementation also contains a unique application-specific variable selection tool. This study demonstrates that super learning is effective in extracting the relevant signal for this prediction problem, and that a small number of drug variables can be used to identify unprofitable enrollees. The results are both encouraging and concerning. While risk adjustment appears to have been reasonably successful at weakening the relationship between therapeutic-class-specific drug utilization and unprofitability, some classes remain predictive of insurer losses. The vulnerable enrollees whose prescription drug regimens include drugs in these classes may need special protection from regulators in health insurance market design. © The Author 2017. Published by Oxford University Press.

  16. Systematic mapping review about costs and economic evaluations of skin conditions and diseases in the aged.

    Science.gov (United States)

    Lichterfeld-Kottner, Andrea; Hahnel, Elisabeth; Blume-Peytavi, Ulrike; Kottner, Jan

    2017-02-01

    Skin conditions and dermatological diseases associated with advanced age (e.g. fungal infection, dry skin and itch) receive increasingly attention in clinical practice and research. Cost and economic evaluations are important sources to inform priority setting and ressource allocation decisions in healthcare. The economics of skin conditions in aged populations has not been systematically reviewed so far. The aim of this mapping review was to summarize the economic evidence of selected skin conditions in the aged (65 + years). A mapping literature review and evidence summary was conducted. Searches were conducted in data bases Medline and Embase via OVID. Cinahl was searched using EBSCO. References lists of potential eligible studies, reviews, guidelines or other sources were screened for additional literature. For evaluation of methodological quality of full economic analyses the Consensus on Health Economic Criteria (CHEC) checklist was used. Database searches resulted in 1388 records. A total of 270 articles were read in full-text. Thirty-five publications were finally included in the data analysis reporting 38 economic analyses. Ten cost of illness analyses and 26 cost-effectiveness analyses reporting about pressure ulcers, skin tears, pressure ulcers, incontinence associated dermatitis and intertrigo/contact dermatitis/candidiasis treatment and prevention and onychomycosis testing were identified. Limited evidence indicated that low air loss beds were more cost effective than standard beds for prevention of pressure ulcers. Standardized skin care regimens seem to lower the incidence of pressure ulcers, skin tears and IAD but a cost saving effect was not always observed. Findings of this mapping review indicate that there is a paucity of high quality evidence regarding the economic impact of age-associated skin conditions and diseases. Substantial heterogeneity in terms of study design, evaluation perspective, time period, and way of cost estimation was

  17. Economic evaluation of spondyloarthritis: economic impact of diagnostic delay in Italy.

    Science.gov (United States)

    Mennini, Francesco S; Viti, Raffaella; Marcellusi, Andrea; Sciattella, Paolo; Viapiana, Ombretta; Rossini, Maurizio

    2018-01-01

    Spondyloarthritis (SpA) is a disease that normally affects the axial skeleton. It progressively leads to overall stiffness up to severe postural deformity of rachis and functional impotence. The objective of the study was to quantify, through an economic model, the impact of specialized testing and pharmacological treatments carried out by the National Health Service (NHS) in normal clinical practice, before the patient is diagnosed with SpA in Italy. In line with the analysis objective, the chosen perspective is that of the NHS. The study was conducted by analyzing the Health Search Database - IMS Health Longitudinal Patient Database, from which newly diagnosed SpA patients were identified over the period 1 January 2007 to 31 December 2013. The use of specialist health care services and pharmacological treatments provided to the patients before the final SpA diagnosis were estimated. Through a retrospective analysis of the Health Search Database, 1,084 subjects (aged 25-45 years) were identified. These patients produced an expense of approximately €153,000 in the 3 years prior to a confirmed SpA diagnosis, in terms of specialist check-ups and drugs, presumably not appropriately used due to a lack of diagnosis. If we assume that the Health Search Database is a representative sample of the Italian population, it may be estimated that, in the 3 years prior to SpA diagnosis, over €5.4 million was largely unduly spent in Italy to examine and manage 38,232 newly diagnosed SpA patients, between 2010 and 2013. The costs due to the delay in SpA diagnosis were quantified for the first time in Italy. For this reason, this work represents a contribution for national and regional decision makers to understand the current clinical practice and the economic consequences of a diagnostic delay in the short and medium term.

  18. Effect of the Economic Recession on Primary Care Access for the Homeless.

    Science.gov (United States)

    White, Brandi M; Jones, Walter J; Moran, William P; Simpson, Kit N

    2016-01-01

    Primary care access (PCA) for the homeless can prove challenging, especially during periods of economic distress. In the United States, the most recent recession may have presented additional barriers to accessing care. Limited safety-net resources traditionally used by the homeless may have also been used by the non-homeless, resulting in delays in seeking treatment for the homeless. Using hospitalizations for ambulatory care sensitivity (ACS) conditions as a proxy measure for PCA, this study investigated the recession's impact on PCA for the homeless and non-homeless in four states. The State Inpatient Databases were used to identify ACS admissions. Findings from this study indicate the recession was a barrier to PCA for homeless people who were uninsured. Ensuring that economically-disadvantaged populations have the ability to obtain insurance coverage is crucial to facilitating PCA. With targeted outreach efforts, the Affordable Care Act provides an opportunity for expanding coverage to the homeless.

  19. Evaluation of the Costs of Caring for the Senile Demented Elderly: A Pilot Study.

    Science.gov (United States)

    Hu, Teh-wei; And Others

    1986-01-01

    Evaluated economic costs for nursing home patients and elderly living in their own homes. Using time records compiled by nurses or family members, the costs incurred annually in caring for a senile demented elderly person at home were estimated to average $11,735, and in a nursing home, $22,458. (Author/BL)

  20. Implementation of computer-based patient records in primary care: the societal health economic effects.

    OpenAIRE

    Arias-Vimárlund, V.; Ljunggren, M.; Timpka, T.

    1996-01-01

    OBJECTIVE: Exploration of the societal health economic effects occurring during the first year after implementation of Computerised Patient Records (CPRs) at Primary Health Care (PHC) centres. DESIGN: Comparative case studies of practice processes and their consequences one year after CPR implementation, using the constant comparison method. Application of transaction-cost analyses at a societal level on the results. SETTING: Two urban PHC centres under a managed care contract in Ostergötland...

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

    NARCIS (Netherlands)

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

    2013-01-01

    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

  2. Evaluating health care interventions in the European Union.

    Science.gov (United States)

    McDaid, David; Cookson, Richard

    2003-02-01

    This paper examines the current state of evaluations of health care interventions in the European Union, from the identification and commissioning of research through to its impact on policy and practice. Material is drawn from a survey conducted for the ASTEC project as well as a review of literature. Although the use of evaluative research has increased substantially in the last decade, both the pace of change and preferred research methodologies employed differ markedly. Much research still concentrates on issues of safety, efficacy and effectiveness, although there is evidence of an increasing emphasis on cost-effectiveness. Many countries are beginning to introduce systems linking economic evaluation to the decision-making process, while networks for the exchange of information continue to evolve. Research capacity in the public sector, although improving, is uneven, in part due to the uncertainty over long term career prospects and competition from industry. Capacity building measures should in particular ensure that dissemination expertise is strengthened, and that more emphasis is placed on developing receptor capacity within different stakeholder groups. Linking knowledge production to changes in practice remains a key challenge. Further research on implementation and impact assessment is required, to help demonstrate the value of evaluations on both policy and practice.

  3. The International Decision Support Initiative Reference Case for Economic Evaluation: An Aid to Thought.

    Science.gov (United States)

    Wilkinson, Thomas; Sculpher, Mark J; Claxton, Karl; Revill, Paul; Briggs, Andrew; Cairns, John A; Teerawattananon, Yot; Asfaw, Elias; Lopert, Ruth; Culyer, Anthony J; Walker, Damian G

    2016-12-01

    Policymakers in high-, low-, and middle-income countries alike face challenging choices about resource allocation in health. Economic evaluation can be useful in providing decision makers with the best evidence of the anticipated benefits of new investments, as well as their expected opportunity costs-the benefits forgone of the options not chosen. To guide the decisions of health systems effectively, it is important that the methods of economic evaluation are founded on clear principles, are applied systematically, and are appropriate to the decision problems they seek to inform. The Bill and Melinda Gates Foundation, a major funder of economic evaluations of health technologies in low- and middle-income countries (LMICs), commissioned a "reference case" through the International Decision Support Initiative (iDSI) to guide future evaluations, and improve both the consistency and usefulness to decision makers. The iDSI Reference Case draws on previous insights from the World Health Organization, the US Panel on Cost-Effectiveness in Health Care, and the UK National Institute for Health and Care Excellence. Comprising 11 key principles, each accompanied by methodological specifications and reporting standards, the iDSI Reference Case also serves as a means of identifying priorities for methods research, and can be used as a framework for capacity building and technical assistance in LMICs. The iDSI Reference Case is an aid to thought, not a substitute for it, and should not be followed slavishly without regard to context, culture, or history. This article presents the iDSI Reference Case and discusses the rationale, approach, components, and application in LMICs. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  4. Socio-Economic Determinants of the Need for Dental Care in Adults.

    Science.gov (United States)

    Trohel, Gilda; Bertaud-Gounot, Valérie; Soler, Marion; Chauvin, Pierre; Grimaud, Olivier

    2016-01-01

    Oral health has improved in France. However, there are still inequalities related to the socio-economic status. The aim of this study was to measure the prevalence of dental care needs in an adult population and to identify the demographic, socio-economic and behavioral variables that may explain variations in this parameter. A cross-sectional analysis of the French SIRS cohort (n = 2,997 adults from the Paris region; 2010 data) was carried out to determine the prevalence of self-reported dental care needs relative to demographic, socio-economic and behavioral variables. A logistic regression model was used to identify the variables that were most strongly associated with the level of need. In 2010, the prevalence of the need for dental care in the SIRS cohort was 35.0% (95% CI [32.3-37.8]). It was lower in people with higher education levels (31.3% [27.9-34.6]), without immigrant background (31.3% [28.0-34.6]) and with comprehensive health insurance (social security + complementary health cover; 32.8% [30.2-35.4]). It decreased as the socio-economic status increased, but without following a strict linear change. It was also lower among individuals who had a dental check-up visit in the previous two years. In multivariate analyses, the socioeconomic variables most strongly associated with the need for dental care were: educational attainment (OR = 1.21 [1.02-1.44]), income level (OR = 1.66 [1.92-2.12]) and national origin (OR = 1.53 [1.26-1.86]). These results confirm that the prevalence of dental care needs is higher among adults with low socio-economic status. Education level, income level and also national origin were more strongly associated with the need for dental care than insurance cover level.

  5. Economic evaluation of chronic disease self-management for people with diabetes: a systematic review.

    Science.gov (United States)

    Teljeur, C; Moran, P S; Walshe, S; Smith, S M; Cianci, F; Murphy, L; Harrington, P; Ryan, M

    2017-08-01

    To systematically review the evidence on the costs and cost-effectiveness of self-management support interventions for people with diabetes. Self-management support is the provision of education and supportive interventions to increase patients' skills and confidence in managing their health problems, potentially leading to improvements in HbA 1c levels in people with diabetes. Randomized controlled trials, observational studies or economic modelling studies were eligible for inclusion in the review. The target population was adults with diabetes. Interventions had to have a substantial component of self-management support and be compared with routine care. Study quality was evaluated using the Consensus on Health Economic Criteria and International Society of Pharmacoeconomic Outcomes Research questionnaires. A narrative review approach was used. A total of 16 costing and 21 cost-effectiveness studies of a range of self-management support interventions were identified. There was reasonably consistent evidence across 22 studies evaluating education self-management support programmes suggesting these interventions are cost-effective or superior to usual care. Telemedicine-type interventions were more expensive than usual care and potentially not cost-effective. There was insufficient evidence regarding the other types of self-management interventions, including pharmacist-led and behavioural interventions. The identified studies were predominantly of poor quality, with outcomes based on short-term follow-up data and study designs at high risk of bias. Self-management support education programmes may be cost-effective. There was limited evidence regarding other formats of self-management support interventions. The poor quality of many of the studies undermines the evidence base regarding the economic efficiency of self-management support interventions for people with diabetes. © 2016 Diabetes UK.

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

    Science.gov (United States)

    Zhang, Rongrong; Modaresi, Farhang; Borisenko, Oleg

    2015-01-01

    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. 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. 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. This study indicates that there are major limitations and deficiencies in the health economic evaluations on medical devices performed in the People's Republic of China. Further efforts are required from different stakeholders - academic, governmental

  7. Ecological and economic evaluation of biogas from intercrops

    Energy Technology Data Exchange (ETDEWEB)

    Niemetz, Nora; Kettl, Karl-Heinz [Graz Univ. of Technology (Austria). Inst. for Process and Particle Engineering

    2012-12-01

    Biogas made from main crops (e.g., corn) is commonly used for producing electricity and heat. Nevertheless, the production of energy from monocultures is highly unsustainable and not truly renewable. Since neither monocultures nor food competition are desirable, intercrops can be used to increase the yield per hectare instead of leaving agricultural fields unplanted for soil regeneration. The extra biomass can be used for biogas production. In a case study, the economic as well as the ecological feasibility of biogas production using intercrops, cattle manure, grass and corn silage as feedstocks for fermenters was analyzed. The set-up for the case study included different feedstock combinations as well as spatial distributions of substrate supply and heat demand for modeling and optimization. Using the process network synthesis, an optimum structure was generated representing the most economical technology constellation which included transport of substrates, heat and biogas (when applicable). The ecological evaluation was carried out by using the sustainable process index method. The application of both methodologies to different scenarios allowed a constellation to be found which is economically feasible while entailing low ecological pressure. It is demonstrated that the production of intercrops for producing biogas has so far not been regarded as a viable option by the farmers due to a variety of barriers. Sensitization is needed to emphasize that planting intercrops holds many advantages like positive effects on soil regeneration and raised nitrogen fixation, as well as increased biomass output per hectare and, last but not least, it allows the production of energy without conflicts between food and energy production. (orig.)

  8. A technical and economic evaluation of wood conversion processes

    Energy Technology Data Exchange (ETDEWEB)

    Douglas, L J

    1990-08-08

    A technical and economic evaluation of the Iogen wood-to-ethanol bioconversion process was carried out using a computer simulation model based on an engineering analysis of the process. The model was used to run sensitivity analyses for the process and to estimate the parameters with significant economic impact and promise for future improvement to process economics. The most important parameters were then used in Monte Carlo simulations to estimate the potential for future improvements and to assess the commercial potential of the process. Finally, the process was subjected to second-law analysis, in which its thermodynamic efficiency was assessed in terms of lost work potential. The Iogen process is a highly optimized process using state-of-the-art enzymatic hydrolysis with steam explosion pretreatment; lactose sugar from cheese whey is used as the carbon source for enzyme production. The base case design would use 1000 tonnes/d of aspen wood and would produce 91 Ml/y of ethanol. Assuming no value for byproducts, the break-even price for ethanol would be 45-70{cents}/l, depending on the financing method employed. If byproduct credit is added for lignin and molasses, the required ethanol selling price would drop to 30-50{cents}/l. Forecasts for future technology improvements show that it is possible to construct scenarios where the ethanol price could be as low as 10-20{cents}/l including byproduct credits. Potential improvements to the process include reduced enzyme production cost; xylose fermentation to ethanol; lower-cost feedstock; and substitution of wood sugars for lactose. 48 refs., 39 figs., 21 tabs.

  9. ECONOMIC EVALUATION OF CO2 SEQUESTRATION TECHNOLOGIES; SEMIANNUAL

    International Nuclear Information System (INIS)

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

    2001-01-01

    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

  10. Socio-economic disadvantage, quality of medical care and admission for acute severe asthma.

    Science.gov (United States)

    Kolbe, J; Vamos, M; Fergusson, W

    1997-06-01

    In asthma, socio-economic and health care factors may operate by a number of mechanisms to influence asthma morbidity and mortality. To determine the quality of medical care including the patient perception of the doctor-patient relationship, and the level of socio-economic disadvantage in patients admitted to hospital with acute severe asthma. One hundred and thirty-eight patients (15-50 years) admitted to hospital (general ward or intensive care unit) with acute asthma were prospectively assessed using a number of previously validated instruments. The initial subjects had severe asthma on admission (pH = 7.3 +/- 0.2, PaCO2 = 7.1 +/- 5.0 kPa, n = 90) but short hospital stay (3.7 +/- 2.6 days). Although having high morbidity (40% had hospital admission in the last year and 60% had moderate/severe interference with sleep and/or ability to exercise), they had indicators of good ongoing medical care (96% had a regular GP, 80% were prescribed inhaled steroids, 84% had a peak flow meter, GP measured peak flow routinely in 80%, 52% had a written crisis plan and 44% had a supply of steroids at home). However, they were severely economically disadvantaged (53% had experienced financial difficulties in the last year, and for 35% of households the only income was a social security benefit). In the last year 39% had delayed or put off GP visit because of cost. Management of the index attack was compromised by concern about medical costs in 16% and time off work in 20%. Patients admitted to hospital with acute asthma have evidence of good quality on-going medical care, but are economically disadvantaged. If issues such as financial barriers to health care are not acknowledged and addressed, the health care services for asthmatics will not be effectively utilised and the current reductions in morbidity and mortality may not be maintained.

  11. Economic evaluation of occupational safety preventive measures in a hospital.

    Science.gov (United States)

    Ramos, Delfina G; Arezes, Pedro M; Afonso, Paulo

    2015-01-01

    When an organization performs an integrated analysis of risks through its Occupational Health and Safety Management System, several steps are suggested to address the implications of the identified risks. Namely, the organization should make a detailed analysis of the monetary impact for the organization of each of the preventive measures considered. However, it is also important to perform an analysis of the impact of each measure on society (externalities). The aim of this paper is to present a case study related to the application of the proposed economic evaluation methodology. An analysis of the work accidents in a hospital has been made. Three of the major types of accidents have been selected: needle stings, falls and excessive strain. Following the risk assessment, some preventive measures have been designed. Subsequently, the Benefit/Cost ratio (B/C) of these measures has been calculated, both in financial terms (from the organization's perspective) and in economic terms (including the benefits for the worker and for the Society). While the financial ratio is only advantageous in some cases, when the externalities are taken into account, the B/C ratio increases significantly. It is important to consider external benefits to make decisions concerning the implementation of preventive measures in Occupational Health and Safety projects.

  12. Operative and economic evaluation of a 'Laser Printer Multimodality' System

    International Nuclear Information System (INIS)

    Battaglia, G.; Moscatelli, G.; Maroldi, R.; Chiesa, A.

    1991-01-01

    The increasing application of digital techniques to diagnostic imaging is causing significant changes in several related activities, such as a reproduction of digital images on film. In the Department of Diagnostic Imaging of the University of Brescia, about 70% of the whole of images are produced by digital techniques; at present, most of these images are reproduced on film with a Multimodality System interfacing CT, MR, DSA, and DR units with a single laser printer. Our analysis evaluates the operative and economics aspects of image reproduction, by comparing the 'single cassette' multiformat Camera and the Laser Printer Multimodality SAystem. Our results point out the advantages obtained by reproducing images with a Laser Printer Multimodality System: outstanding quality, reproduction of multiple originals, and marked reduction in the time needed for both image archiving and film handling. The Laser Printer Multimodality System allows over 5 hours/day to be saved -that is to say the working day of an operator, who can be thus shifted to other functions. The important economic aspect of the reproduction of digital images on film proves the Laser Printer Multimodality System to have some advantage over Cameras

  13. Multiplicative utility and the influence of environmental care on the short-term economic growth rate

    NARCIS (Netherlands)

    Vellinga, N.

    1999-01-01

    This paper addresses the issue of determining under what circumstances economic growth rates are influenced by environmental care. The models used are extensions of the model by Lucas. The extensions consist of output leading to pollution and there is a stock of nature. There is also abatement to

  14. 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

  15. 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

  16. Comparative economic evaluation of environmental impact of different cogeneration technologies

    International Nuclear Information System (INIS)

    Patrascu, Roxana; Athanasovici, Victor; Raducanu, Cristian; Minciuc, Eduard; Bitir-Istrate, Ioan

    2004-01-01

    Cogeneration is one of the most powerful technologies for reduction of environmental pollution along with renewable energies. At the Kyoto Conference cogeneration has been identified as being the most important measure for reducing emissions of greenhouse effect gases. It has also been mentioned that cogeneration has a potential of reducing pollution with about 180 million tones per year. In order to promote new cogeneration technologies and evaluate the existing ones it is necessary to know and to be able to quantify in economical terms the environmental issues. When comparing different cogeneration technologies: steam turbine (TA), gas turbine (TG), internal combustion engine (MT), in order to choose the best one, the final decision implies an economic factor, which is even more important if it includes the environmental issues. The environmental impact of different cogeneration technologies is quantified using different criteria: depletion of non-renewable natural resources, eutrofisation, greenhouse effect, acidification etc. Environmental analysis using these criteria can be made using the 'impact with impact' methodology or the global one. The results of such an analysis cannot be quantified economically directly. Therefore there is a need of internalisation of ecological effects within the costs of produced energy: electricity and heat. In the energy production sector the externalizations represent the indirect effects on the environment. They can be materialised within different types of environmental impact: - Different buildings of mines, power plants etc; - Fuel losses during transportation and processing; - Effect of emissions in the air, water and soil. Introduction of the environmental impact costs in the energy price is called internalisation and it can be made using the direct and indirect methods. The paper discusses aspects regarding the emissions of cogeneration systems, the eco-taxes - method of 'internalisation' of environmental

  17. Methods for Health Economic Evaluation of Vaccines and Immunization Decision Frameworks : A Consensus Framework from a European Vaccine Economics Community

    NARCIS (Netherlands)

    Ultsch, Bernhard; Damm, Oliver; Beutels, Philippe; Bilcke, Joke; Brueggenjuergen, Bernd; Gerber-Grote, Andreas; Greiner, Wolfgang; Hanquet, Germaine; Hutubessy, Raymond; Jit, Mark; Knol, Mirjam; von Kries, Ruediger; Kuhlmann, Alexander; Levy-Bruhl, Daniel; Perleth, Matthias; Postma, Maarten; Salo, Heini; Siebert, Uwe; Wasem, Jurgen; Wichmann, Ole

    Incremental cost-effectiveness and cost-utility analyses [health economic evaluations (HEEs)] of vaccines are routinely considered in decision making on immunization in various industrialized countries. While guidelines advocating more standardization of such HEEs (mainly for curative drugs) exist,

  18. Current trends in Canadian health care: myths and misconceptions in health economics.

    Science.gov (United States)

    Coyte, P C

    1990-01-01

    This paper is concerned with the economic aspects of the trends in Canadian health care. Various myths and misconceptions abound regarding the applicability of economics to behaviour in the health care industry as well as to the interpretation of recent trends. Both issues are examined in this paper. While most discussions regarding health care trends begin with the share of health expenditures in Gross National Product, I propose an alternative share that adjusts for cyclical variations in both unemployment and labour force participation. Using this measure, I show that the "real" growth of resources devoted to the health care industry is much larger than that obtained with conventional measures, and that the difference in growth rates between Canada and the U.S. is narrowed considerably. The paper outlines and disputes the validity of three public health policy propositions. First, it is not empirically valid to say that the introduction of universal medical insurance in Canada successfully contained the growth in the share of society's resources devoted to the health care industry. Second, it is not correct to argue that the change in the federal funding for hospital and medical care in 1977 was a "fiscal non-event". And finally, the proposed "equity" funding formula for Ontario hospitals is unlikely to contain costs and will potentially skew hospitals towards the provision of complex forms of care instead of cost-effective community-based alternatives.

  19. Health economic evaluation in lumbar spinal fusion: a systematic literature review anno 2005

    DEFF Research Database (Denmark)

    Soegaard, Rikke; Christensen, Finn B

    2006-01-01

    in clinical practice are present, economic evaluation is needed in order to facilitate the decision-makers' budget allocations. NHS Economic Evaluation Database, MEDLINE, EMBASE and Cochrane Library were searched. Two independent reviewers (one clinical content expert and one economic content expert) applied...... that the clinical effects are statistically synonymous, it does not support the use of high-cost techniques. There is a great potential for improvement of methodological quality in economic evaluations of lumbar spinal fusion and further research is imperative....

  20. Economic evaluation of volume reduction for Defense transuranic waste

    International Nuclear Information System (INIS)

    Brown, C.M.

    1982-03-01

    The economics of volume reduction of retrievably stored and newly generated DOE transuranic wastes are evaluated by comparing the costs of reduction of the wastes with the savings possible in transportation and disposal. A general approach to the comparison of TRU waste volume reduction costs and cost savings is developed, an initial set of cost data is established, conclusions to support selecting technologies and facilities for the disposal of DOE transuranic waste are developed. Section I outlines the analysis which considers seven types of volume reduction from incineration and compaction of combustibles to compaction, size reduction, shredding, melting, and decontamination of metals. The study considers the volume reduction of contact-handled, newly generated and retrievably stored DOE transuranic wastes. Section II of this report describes the analytical approach, assumptions, and flow of waste material through sites. Section III presents the waste inventories, disposal and transportation savings, and volume reduction techniques and costs. Section IV contains the results and conclusions of the study. The major conclusions drawn from the study are: For DOE sites with a small amount of waste requiring disposal ( 3 /year) the cost of volume reduction is greater than the transportation and disposal savings from volume reduction provided the waste requires little additional preparation to meet transportation and disposal criteria. Wastes that do not meet these criteria require site specific economic analysis outside the general evaluations of this study. For Idaho National Engineering Laboratory, incineration and metal shredding are cost-effective, provided a facility is to be constructed as a consequence of repackaging the fraction of stored waste which may require repackaging and immobilizing chemical process waste to meet disposal criteria

  1. Economic evaluation of CO2 pipeline transport in China

    International Nuclear Information System (INIS)

    Zhang Dongjie; Wang Zhe; Sun Jining; Zhang Lili; Li Zheng

    2012-01-01

    Highlights: ► We build a static hydrodynamic model of CO 2 pipeline for CCS application. ► We study the impact on pressure drop of pipeline by viscosity, density and elevation. ► We point out that density has a bigger impact on pressure drop than viscosity. ► We suggest dense phase transport is preferred than supercritical state. ► We present cost-optimal pipeline diameters for different flowrates and distances. - Abstract: Carbon capture and sequestration (CCS) is an important option for CO 2 mitigation and an optimized CO 2 pipeline transport system is necessary for large scale CCS implementation. In the present work, a hydrodynamic model for CO 2 pipeline transport was built up and the hydrodynamic performances of CO 2 pipeline as well as the impacts of multiple factors on pressure drop behavior along the pipeline were studied. Based on the model, an economic model was established to optimize the CO 2 pipeline transport system economically and to evaluate the unit transport cost of CO 2 pipeline in China. The hydrodynamic model results show that pipe diameter, soil temperature, and pipeline elevation change have significant influence on the pressure drop behavior of CO 2 in the pipeline. The design of pipeline system, including pipeline diameter and number of boosters etc., was optimized to achieve a lowest unit CO 2 transport cost. In regarding to the unit cost, when the transport flow rate and distance are between 1–5 MtCO 2 /year and 100–500 km, respectively, the unit CO 2 transport cost mainly lies between 0.1–0.6 RMB/(tCO 2 km) and electricity consumption cost of the pipeline inlet compressor was found to take more than 60% of the total cost. The present work provides reference for CO 2 transport pipeline design and for feasibility evaluation of potential CCS projects in China.

  2. Smoking, health-related quality of life and economic evaluation.

    Science.gov (United States)

    López-Nicolás, Ángel; Trapero-Bertran, Marta; Muñoz, Celia

    2018-06-01

    The economic evaluation of tobacco control policies requires the adoption of assumptions about the impact of changes in smoking status on health-related quality of life (HRQoL). Estimates for such impacts are necessary for different populations. This paper aims to test whether smoking status has an independent effect on HRQoL over and above the effect derived from the increased likelihood of suffering a tobacco related disease, and to calculate utility values for the Spanish population. Using data from the Spanish Encuesta Nacional de Salud of 2011-12, we estimate statistical models for HRQoL as measured by the EQ-5D-5L instrument as a function of smoking status. We include a comprehensive set of controls for biological, clinical, lifestyle and socioeconomic characteristics. Smoking status has an independent, statistically significant effect on HRQoL. However, the size of the effect is small. The typical smoking related diseases, such as lung cancer, are associated with a reduction in HRQoL about 5 times larger than the difference between current smokers and never smokers. Attributing substantive HRQoL gains to quitting smoking as well as accounting for the concomitant HRQoL gain derived from a smaller likelihood of contracting tobacco related diseases might lead to an overestimation of the benefits of tobacco control policies. Nonetheless, the relatively large drops in HRQoL associated with being diagnosed with diseases that might be causally linked to tobacco suggest that such diseases should not be omitted from the economic evaluations of tobacco control policies.

  3. An introduction to economic analysis in medicine - the basics of methology and chosen trems. Examples of results of evaluation in nuclear medicine

    International Nuclear Information System (INIS)

    Brockhuis, B.M.; Lass, P.

    2002-01-01

    This article overviews the basics terms and methodology of economic analysis in health care. The most important forms of economic analysis: cost-effectiveness, cost-utility and cost-minimisation analysis and aims of their application are presented. Particular emphasis is put on economic evaluation in nuclear medicine, e.g. FDG-PET v. thoracotomy in lung cancer diagnosis, radioiodine therapy v. antithyroid drugs in hyperthyroidism and technetium-99m-MIBI breast imaging v. biopsy in nonpalpable breast abnormalities. (author)

  4. 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.

  5. [Economic and organizational evaluation of an imaging network (PACS)].

    Science.gov (United States)

    Charvet-Protat, S; Thoral, F

    1998-12-01

    Over the last twenty years, imaging modalities featuring new image production methods (ultrasound, nuclear magnetic resonance, etc.) have appeared on the market. Nevertheless, conventional radiology still accounts for 70% of the image examinations carried out in most western countries, including France. The conventional radiological image is in the process of evolving from analog to digital form. Digitalization of radiology means that image acquisition, archiving and distribution functions that were previously carried out by hand can now be automated using a Picture Archiving and Communication System. Decision-makers are having to decide whether or not to promote the development of PACS which, while they considerably modernize the way in which images are managed, also require heavy capital outlays. A critical appraisal of the literature allowed us to evaluate the relative cost and the efficiency of these image networks in comparison with film-based archiving and communication systems. It is clear from the economic evaluation that a PACS strategy involves greater costs than a film system. While PACS systems do generate savings on film and on storage space and obviate the need for certain staff, these savings do not offset the extra equipment and maintenance costs. This situation is likely to persist for some years yet, even when future price reductions are taken into account. The objective of this new radiological information management method is to improve organizational efficiency and hospital productivity. However, the economic evaluations that have been published to date are cost studies which do not take the efficiency criterion into account. A number of potential organizational benefits such as the fact that medical decisions can be made more quickly or that the average length of hospital stays can be reduced, are often claimed for PACS. However, for methodological reasons, these results cannot be generalised to cover all PACS. It is difficult to compare PACS

  6. Economic evaluation of targeted cancer interventions: critical review and recommendations.

    Science.gov (United States)

    Elkin, Elena B; Marshall, Deborah A; Kulin, Nathalie A; Ferrusi, Ilia L; Hassett, Michael J; Ladabaum, Uri; Phillips, Kathryn A

    2011-10-01

    Scientific advances have improved our ability to target cancer interventions to individuals who will benefit most and spare the risks and costs to those who will derive little benefit or even be harmed. Several approaches are currently used for targeting interventions for cancer risk reduction, screening, and treatment, including risk prediction algorithms for identifying high-risk subgroups and diagnostic tests for tumor markers and germline genetic mutations. Economic evaluation can inform decisions about the use of targeted interventions, which may be more costly than traditional strategies. However, assessing the impact of a targeted intervention on costs and health outcomes requires explicit consideration of the method of targeting. In this study, we describe the importance of this principle by reviewing published cost-effectiveness analyses of targeted interventions in breast cancer. Few studies we identified explicitly evaluated the relationships among the method of targeting, the accuracy of the targeting test, and outcomes of the targeted intervention. Those that did found that characteristics of targeting tests had a substantial impact on outcomes. We posit that the method of targeting and the outcomes of a targeted intervention are inextricably linked and recommend that cost-effectiveness analyses of targeted interventions explicitly consider costs and outcomes of the method of targeting.

  7. [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.

  8. 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

  9. Evaluation of water resource economics within the Pasco Basin, Washington

    International Nuclear Information System (INIS)

    Leaming, G.F.

    1981-01-01

    The Columbia River basalt beneath the Hanford Site in south-central Washington is being considered for possible use as a terminal repository medium for high-level nuclear waste. Such underground storage would require that the facility be contiguous to at least a portion of the ambient groundwater system of the Pasco Basin. This report attempts to evaluate the economic factors and conditions related to the water resources of the Pasco Basin and the probable economic effects associated with selected hypothetical changes in local water demand and supply as a basis for eventual selection of credible water supply alternatives and more detailed analyses of the consequences of such alternative selection. It is most likely that total demand for water for consumptive uses in the Pasco Basin will increase from nearly 2.0 million acre-feet per year in 1980 to almost 2.8 million acre-feet in 2010, with total demand slightly more than 3.6 million acre-feet per year in 2080. The Columbia River and other surface streams constitute the source of more than 99 percent of the water available each year for all uses, both consumptive and non-consumptive, in the Pasco Basin. It is estimated that pumped groundwater accounted for 3 percent of the value of all water supplied to consumers of water in the Pasco Basin in 1980. Groundwater's share of the total cost is proportionately higher than groundwater's share of total use because it is generally more costly to acquire than is surface water and the value of water is considered equivalent to its cost of acquisition. Because groundwater represents such a small part of the total water supply and demand within the Pasco Basin, it is concluded that if the development of a nuclear waste repository on the Hanford Site were to result in changes in the groundwater supply during the next 100 years, the economic impact on the overall water supply picture for the entire basin would be insignificant

  10. Evaluation and Characterization of Health Economics and Outcomes Research in SAARC Nations.

    Science.gov (United States)

    Mehta, Manthan; Nerurkar, Rajan

    2018-05-01

    To identify, evaluate, and characterize the variety, quality, and intent of the health economics and outcomes research studies being conducted in SAARC (South Asian Association for Regional Cooperation) nations. Studies published in English language between 1990 and 2015 were retrieved from Medline databases using relevant search strategies. Studies were independently reviewed as per Cochrane methodology and information on the type of research and outcomes were extracted. Quality of reporting was assessed. Of the 2638 studies screened from eight SAARC nations, a total of 179 were included for review (India = 140; Bangladesh = 12; Sri Lanka = 8; Pakistan = 7; Afghanistan = 5; Nepal = 4; Bhutan = 2; Maldives = 1). The broad study categories were cost-effectiveness analyses (CEAs = 76 studies), cost analyses (35 studies), and burden of illness (BOI=26 studies). The outcomes evaluated were direct costs, indirect costs, and incremental cost-effectiveness ratio (ICER), quality-adjusted life-years (QALYs), and disability-adjusted life-years (DALYs). Cost of medicines, consultation and hospital charges, and monitoring costs were assessed as direct medical costs along with non-direct medical costs such as travel and food for patients and caregivers. The components of indirect costs were loss of income of patients and caregivers and loss of productivity. Quality of life (QoL) was assessed in 48 studies. The most commonly used instrument for assessing QoL was the WHO-Quality of Life BREF (WHOQOL-BREF) questionnaire (76%). The Quality of Health Economic Studies (QHES) score was used for quality assessment of full economic studies (44 studies). The mean QHES score was 43.76. This review identifies various patterns of health economic studies in eight SAARC nations. The quality of economic evaluation studies for health care in India, Bangladesh, Sri Lanka, Pakistan, Afghanistan, Nepal, Bhutan, and Maldives needs improvement. There is a need to generate the capacity of researchers

  11. Evaluating Home Day Care Mothers' Work with Young Children.

    Science.gov (United States)

    Seattle Community Coll., Washington.

    This checklist was developed to determine the skills of day care home mothers before and after training as observed by a day care home educator. Areas evaluated are: Professional Attitude; Parent Relationships; Nutrition; Health and Safety; Baby Care; Preparing the Teaching Environment; Guidance; Teaching Techniques, Language and Literature; Art;…

  12. Economic development evaluation based on science and patents

    Science.gov (United States)

    Jokanović, Bojana; Lalic, Bojan; Milovančević, Miloš; Simeunović, Nenad; Marković, Dusan

    2017-09-01

    Economic development could be achieved through many factors. Science and technology factors could influence economic development drastically. Therefore the main aim in this study was to apply computational intelligence methodology, artificial neural network approach, for economic development estimation based on different science and technology factors. Since economic analyzing could be very challenging task because of high nonlinearity, in this study was applied computational intelligence methodology, artificial neural network approach, to estimate the economic development based on different science and technology factors. As economic development measure, gross domestic product (GDP) was used. As the science and technology factors, patents in different field were used. It was found that the patents in electrical engineering field have the highest influence on the economic development or the GDP.

  13. Data Management for Evaluating Complications of Health Care

    OpenAIRE

    Streed, Stephen A.; Massanari, R. Michael

    1988-01-01

    This paper describes the design and operating characteristics of a microcomputer-based data management system for assessing complications associated with the delivery of health care. The system was developed in response to the need to promote “risk management” as an essential component of the Quality Assurance effort within the health care delivery environment. The system herein described allows the epidemiological evaluation of complications of health care in a tertiary care referral center....

  14. National female literacy, individual socio-economic status, and maternal health care use in sub-Saharan Africa.

    Science.gov (United States)

    McTavish, Sarah; Moore, Spencer; Harper, Sam; Lynch, John

    2010-12-01

    The United Nations Millennium Development Goals have identified improving women's access to maternal health care as a key target in reducing maternal mortality in sub-Saharan Africa (sSA). Although individual factors such as income and urban residence can affect maternal health care use, little is known about national-level factors associated with use. Yet, such knowledge may highlight the importance of global and national policies in improving use. This study examines the importance of national female literacy on women's maternal health care use in continental sSA. Data that come from the 2002-2003 World Health Survey. Multilevel logistic regression was used to examine the association between national female literacy and individual's non-use of maternal health care, while adjusting for individual-level factors and national economic development. Analyses also assessed effect modification of the association between income and non-use by female literacy. Effect modification was evaluated with the likelihood ratio test (G(2)). We found that within countries, individual age, education, urban residence and household income were associated with lack of maternal health care. National female literacy modified the association of household income with lack of maternal health care use. The strength of the association between income and lack of maternal health care was weaker in countries with higher female literacy. We conclude therefore that higher national levels of female literacy may reduce income-related inequalities in use through a range of possible mechanisms, including women's increased labour participation and higher status in society. National policies that are able to address female literacy and women's status in sub-Saharan Africa may help reduce income-related inequalities in maternal health care use. Copyright © 2010 Elsevier Ltd. All rights reserved.

  15. Evaluating managed care's special telecommunications needs.

    Science.gov (United States)

    Harrison, P; Schenk, D

    1993-11-01

    Right now, managed care is a vast cosmic soup. But whether its ultimate form is the result of a bureaucratic big bang or a series of small industry explosions, one thing seems clear: telecommunications is the framework upon which managed care will be built. Managed care's primary players--purchasers, providers and payors--have already discovered the unifying power of telecommunications within their respective worlds. However, as the three worlds collide, an entirely new set of special telecommunications needs arises. And most of these needs can be distilled into three basic requirements: bigger networks, faster networks and smarter networks.

  16. Evaluation of a Research Mentorship Program in Community Care

    Science.gov (United States)

    Ploeg, Jenny; de Witt, Lorna; Hutchison, Brian; Hayward, Lynda; Grayson, Kim

    2008-01-01

    This article describes the results of a qualitative case study evaluating a research mentorship program in community care settings in Ontario, Canada. The purpose of the program was to build evaluation and research capacity among staff of community care agencies through a mentorship program. Data were collected through in-depth, semi-structured…

  17. [Descriptive Analysis of Health Economics of Intensive Home Care of Ventilated Patients].

    Science.gov (United States)

    Lehmann, Yvonne; Ostermann, Julia; Reinhold, Thomas; Ewers, Michael

    2018-05-14

    Long-term ventilated patients in Germany receive intensive care mainly in the patients' home or in assisted-living facilities. There is a lack of knowledge about the nature and extent of resource use and costs associated with care of this small, heterogeneous but overall growing patient group. A sub-study in the context of a research project SHAPE analyzed costs of 29 patients descriptively from a social perspective. Direct and indirect costs of intensive home care over a period of three months were recorded and analyzed retrospectively. Standardized recorded written self-reports from patients and relatives as well as information from the interviewing of nursing staff and from nursing documentation were the basis for this analysis. There was an average total cost of intensive home care for three months per patient of 61194 € (95% CI 53 884-68 504) including hospital stays. The main costs were directly linked to outpatient medical and nursing care provided according to the Code of Social Law V and XI. Services provided by nursing home care service according to § 37(2) Code of Social Law V (65%) were the largest cost item. Approximately 13% of the total costs were attributable to indirect costs. Intensive home care for ventilated patients is resource-intensive and cost-intensive and has received little attention also from a health economics perspective. Valid information and transparency about the cost structures are required for an effective and economic design and management of the long-term care of this patient group. © Georg Thieme Verlag KG Stuttgart · New York.

  18. Economic analysis of an epilepsy outreach model of care in a university hospital setting.

    Science.gov (United States)

    Maloney, Eimer; McGinty, Ronan N; Costello, Daniel J

    2017-07-01

    The prevalence of epilepsy in people with intellectual disability is higher than in the general population and prevalence rates increase with increasing levels of disability. Prevalence rates of epilepsy are highest among those living in residential care. The healthcare needs of people with intellectual disability and epilepsy are complex and deserve special consideration in terms of healthcare provision and access to specialist epilepsy clinics, which are usually held in acute hospital campuses. This patient population is at risk of suboptimal care because of significant difficulties accessing specialist epilepsy care which is typically delivered in the environs of acute hospitals. In 2014, the epilepsy service at Cork University Hospital established an Epilepsy Outreach Service providing regular, ambulatory outpatient follow up at residential care facilities in Cork city and county in an effort to improve access to care, reduce the burden and expense of patient and carer travel to hospital outpatient appointments, and to provide a dedicated specialist phone service for epilepsy related queries in order to reduce emergency room visits when possible. We present the findings of an economic analysis of the outreach service model of care compared to the traditional hospital outpatient service and demonstrate significant cost savings and improved access to care with this model. Ideally these cost savings should be used to develop novel ways to enhance epilepsy care for persons with disability. We propose that this model of care can be more suitable for persons with disability living in residential care who are at risk of losing access to specialist epilepsy care. Copyright © 2017 Elsevier Inc. All rights reserved.

  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. Clinical and economic impact of various strategies for varicella immunity screening and vaccination of health care personnel.

    Science.gov (United States)

    Baracco, G J; Eisert, S; Saavedra, S; Hirsch, P; Marin, M; Ortega-Sanchez, I R

    2015-10-01

    Exposure to patients with varicella or herpes zoster causes considerable disruption to a health care facility's operations and has a significant health and economic impact. However, practices related to screening for immunity and immunization of health care personnel (HCP) for varicella vary widely. A decision tree model was built to evaluate the cost-effectiveness of 8 different strategies of screening and vaccinating HCP for varicella. The outcomes are presented as probability of acquiring varicella, economic impact of varicella per employee per year, and cost to prevent additional cases of varicella. Monte Carlo simulations and 1-way sensitivity analyses were performed to address the uncertainties inherent to the model. Alternative epidemiologic and technologic scenarios were also analyzed. Performing a clinical screening followed by serologic testing of HCP with negative history diminished the cost impact of varicella by >99% compared with not having a program. Vaccinating HCP with negative screen cost approximately $50,000 per case of varicella prevented at the current level of U.S. population immunity, but was projected to be cost-saving at 92% or lower immunity prevalence. Improving vaccine acceptance rates and using highly sensitive assays also optimize cost-effectiveness. Strategies relying on screening and vaccinating HCP for varicella on employment were shown to be cost-effective for health care facilities and are consistent with current national guidelines for varicella prevention. Published by Elsevier Inc.

  1. [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).

  2. Evaluating the Performance of South African Economics Departments

    OpenAIRE

    John Luiz

    2009-01-01

    Over the past decade economics departments in South Africa have seen major changes and a certain level of disruption. Much of this can be attributed to the integration of our discipline into the global arena after a period of academic isolation. This paper presents a survey of economics departments and covers everything from staff profiles and qualifications, to curricula, and research output. This paper indicates that there has been some improvement in the state of economics at South African...

  3. Economic evaluation of occupational therapy in Parkinson's disease: A randomized controlled trial.

    Science.gov (United States)

    Sturkenboom, Ingrid H W M; Hendriks, Jan C M; Graff, Maud J L; Adang, Eddy M M; Munneke, Marten; Nijhuis-van der Sanden, Maria W G; Bloem, Bastiaan R

    2015-07-01

    A large randomized clinical trial (the Occupational Therapy in Parkinson's Disease [OTiP] study) recently demonstrated that home-based occupational therapy improves perceived performance in daily activities of people with Parkinson's disease (PD). The aim of the current study was to evaluate the cost-effectiveness of this intervention. We performed an economic evaluation over a 6-month period for both arms of the OTiP study. Participants were 191 community-dwelling PD patients and 180 primary caregivers. The intervention group (n = 124 patients) received 10 weeks of home-based occupational therapy; the control group (n = 67 patients) received usual care (no occupational therapy). Costs were assessed from a societal perspective including healthcare use, absence from work, informal care, and intervention costs. Health utilities were evaluated using EuroQol-5d. We estimated cost differences and cost utility using linear mixed models and presented the net monetary benefit at different values for willingness to pay per quality-adjusted life-year gained. In our primary analysis, we excluded informal care hours because of substantial missing data for this item. The estimated mean total costs for the intervention group compared with controls were €125 lower for patients, €29 lower for caregivers, and €122 higher for patient-caregiver pairs (differences not significant). At a value of €40,000 per quality-adjusted life-year gained (reported threshold for PD), the net monetary benefit of the intervention per patient was €305 (P = 0.74), per caregiver €866 (P = 0.01) and per patient-caregiver pair €845 (P = 0.24). In conclusion, occupational therapy did not significantly impact on total costs compared with usual care. Positive cost-effectiveness of the intervention was only significant for caregivers. © 2015 International Parkinson and Movement Disorder Society.

  4. 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.

  5. An Economic Evaluation of Binary Cycle Geothermal Electricity Production

    National Research Council Canada - National Science Library

    Fitzgerald, Crissie

    2003-01-01

    .... Variables such as well flow rate, geothermal gradient and electricity prices were varied to study their influence on the economic payback period for binary cycle geothermal electricity production...

  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; Sanz-Bayona, Ma Teresa; Gil-Lacruz, Ana Isabel

    2013-01-01

    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. 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). 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 health services.

  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. 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

  9. A Systematic Review of Economic Evaluations of Pacemaker Telemonitoring Systems.

    Science.gov (United States)

    López-Villegas, Antonio; Catalán-Matamoros, Daniel; Martín-Saborido, Carlos; Villegas-Tripiana, Irene; Robles-Musso, Emilio

    2016-02-01

    Over the last decade, telemedicine applied to pacemaker monitoring has undergone extraordinary growth. It is not known if telemonitoring is more or less efficient than conventional monitoring. The aim of this study was to carry out a systematic review analyzing the available evidence on resource use and health outcomes in both follow-up modalities. We searched 11 databases and included studies published up until November 2014. The inclusion criteria were: a) experimental or observational design; b) studies based on complete economic evaluations; c) patients with pacemakers, and d) telemonitoring compared with conventional hospital monitoring. Seven studies met the inclusion criteria, providing information on 2852 patients, with a mean age of 81 years. The main indication for device implantation was atrioventricular block. With telemonitoring, cardiovascular events were detected and treated 2 months earlier than with conventional monitoring, thus reducing length of hospital stay by 34% and reducing routine and emergency hospital visits as well. There were no significant intergroup differences in perceived quality of life or number of adverse events. The cost of telemonitoring was 60% lower than that of conventional hospital monitoring. Compared with conventional monitoring, cardiovascular events were detected earlier and the number or hospitalizations and hospital visits was reduced with pacemaker telemonitoring. In addition, the costs associated with follow-up were lower with telemonitoring. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  10. Economic evaluation of human papillomavirus vaccination in the United Kingdom.

    Science.gov (United States)

    Jit, Mark; Choi, Yoon Hong; Edmunds, W John

    2008-07-17

    To assess the cost effectiveness of routine vaccination of 12 year old schoolgirls against human papillomavirus infection in the United Kingdom. Economic evaluation. UK. Population Schoolgirls aged 12 or older. Costs, quality adjusted life years (QALYs), and incremental cost effectiveness ratios for a range of vaccination options. Vaccinating 12 year old schoolgirls with a quadrivalent vaccine at 80% coverage is likely to be cost effective at a willingness to pay threshold of pound30,000 (euro37,700; $59,163) per QALY gained, if the average duration of protection from the vaccine is more than 10 years. Implementing a catch-up campaign of girls up to age 18 is likely to be cost effective. Vaccination of boys is unlikely to be cost effective. A bivalent vaccine with the same efficacy against human papillomavirus types 16 and 18 costing pound13- pound21 less per dose (depending on the duration of vaccine protection) may be as cost effective as the quadrivalent vaccine although less effective as it does not prevent anogenital warts. Routine vaccination of 12 year old schoolgirls combined with an initial catch-up campaign up to age 18 is likely to be cost effective in the UK. The results are robust to uncertainty in many parameters and processes. A key influential variable is the duration of vaccine protection.

  11. CITRICULTURE ECONOMIC AND FINANCIAL EVALUATION UNDER CONDITIONS OF UNCERTAINTY

    Directory of Open Access Journals (Sweden)

    DANILO SIMÕES

    2015-12-01

    Full Text Available ABSTRACT The citriculture consists in several environmental risks, as weather changes and pests, and also consists in considerable financial risk, mainly due to the period ofreturn on the initial investment. This study was motivated by the need to assess the risks of a business activity such as citriculture. Our objective was to build a stochastic simulation model to achieve the economic and financial analysis of an orange producer in the Midwest region of the state of Sao Paulo, under conditions of uncertainty. The parameters used were the Net Present Value (NPV, the Modified Internal Rate of Return(MIRR, and the Discounted Payback. To evaluate the risk conditions we built a probabilistic model of pseudorandom numbers generated with Monte Carlo method. The results showed that the activity analyzed provides a risk of 42.8% to reach a NPV negative; however, the yield assessed by MIRR was 7.7%, higher than the yield from the reapplication of the positive cash flows. The financial investment pays itself after the fourteenth year of activity.

  12. Evaluating Post-Earthquake Building Safety Using Economical MEMS Seismometers.

    Science.gov (United States)

    Hsu, Ting-Yu; Yin, Ren-Cheng; Wu, Yih-Min

    2018-05-05

    The earthquake early warning (EEW)-research group at National Taiwan University has been developing a microelectromechanical system-based accelerometer called “P-Alert”, designed for issuing EEWs. The main advantage of P-Alert is that it is a relatively economical seismometer. However, because of the expensive nature of commercial hardware for structural health monitoring (SHM) systems, the application of SHM to buildings remains limited. To determine the performance of P-Alert for evaluating post-earthquake building safety, we conducted a series of steel-frame shaking table tests with incremental damage. We used the fragility curves of different damage levels and the interstory drift ratios (calculated by the measured acceleration of each story using double integration and a filter) to gauge the potential damage levels. We concluded that the acceptable detection of damage for an entire building is possible. With improvements to the synchronization of the P-Alert sensors, we also anticipate a damage localization feature for the stories of a building.

  13. Economic evaluation of nuclear reactor operation utilizing power effect

    International Nuclear Information System (INIS)

    Budinsky, M.; Mydliar, J.

    1988-01-01

    The operation of a reactor at the so-called power effect may substantially increase the burnup of fuel to be removed. The aim of the evaluation of such reactor operation is the optimal determination of the time over which the yield of the higher use of fuel exceeds economic losses resulting from the increased share of constant expenditure of the price of generated kWh of electric power which ensues from such operation. A mathematical model is presented for such evaluation of reactor operation with regard to benefits for the national economy which is the basis of the ESTER 2 computer program. The calculations show that the prices of generated and delivered kWh are minimally 2% less than the prices of generated power without the power effect use. The minimum ranges in the interval of 30 to 50 days. The dependence of the price of generated and delivered kWh from the point of view of the operator of the power plant as well as the component of fuel price of generated kWh will not reach the minimum even after 50 days of operation. From the operating and physical points of view the duration of power effect is not expected to exceed 20 to 30 days which means that from the point of view of the national economy the price of generated and delivered kWh will be 1.6 to 2% less and the fuel component of the price of the generated kWh will be 3 to 4.5% lower. (Z.M.). 5 figs., 3 refs

  14. Desalination Economic Evaluation Program (DEEP-3.0). User's manual

    International Nuclear Information System (INIS)

    2006-01-01

    DEEP is a Desalination Economic Evaluation Program developed by the International Atomic Energy Agency (IAEA) and made freely available for download, under a license agreement (www.iaea.org/nucleardesalination). The program is based on linked Microsoft Excel spreadsheets and can be useful for evaluating desalination strategies by calculating estimates of technical performance and costs for various alternative energy and desalination technology configurations. Desalination technology options modelled, include multi-stage flashing (MSF), multi-effect distillation (MED), reverse osmosis (RO) and hybrid options (RO-MSF, RO-MED) while energy source options include nuclear, fossil, renewables and grid electricity (stand-alone RO). Version 3 of DEEP (DEEP 3.0) features important changes from previous versions, including upgrades in thermal and membrane performance and costing models, the coupling configuration matrix and the user interface. Changes in the thermal performance model include a revision of the gain output ratio (GOR) calculation and its generalization to include thermal vapour compression effects. Since energy costs continue to represent an important fraction of seawater desalination costs, the lost shaft work model has been generalized to properly account for both backpressure and extraction systems. For RO systems, changes include improved modelling of system recovery, feed pressure and permeate salinity, taking into account temperature, feed salinity and fouling correction factors. The upgrade to the coupling technology configuration matrix includes a re-categorization of the energy sources to follow turbine design (steam vs. gas) and cogeneration features (dual-purpose vs. heat-only). In addition, cost data has also been updated to reflect current practice and the user interface has been refurbished and made user-friendlier

  15. Economic evaluation of treatments for chronic hepatitis B

    Directory of Open Access Journals (Sweden)

    Astrid Wiens

    Full Text Available The aim of this study was to conduct a cost-utility study of adefovir, entecavir, interferon alpha, pegylated interferon alpha, lamivudine and tenofovir for chronic hepatitis B in the context of Brazilian Public Health Care System. A systematic review was carried out for efficacy and safety. Another review was performed to collect utility data and transition probabilities between health states. A Markov model was developed in a time horizon of 40 years with annual cycles for three groups of: HBeAg positive, HBeAg negative, and all patients. These strategies were compared to a fourth group that received no treatment. Discount rates of 5% were applied and sensitivity analyses were performed. Tenofovir offered the best cost-utility ratio for the three evaluated models: U$397, U$385 and U$384 (per QALY, respectively, for HBeAg positive, negative, and all patients. All other strategies were completely dominated because they showed higher costs and lower effectiveness than tenofovir. The sequence of cost-utility in the three models was: tenofovir, entecavir, lamivudine, adefovir, telbivudine, pegylated interferon alpha, and interferon alpha. In the sensitivity analysis, adefovir showed lower cost-utility than telbivudine in some situations. The study has some limitations, primarily related to the creation of scenarios and modeling. In this study, tenofovir presented the best cost-utility ratio. The results obtained in this study will be valuable in decision-making and in the review of the clinical protocol, mainly involving the allocation of available resources for health care.

  16. The role of health economics in the evaluation of surgery and operative technologies.

    Science.gov (United States)

    Taylor, Matthew

    2017-02-01

    Dr Matthew Taylor is the director of York Health Economics Consortium and leads the Consortium's health technology assessment program. The work of York Health Economics Consortium involves empirical research in health economics for both the private and public sectors. Dr Taylor is the scientific lead for the National Institute for Health and Care Excellence (NICE) Economic and Methodological Unit and a former member of NICE's Public Health Advisory Committee. He is also managing director (Europe) of Minerva, an international network of health economics consultancies. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Including adverse drug events in economic evaluations of anti-tumour necrosis factor-α drugs for adult rheumatoid arthritis: a systematic review of economic decision analytic models.

    Science.gov (United States)

    Heather, Eleanor M; Payne, Katherine; Harrison, Mark; Symmons, Deborah P M

    2014-02-01

    Anti-tumour necrosis factor-α drugs (anti-TNFs) have revolutionised the treatment of rheumatoid arthritis (RA). More effective than standard non-biological disease-modifying anti-rheumatic drugs (nbDMARDs), anti-TNFs are also substantially more expensive. Consequently, a number of model-based economic evaluations have been conducted to establish the relative cost-effectiveness of anti-TNFs. However, anti-TNFs are associated with an increased risk of adverse drug events (ADEs) such as serious infections relative to nbDMARDs. Such ADEs will likely impact on both the costs and consequences of anti-TNFs, for example, through hospitalisations and forced withdrawal from treatment. The aim of this review was to identify and critically appraise if, and how, ADEs have been incorporated into model-based cost-effectiveness analyses of anti-TNFs for adult patients with RA. A systematic literature review was performed. Electronic databases (Ovid MEDLINE; Ovid EMBASE; Web of Science; NHS Economic Evaluations Database) were searched for literature published between January 1990 and October 2013 using electronic search strategies. The reference lists of retrieved studies were also hand searched. In addition, the National Institute for Health and Care Excellence technology appraisals were searched to identify economic models used to inform UK healthcare decision making. Only full economic evaluations that had used an economic model to evaluate biological DMARDs (bDMARDs) (including anti-TNFs) for adult patients with RA and had incorporated the direct costs and/or consequences of ADEs were critically appraised. To be included, studies also had to be available as a full text in English. Data extracted included general study characteristics and information concerning the methods used to incorporate ADEs and any associated assumptions made. The extracted data were synthesised using a tabular and narrative format. A total of 43 model-based economic evaluations of bDMARDs for adult RA

  18. 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

  19. The mental health risks of economic crisis in Spain: evidence from primary care centres, 2006 and 2010.

    Science.gov (United States)

    Gili, Margalida; Roca, Miquel; Basu, Sanjay; McKee, Martin; Stuckler, David

    2013-02-01

    Nearly all European countries have been affected by the economic crisis that began in 2007, but the consequences have been among the worst in Spain. We investigated the associations of the recession on the frequency of mood, anxiety, somatoform, alcohol-related and eating disorders among those visiting Spanish primary care settings. Primary care physicians selected randomized samples of patients attending primary care centres representing Spain's consulting populations. A total of 7940 patients in 2006-07 and 5876 in 2010-11 were administered the Primary Care Evaluation of Mental Disorders (PRIME-MD) instrument to diagnose mental disorders. Multivariate logistic regression models were used to quantify overall changes in the frequency of mental disorders, adjusting for potential socio-demographic differences in consulting populations unrelated to economic factors. Compared with the pre-crisis period of 2006, the 2010 survey revealed substantial and significant increases in the proportion of patients with mood (19.4% in major depression), anxiety (8.4% in generalized anxiety disorder), somatoform (7.3%) and alcohol-related disorders (4.6% in alcohol dependence), all significant at P < 0.001, but not in eating disorders (0.15%, P = 0.172). Independent of observed risks of unemployment [odds ratio (OR) = 1.72, P < 0.001], we observed a significantly elevated risk of major depression associated with mortgage repayment difficulties (OR = 2.12, P < 0.001) and evictions (OR = 2.95, P < 0.001). About one-third of the overall risk in the consulting population's attendance with mental health disorders could be attributed to the combined risks of household unemployment and mortgage payment difficulties. Recession has significantly increased the frequency of mental health disorders and alcohol abuse among primary care attendees in Spain, particularly among families experiencing unemployment and mortgage payment difficulties.

  20. [Health care economic guidance in Germany from the example Morbi-RSA].

    Science.gov (United States)

    Litmathe, Jens

    2016-04-01

    Increasing costs in health care represent still a major challenge in most industrial contries. A lot of attempts especially in Germany have been made to manage such problems and for a fair allocation oft he underlying resources. One of this ist the Morbi-RSA. The current review reflects all historical, medical and economical aspects of the Morbi-RSA and gives a perspective to possible future developments.

  1. Providing inbuilt economic resilience options : an obligation of comprehensive cancer care.

    Science.gov (United States)

    Cross, Eva Reitschuler; Emanuel, Linda

    2008-12-15

    For many, a cancer death in the family is the immediately obvious part of what is actually a double devastation. Overwhelming financial damage also results for many families, from the cost of medical care and from the loss of earning power by the patient and family. For some families, the consequences may be multigenerational and can affect the health of the survivors. Although this situation is not limited to cancer, the authors argue that oncology can take a lead in attending to these consequences of cancer as an integral part of its commitment to comprehensive cancer care. They make this case for both the national and the international settings. They also articulate and illustrate the notion of inbuilt options for economic resilience (IERs), which the authors suggest the medical industry, and its cancer care sectors in particular, should be providing to all patients and their families if they are at risk for damaging financial losses. After describing key features to IER, the authors illustrate it with 1 type of approach for households of the terminally ill: hospice care with provision of supplementary training and certification to the family caregiver. Such programming could generate a low-technology, semiskilled healthcare service economy as trained family caregivers provide support to other households in need, thereby both providing a recovery option for themselves and reduced economic devastation to the households which, by receiving the services, can stay in the workforce. Finally, the authors call for invigorated research on the economic impact of cancer on families and for the modeling, demonstration, and study of options for economic resilience, including IER programs.

  2. 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.

  3. Economic evaluations of follow-up strategies for cancer survivors: a systematic review and quality appraisal of the literature.

    Science.gov (United States)

    Meregaglia, Michela; Cairns, John

    2015-01-01

    The aim of this study was to review and critically assess the health economics literature on post-treatment follow-up for adult cancer survivors. A systematic search was performed using PubMed, EMBASE and the Cochrane Library. The Consolidated Health Economic Evaluation Reporting Standards checklist was adopted to assess the quality of the included studies. Thirty-nine articles met the eligibility criteria. Around two thirds of the studies addressed the most common cancers (i.e., breast, colorectal, cervical and lung); 21 were based on a single clinical study, while the rest were modeling papers. All types of economic evaluations were represented other than cost-benefit analysis. The overall quality was generally high with an average proportion of 74% of checklist criteria fulfilled. The cost-effectiveness results supported the current trend towards less intensive, primary care-based and risk-adapted follow-up schemes.

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

    DEFF Research Database (Denmark)

    Pouwer, F; Snoek, Frank J

    2002-01-01

    aspects of the quality of diabetes care as delivered by the specialist in internal medicine (internist) and the diabetes nurse specialist (DNS). Two principal components analyses (internist/DNS) both yielded one 14 item factor with a high internal consistency. Satisfaction with diabetes care, fewer......OBJECTIVES: To develop a brief measure of patients' evaluation of the quality of diabetes care and to study predictors of consumers' rating of the quality of diabetes care. DESIGN: A prospective design. SUBJECTS: 176 adults with type 1 (39%) or type 2 (61%) diabetes. MAIN MEASURES: Demographic...... variables, HbA1c, number of diabetes complications, satisfaction with diabetes care, diabetes related distress, and fear of hypoglycaemia were assessed by self-report. In addition, satisfaction with diabetes care and evaluations about quality of the care were measured at 16 month follow up. Statistical...

  5. 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

  6. 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

  7. I care, even after the first impression: Facial appearance-based evaluations in healthcare context.

    Science.gov (United States)

    Mattarozzi, Katia; Colonnello, Valentina; De Gioia, Francesco; Todorov, Alexander

    2017-06-01

    Prior research has demonstrated that healthcare providers' implicit biases may contribute to healthcare disparities. Independent research in social psychology indicates that facial appearance-based evaluations affect social behavior in a variety of domains, influencing political, legal, and economic decisions. Whether and to what extent these evaluations influence approach behavior in healthcare contexts warrants research attention. Here we investigate the impact of facial appearance-based evaluations of trustworthiness on healthcare providers' caring inclination, and the moderating role of experience and information about the social identity of the faces. Novice and expert nurses rated their inclination to provide care when viewing photos of trustworthy-, neutral-, and untrustworthy-looking faces. To explore whether information about the target of care influences caring inclination, some participants were told that they would view patients' faces while others received no information about the faces. Both novice and expert nurses had higher caring inclination scores for trustworthy-than for untrustworthy-looking faces; however, experts had higher scores than novices for untrustworthy-looking faces. Regardless of a face's trustworthiness level, experts had higher caring inclination scores for patients than for unidentified individuals, while novices showed no differences. Facial appearance-based inferences can bias caring inclination in healthcare contexts. However, expert healthcare providers are less biased by these inferences and more sensitive to information about the target of care. These findings highlight the importance of promoting novice healthcare professionals' awareness of first impression biases. Copyright © 2017 Elsevier Ltd. All rights reserved.